1. 2 3 state psychiatric hospitals 4 “we need treatment, not detention.” “ who the hell is in...
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3STATE PSYCHIATRIC HOSPITALS
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“We need treatment, not
detention.”
“Who the hell is in charge here?”
STATE PSYCHIATRIC HOSPITALS
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#1 Fiscal Priority: State Psychiatric
Hospitals
Priorities2013
STATE PSYCHIATRIC HOSPITALS
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Ron Adler, CEOWestern State HospitalLakewood, Washington
Dorothy Sawyer, CEOEastern State HospitalMedical Lake, Washington
Rick Mehlman, CEOChild Study and Treatment CenterLakewood, Washington
Three Pros, Three HeroesTransforming Lives
STATE PSYCHIATRIC HOSPITALS
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7STATE PSYCHIATRIC HOSPITALS
Western State Hospital FTE to Bed Ratio
SFY 2010 SFY 2011 SFY 2012 SFY 2013 SFY 2014 SFY 20152.00
2.05
2.10
2.15
2.20
2.25
2.202.19
SOURCE: Washington State Department of Social and Health Services, Financial Services Administration, August 2015.
Western State Hospital FTE Expenditure to Bed Allotment
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Budgets Still Not RightState Hospital GF-S Ending Year Balance Deficit (Before Proviso)
NOTES: 1. Dollars are rounded to the thousands. 2. SFY 2012 through SFY 2014 cash and liquidations, SFY cash and accruals.3. SFY 2013 Supplemental Security Enhancement funding removed. 4. SFY 2014 Supplemental Overtime funding removed. 5. SFY 2015 Supplemental Hospital Shortfall funding removed. Data provided by DSHS Financial Services Administration, August 2015.
Western State Hospital
Eastern State Hospital
Child Study & Treatment Center GRAND TOTAL
FY 2012 —$3,198,000 —$1,011,000 $655,000 —$3,554,000
FY 2013 $973,000 —$1,765,000 $881,000 $89,000
FY 2014 —$196,000 —$1,731,000 $228,000 —$1,699,000
FY 2015 —$8,203,000 —$3,132,000 $96,000 —$11,239,000
STATE PSYCHIATRIC HOSPITALS
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J J F F MMM A A MM J J J J A A A S S O O N N D D J J J F F MM A A MM J J J J A A A S S O O N N D D J J J F F MM A A MM J J J J J A
10
15
24
27
2221
20
32
Western State Hospital Civil Wait ListJanuary 2013 – August 2015
2013 2014 2015
SOURCE: Washington State Department of Social and Health Services, Behavioral Health and Service Integration Administration, Division of Behavioral Health and Recovery, August 2015.
STATE PSYCHIATRIC HOSPITALS
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Five
Goals for State Psychiatric Hospitals
Eliminate waitlists
Increase treatment hours
Reduce assaults
Reduce seclusion and restraint
Reduce overtime
STATE PSYCHIATRIC HOSPITALS
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11STATE PSYCHIATRIC HOSPITALS
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12CHILDREN’S INTENSIVE MENTAL HEALTH SERVICES
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5970SERVICES
DENIED
CHILDREN’S INTENSIVE MENTAL HEALTH SERVICES
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T.R. Settlement (December 2013) Services to be Provided through CANS Screening and WISe Model
Child and Adolescent Needs and Strengths Screening and Assessment (CANS)• Comprehensive and holistic assessment
• Available for any child
Wraparound with Intensive Services (WISe)• Intensive care coordination
• Intensive services provided in home and community setting
• Mobile crisis intervention and stabilization
CHILDREN’S INTENSIVE MENTAL HEALTH SERVICES 14
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WISe Rollout as of August 2015• 19 of Washington’s 39 counties currently offer WISe, with
a statewide monthly caseload capacity of 740 youth and their families/caregivers receiving services each month
THURSTON
GRAYS HARBOR MASON
JEFFERSON
CLALLAM
WHATCOM
KITSAP
SKAGIT
SNOHOMISH
KING
PIERCE
LEWISPACIFIC
WAHKIAKUMCOWLITZ
CLARK
SKAMANIA
YAKIMA
KLICKITAT
KITTITAS
CHELAN
DOUGLAS
OKANOGAN FERRY STEVENSPEND OREILLE
GRANT
BENTON
FRANKLIN
WALLA WALLA
ADAMS
LINCOLN SPOKANE
WHITMAN
GARFIELD
COLUMBIA
ASOTIN
Counties Offering WISe Services
AS OF AUGUST 2015
19
CHILDREN’S INTENSIVE MENTAL HEALTH SERVICES
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WISe Clients and FundingJuly 2014 – June 2018 (Monthly Data)
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
$0
$7,500,000
0
3,000
$1.2
$7.0
597
2928
2014 2015 2016 2017
Monthly Funding
Clients
PROJECTED
2018
2015-17 BIENNIUM END
FULL ROLL-OUTMillion/Month
Million/Month
SOURCE: Washington State Department of Social and Health Services, Behavioral Health and Service Integration Administration, Division of Behavioral Health and Recovery, August 2015.
CHILDREN’S INTENSIVE MENTAL HEALTH SERVICES
June 2015
June 2018
$85 millionANNUALLY
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17CHILDREN’S INTENSIVE MENTAL HEALTH SERVICES
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18PSYCHIATRIC BOARDING
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Washington State’s Psychiatric Bed AvailabilityPsychiatric Beds per 100,000 persons National Mental Health Services Survey, 2010
Sout
h D
akot
aO
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ew M
exic
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evad
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rgin
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xas
Calif
orni
aM
onta
naW
iscon
sinW
est V
irgin
iaM
aryl
and
Ariz
ona
Geo
rgia
Haw
aii
Indi
ana
Mic
higa
nAl
aska
Neb
rask
aO
hio
Kans
asFl
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aId
aho
Nor
th C
arol
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Dist
rict o
f Col
umbi
aIll
inoi
sTe
nnes
see
Min
neso
taSo
uth
Caro
lina
Wyo
min
gN
ew Y
ork
Mas
sach
usett
sAl
abam
aD
elaw
are
Iow
aM
aine
New
Jers
eyO
klah
oma
Penn
sylv
ania
Conn
ectic
utLo
uisia
naAr
kans
asM
issou
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ode
Isla
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ew H
amps
hire
Kent
ucky
Miss
issip
piVe
rmon
tN
orth
Dak
ota
4.49.1
75.9
WA
SHIN
GTO
N
46th in the Nation
SOURCE: Washington State Institute for Public Policy, “Inpatient Psychiatric Capacity and Utilization in Washington State,” January 2015. Data used for ranking includes non-hospital psychiatric facilities, such as Evaluation and Treatment centers, and is considered a more reliable estimate of bed capacity than the widely circulated “report card” figure from the Academy of Emergency Physicians.
PSYCHIATRIC BOARDING
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Psychiatric Boarding: SFY 2014 Daily SBC CensusSingle Bed Certifications and Community Hospital Emergency Department Estimates
JUL JUL JUL AUG AUG AUG SEP SEP SEP OCT OCT OCT NOV NOV DEC DEC DEC JAN JAN JAN FEB FEB FEB MAR MAR APR APR APR MAY MAY MAY JUN JUN JUN
121 102
160 148
170 179
134
20142013
SOURCE: Washington State Department of Social and Health Services, Behavioral Health and Service Integration Administration, Division of Behavioral Health and Recovery, August 2015.
PSYCHIATRIC BOARDING
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Q.PSYCHIATRIC BOARDING
When is a 0-9 loss in the State Supreme Court a huge victory?
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When it triggers $30 million in spending to “buy” 145 more beds
. . . which could serve as many as 3,200 people per year
A.PSYCHIATRIC BOARDING
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System ChangeIncrease in state hospital civil beds
Increase in evaluation and treatment (E&T) beds
Increase diversionIncrease crisis stabilization
Positive
PSYCHIATRIC BOARDING
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Inpatient and Diversion Resources 2013 – 2017
Resources
New Freestanding E&TNew Inpatient BedsNew Crisis TriageMobile Crisis TeamPACT TeamPlanned E&T
Thurston
Grays Harbor
Mason
Jefferson
Clallam
Whatcom
Kitsap
Skagit
Snohomish
King
Pierce
LewisPacific
Wahkiakum Cowlitz
Clark
Skamania
Yakima
Klickitat
Kittitas
Chelan
Douglas
Okanogan Ferry Stevens Pend Oreille
Grant
Benton
Franklin
Walla Walla
Adams
Lincoln Spokane
Whitman
Garfield
Columbia
Asotin
Island
San Juan
New
PSYCHIATRIC BOARDING
SOURCE: Washington State Department of Social and Health Services, Behavioral Health and Service Integration Administration, Division of Behavioral Health and Recovery, August 2015.
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Single Bed Certifications
2014 2015
NOV DEC JAN FEB MAR APR MAY JUN
Unduplicated people 263 328 288 327 380 417 397 531
Average Daily Census 91 81 73 95 100 103 99 154
Median Length of Stay (days) 2 4 2 2 2 2 2 2
Timely and Appropriate Mental Health Treatment
PSYCHIATRIC BOARDING
Blue Ribbon
SOURCE: Washington State Department of Social and Health Services, Behavioral Health and Service Integration Administration, Division of Behavioral Health and Recovery, August 2015.
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26FORENSIC COMPETENCY SERVICES
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Forensic Evaluation and Competency Restoration Wait Times
Average Number of Days Includes Felony and Misdemeanor
Q4 Q1 Q2 Q3 Q4 Q1 Q2
120
85
41 42
59
68
75
29 26
31 34 31
22
14
Q4 Q1 Q2 Q3 Q4 Q1 Q225 28
21 20 18
13
32
21 18
30
35
46 48
28
Competency RestorationsCompetency Evaluations 125 days 125 days
Eastern State HospitalWestern State Hospital
Average (Both Hospitals)TARGET
2014 20152013 2014 20152013
FORENSIC COMPETENCY SERVICES
SOURCE: Washington State Department of Social and Health Services, Behavioral Health and Service Integration Administration, Division of Behavioral Health and Recovery, August 2015.
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When is a federal judge your friend?Q.
FORENSIC COMPETENCY SERVICES
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When she is 95% right that wait times are unconstitutionally longA.
FORENSIC COMPETENCY SERVICES
. . . and the legislature budgets $36 million to initiate the needed changes
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Fix Required by January 2016
13 more evaluators
90 more hospital beds
$1.7 million more for diversion
To achieve a 7-day service standard
FORENSIC COMPETENCY SERVICES
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A Long Journey AheadChallenges... Too few psychiatrists in the state Veterans Administration and private hospitals pay higher salaries to
psychiatrists, psychologists, and social workers Number of orders received Length of time it takes to receive an order Length of time it takes to receive discovery information The availability of mental health records Scheduling of evaluations for evaluators Length of time it takes to receive mental health records Space in the jail to conduct evaluations Jail staff availability to supervise area
Availability of interpreters Availability of defense attorneys who want to be present Willingness of defendants to participate in the evaluations Travel times between the hospitals and jails Medical
clearances Jail transport to the hospitals Space in the hospitals Difficulty recruiting forensic psychologists Difficulty recruiting forensic psychiatrists Difficulty recruiting forensic RNs Lack of
support staff Construction delays Renovating old wards that have been unoccupied Moving patients around to accommodate more competency restoration space Scheduling out of custody evaluations Permits to use other state facilities RFP timelines Notifications to labor Bargaining with four labor
groups Major remodel for state hospital wards Too much staff turnover at the hospitals Skyrocketing referrals for competency evaluations from county prosecutors Chronic underfunding of staff training Staff retention Competing demands on staff to run a safe hospital and meet compliance for L&I, CMS, the Joint Commission, and others Staff and patient safety concerns in the forensic admission wards Important data is often unavailable Lack of communication between different parts of the system
Notifications to labor Concurrent implementation of Electronic Health Records at state hospitals
NOTE: This is not an exclusive list.
FORENSIC COMPETENCY SERVICES
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Clear WinLess untreated jail time
Quicker path to recovery
Yes!
FORENSIC COMPETENCY SERVICES
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Hidden Super-WinDiversion
Diversion
Diversion
FORENSIC COMPETENCY SERVICES
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34FORENSIC COMPETENCY SERVICES
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• Psychiatric hospitals for treatment
• Increased community-based alternatives
• High needs children will be served
• Civil boarding is ended
• Forensic competency services will be provided timely
New Era in Mental Health
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New Era in Mental Health
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Beginning 2013-15 Biennium
End 2013-15 Biennium
2015-17 Biennium
Total Dollars, All Funds
1% increase
6% increase
$1.6 billionBASELINE LEVEL
$1.9 billionBASELINE LEVEL
$2.2 billionBASELINE LEVEL
$0
NEW RESOURCES
SOURCE: Washington State Department of Social and Health Services, Behavioral Health and Service Integration Administration, Division of Behavioral Health and Recovery, August 2015.
New Funding Level$2.3 billion
Some Components of 2015-17 Increase:Competency Evaluations 4.6 millionNon-Felony Diversion 4.8 millionCompetency Restoration Wards 26.8 millionPsychiatric Boarding 57.1 millionChildren (T.R.) 46.0 million
NEW RESOURCES $139.3 million
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3,000 persons no longer “boarding” without appropriate care
5,900 children will receive the enhanced care they need
260 more persons will be served in the state hospitals
78 persons/month will no longer be waiting in jails for competency services
Results that MatterYes!
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Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep
58,402 58,735
69,645
The number of persons served in the community mental health system has increased under the ACA
Average Monthly Caseload, Age 18 and Over
2014
SOURCE: Washington State Department of Social and Health Services, Behavioral Health and Service Integration Administration, Division of Behavioral Health and Recovery, August 2015.
2013
Plus 11,000 people
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2003-05 2005-07 2007-09 2009-11 2011-13 2013-15 2015-17
$240
$631
Up 163%Since 2003-05 Biennium
Spending on Chemical Dependency Treatment is Up2003-05 through 2015-17 Biennium
SOURCE: Washington State Department of Social and Health Services, Behavioral Health and Service Integration Administration, Division of Behavioral Health and Recovery, August 2015.
Million
Million
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40