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Washington state has agreed to better coordinate care for people leaving involuntary commitment at state hospitals in the West and East, according to an agreement reached this month with Disability Rights Washington.
The Department of Health and Human Services and the State Health Care Authority said they would improve people’s discharge processes by starting to plan earlier, allowing behavioral health care providers and peers to connect with patients prior to release, and assuming people can live independently with appropriate support services, instead of needing to find a group facility to live.
The agreement comes as Western State Hospital transitions to serve more patients accused of crimes and coming to the facility through the criminal justice system, also known as medical patients. -legal, rather than people who have been convicted in civil courts. Governor Jay Inslee has called for reducing the number of civilian beds in the western state, hoping that civilian patients will instead get support from smaller community health care centers.
While the push towards community care may help keep patients closer to home and their support systems, it also raises questions about where patients will go and whether there are enough community resources. available to support them.
The state has struggled to get forensic patients a mental capacity assessment or restorative services in a timely manner, under a different settlement called the Trueblood case. Wait times are getting worse, meaning hundreds of incarcerated people remain in limbo for weeks or even months.
This reflects bottlenecks in the system, said Todd Carlisle, an attorney with Disability Rights Washington. Because there are delays in the release of civilian patients, they occupy the beds necessary for forensic patients whose charges were dropped because they were deemed unfit to stand trial, but who also cannot no longer be released and must go to the civil part of the hospital. This backlog then leads to waiting for forensic beds, leaving people stuck in county jails. And staying institutionalized longer than necessary can cause people to decompensate and get off the exit list.
“It’s a major problem. It’s expensive. It’s not effective. And it is illegal to keep people in an institutional setting for much longer than necessary,” Carlisle said, referring to a case called the Olmstead decision, which found that people are entitled to be served in the setting the less restrictive that suits their needs.
People leaving public hospitals are often sent back to an institutional setting such as an assisted living facility. For many people, these are “too restrictive,” Carlisle said. Most people want to live in their own home with adequate support systems, he said. The state agreed, through the settlement.
Another obstacle delaying discharges is that most facilities are private and can choose which patients they will take, leading to long waits to find a place willing to accept a specific person. It is particularly difficult to find a placement for someone who has medical problems or a history of violence, for example.
Under this regulation, the state will start from the presumption that a person can live independently with adequate support, such as intensive community mental health care and housing allowances, instead of relying on the institutions that accept them.
Staffing shortages, technology issues and bureaucratic issues contribute to further release delays.
When a treatment team says a patient is ready for discharge, “unfortunately, historically and currently, that’s when their discharge planning begins,” Carlisle said. This agreement requires the state to begin planning for discharge earlier, so that when the patient is ready, the plans are already in place. Providers and peers – people with lived experiences with mental and behavioral health issues – would be able to connect with people earlier and allow for a more seamless transition to services.
“Now that the settlement is reached, the work begins to improve their release planning and to do whatever they need to do sooner, so they don’t keep people waiting,” Carlisle said.
The settlement gives the state up to 120 days to meet with staff, vendors and other system workers to discuss the new requirements. The goals related to updating IT systems have a 15-month implementation window.
If the state fails to meet the requirements, Carlisle said DRW will take legal action to enforce the agreement.
“We at the Department of Health and Human Services have a common interest with Disability Rights Washington in helping our civilian patients get to facilities or locations that will benefit their reintegration into the community, which will increase the likelihood that they don’t come back. to state hospitals in the future,” Tyler Hemstreet, spokesman for the Washington Department of Health and Human Services, said in a statement.
“We also believe that the metrics set out in the agreement for a more detailed and refined system to track our patients’ progress will not only help them in the long term, but will also help our staff, as we continue to meet the needs. of our patients at the forefront of our discharge processes.
Hemstreet said the state has the resources, including personnel and technology, to meet those requirements and negotiated the deal to be “as budget-neutral as possible.”
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