Progress at Western State Hospital in Washington State: A Good Example for Other Beleaguered Hospital Systems?

Western State (psychiatric) Hospital has been in operational distress for more than a year now and following the travails of this facility and its staff from the line ward workers and behavioral care technicians, nurses and professional staff has been quite sad and discouraging for anyone interested in mental health reform and service delivery policy.

Professional staff such as psychiatrists left in some numbers approximately two years creating a staffing and coverage crisis. I infer that at least some were burned out, discouraged by the working conditions etc. In some media back then in 2015 and 2016 it was implied briefly that some left for higher pay at VA hospitals in the Northwest. The hospital had to abruptly close one or more units for lack of professional staffing. It sounded awful to this reader who had never “heard of such a thing,” as the common saying goes and I had never experienced anything like whatever happened in those times.

Then last year the hospital was beset by two sets of escapes by pairs of inpatients, at least one of which was portrayed by the media as dangerous. Bad publicity. And to have more than one escape incident was beyond my ken as I have only once experienced a patient escape and that was as a student extern at a forensic center in another state in the 1970’s when five dangerous felons who had made threats against various professional figures at the facility managed to escape a very secure facility. And there have been other escapes of patients in the news the last several years in different facilities in other parts of the country.

Then Western began to experience staff shortages at the wards’ levels and staff started reportedly resigning because of having to work a great deal of overtime, double shifts and facing full units with minimal staffing. It seemed to become a spiraling effect, the more that staff resigned, the greater the stressors on remaining staff and more reportedly left their employment.

The governor and that state’s legislature somehow could not work things out, and it is really impossible to know all that was involved when one reads media accounts from afar. In any case, Western kept making the news regionally and at times nationally as a facility in great distress.

Now emerges a more hopeful report, “Legislature finds common ground on proposal to reshape Western State Hospital,” published January 11, 2017, in “The Daily World,” which I must confess I am not sure if it is a newspaper, an IInternet-based publication or an Internet-based organ of The News Tribune newspaper.

I will try to distill down to some extent the crux of the issues from the article but the reader is encouraged to read this well-written article for yourself as it contains one of the better historical explanations of the course of development of long term and the recent more acute headline-making problems this facility and its staff and patients have been faced with.

The basic new idea is to transfer as many as possible, non-dangerous, non-legal system patients to other smaller treatment facilities around the state. This will be done to try to accommodate the enormous service delivery demand that Western Hospital, like literally almost ALL other state psychiatric hospitals in this country have had to face: how to work with the growing numbers of court ordered patients from the state’s courts who are court ordered to the hospital for treatment of their illnesses and to restore them to “competency  to proceed” to trial. This population has grown enormously in the past decade or more in this country. Most of us who follow mental health reform issues know that the mentally ill who have had insufficient outpatient services because of the cuts in services nationwide in the public sector have ended up in the jails in counties and state levels all over the USA. When these patients are court mandated to be hospitalized, the state hospitals HAVE to accommodate them even if they are full, etc. No choice. This growing cohort of patients, as deserving of treatment as anyone, though have taken up beds in increasing numbers. Other patients needing urgent or emergent inpatient psychiatric care have ended up waiting in hospital ERs all over the country. The article correctly identifies this make-shift practice as “boarding,” in which patients, even children end up waiting in local ERs for days or weeks until a psychiatric bed is available for them somewhere.

This is of no small consequence. People really have died as a result of not being able to be hospitalized and treated. With sadness and apologies to the Deeds family of Virginia, perhaps the most famous case of the past decade, is an incredibly sad example of this. The father is State Senator Craig Deeds of Virginia, himself a mental health professional. His young adult son Gus, became ill and violent and stabbed the father several times and luckily his father survived. Gus was taken to a local ER and waited four days in an ER and was, I assume, I do not know for sure, started on psychiatric medicine since he was by all accounts I have read in the media, suffering from a schizophrenic illness. A bed could not be found for Gus and he was released from the hospital ER. He suicided successfully within a few days and was lost to the family. This motivated State Senator Deeds to start a vigorous campaign in the Virginia legislature to effect laws of reform that would really help and he has been partially successful. I cannot imagine the grief Senator Deeds and his wife and family suffered from the loss of their then 23 or 24-year-old son. But the father is a hero in my view as he did the almost impossible, worked with his grief to do something constructive no matter how hard it was for him personally. I personally think State Senator Deeds deserves the United States’ Medal of Freedom for his efforts. But this tragedy illustrated all too sadly what can happen when services are not available. And I suppose to be complete about this issue, one must assume this happens all too often in many families’ lives who do not make the headlines…

Senator Craig Deeds and son Gus
Senator Deeds and his son in 2009 at Sen. Deeds re-election celebration

What is starting to happen in Washington state sounds very positive and appears to represent a new spirit of working together of Governor Inslee and that state’s legislature, as for more than a  year or two, it has sounded like no one was getting anywhere and the system was slowly breaking down in a visible freefall.

Blaming anyone in particular or in general serves no purpose. Washington state has had to cut services and economics played at least some role in the slow unwinding of the abilities of their state public psychiatric treatment system. Almost all states have been going through this kind of economic agony. In my view, first perhaps was Michigan in the early 1990’s when the Big Three Automakers began to implode and thousands of jobs were lost, factories closed and Michigan’s revenues plunged and the then Governor Engler had to start cutting the state’s budget drastically a number of years before many other states joined the ranks of decreasing state tax revenues in 1999 in the “.dot com bust,” and in 2008 in the Great Recession prompted by the housing mortgage bubble that burst and nearly took down a portion of the financial system of this country in President Bush’ last year, and much of President Obama’s terms in office. And many would argue that the Great Recession is still partially with us, even though unemployment is finally down to 4.7% by recent news accounts, jobs are being created again. But this recovery has been different, much slower and more painful, something Americans were not accustomed to since the Great Depression of the pre-World War II Hoover and Roosevelt years that took over a decade and World War II to “get the country going again,” through weapons production for the War Effort, a tough way to have economic recovery that no one would wish upon any of us again.

But perhaps Washington state is the start of something new and more positive. People in governing positions of power are talking to and working with each other again. Solutions are being forwarded and put into place. Everyone is facing up to the reality that solutions do cost money and there is no avoiding that, which over the last 20 years has been an anathema to speak of, or advocate for. I hope Washington state can serve as a healthy example for the rest of the country. We need to start working together, positively and constructing solutions and instituting what needs to be done. Listening, negotiating, exchanging ideas, finding common areas of agreement, good old give and taken, is needed everywhere in this country. The vitriol on the national political stage through President Bush’s and Obama’s presidencies have not helped any of us one single bit.

The approval rating of Congress continues to be at all-time lows, no matter which party one is speaking of. Today I saw a statistic online on the Fox websites that Congressional approval was still in the teens. Whether deserved or not, it needs to be re-earned and elevated so we can get this country going again in almost all areas of governance, services, defense, whatever. Extremism is on the rise and that is a symptom of the malaise and desperation of us all in a sense.

So let us all watch Washington state hopefully show us all the way back to sensible functioning and the hard work of managing our country without rancor, backbiting, inflexible opposition to anything the ‘other side’ proposes and restore healthier progress of all political stripes.

I close with a picture of an employee’s truck in the parking lot of the hospital where I work. I think it says it best:

Got Er Done Truck
The “Got Er Done” Truck

 

 

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Author: Frank

I am a older child, adult, geriatric teaching psychiatrist with over 30 years' practice experience in North Carolina, first at Duke as clnical teaching faculty, then in Western NC as a primary child psychiatry specialist. I have taught and supervised child psychiatrists and psychiatrists in training and many other mental health professionals and taught at two medical schools. I have served in many public and private practice settings. My primary interest is in observing and documenting the ongoing mental health reform efforts in the State of North Carolina and documenting its sucessess and failures at all levels. My favorite pastime among many others is spoofing my friends and kids with my deadpan sense of humor.

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