Fw: Washington state is rethinking its mental hospitals

>
>> Washington state is rethinking its mental hospitals
>>
>> 08/27/02
>>
>> JIM LYNCH
>> Oregon Live
>>
>> TACOMA -- Ringed by a rock wall and studded with century-old brick
>> buildings,
>> Western State Hospital stands out amid the south Tacoma sprawl like a
>> historic university or a strangely preserved city from the early 1900s.
>>
>> It has its own stores, pharmacy, steam plant, library, bowling alley and
>> graveyard. It has 2,000 workers and 1,000 patients scattered among 56
>> buildings on 264 acres. It even has its own patients' rock band, called
>> N.G.R.I -- not guilty by reason of insanity.
>>
>> The largest mental hospital west of the Mississippi has been one of
>> Washington's fixtures and priciest ventures since before statehood, when
>> Fort
>> Steilacoom's barracks were transformed into "The Insane Asylum of
>> Washington
>> Territory" in 1871.
>>
>> But the landmark hospital, which costs $400 a day per patient to operate
>> and
>> has a budget of $121.5 million this year, is increasingly seen as an
>> outdated
>> behemoth Washington can't afford. The state has begun closing wards,
>> which
>> will, by next spring, move 150 patients into neighborhoods and
>> community-based psychiatric care.
>>
>> An additional 200 patients may eventually be released from the
>> institution if
>> the state heeds the advice of a consultant who suggests almost a third of
>> Western State's patients should be let out.
>>
>> The looming ward closures alarm some mental health experts who see them
>> as
>> foolish and inhumane.
>>
>> "The fact is we don't have the beds at the community level to keep these
>> people," said Dean Brooks, Western State's recently retired board
>> chairman
>> and the former longtime superintendent of Oregon State Hospital in Salem.
>> "We've ultimately only got two places for them to go -- in jail or under
>> the
>> bridge."
>>
>> Brooks also said Western State is an easy target for people who cast
>> large
>> mental institutions as villainous boondoggles. "Just because it's big
>> doesn't
>> mean it's bad."
>>
>> But the Washington Legislature, faced with a $1.5 billion budget hole
>> this
>> year, lunged at the prospect of downsizing the institution and saving
>> about
>> $100,000 a year per mental patient by putting them into community care
>> instead.
>>
>> Other states' hospitals are closed The decision to cut beds fits into a
>> national movement that seemingly bypassed Washington until now. State
>> mental
>> hospital populations peaked in 1960 and have steadily declined since then
>> with 44 hospitals closing in the 1990s alone, three times as many as the
>> combined closures in the 1970s and 1980s.
>>
>> Oregon, for example, shut its 390-bed Dammasch State Hospital in 1995,
>> with
>> two-thirds of its patients going into community-based care and the other
>> third folding into Oregon State Hospital facilities in Salem and
>> Portland.
>>
>> A draft copy of a consultant's recent report on Washington's mental
>> health
>> program concludes that the state has a 90 percent higher reliance on
>> state
>> hospital beds than similar-sized "peer states."
>>
>> Washington also spends far less than its peer states on creating
>> community-based psychiatric support and supervised housing to help
>> patients
>> live safely outside hospitals. For comparison, Oregon spends $10.56 per
>> capita on residential mental health care, while Washington spends $3.93
>> per
>> capita, the study said.
>>
>> The study also concluded that about 30 percent of the admissions to
>> Western
>> State every year are unnecessary, resulting from a shortage of
>> appropriate
>> residential and nursing home options.
>>
>> Kari Burrell, a policy adviser to Washington Gov. Gary Locke, said budget
>> pressures helped spur the state to do what it's needed to do for years:
>> make
>> sure everyone in the state's two mental hospitals needs to be there.
>>
>> "It's just not appropriate care for someone to be institutionalized if
>> they
>> can live in the community with support," Burrell said. "We began to ask,
>> 'Are
>> we institutionalizing people just because it's easier for us?' "
>>
>> Outpatient care is also costly Jess Jamieson, director of Compass Health,
>> a
>> nonprofit community mental health center that offers 400 community-based
>> beds
>> north of Seattle, praises the goal of moving Western State patients back
>> into
>> society. But Jamieson says the state underestimates the startup costs
>> involved with expanding and creating quality housing and psychiatric
>> services.
>>
>> "It's not a cost-saving measure, not if you do it correctly," he said.
>>
>> Stan Mazur-Hart, superintendent of Oregon State Hospital's 687-bed
>> institution in Salem, says closing the Dammasch hospital produced mixed
>> results: Many patients thrived in the community setting -- with the help
>> of
>> modern anti-psychotic drugs -- but the loss of hospital beds made it
>> harder
>> to find beds for people experiencing psychiatric emergencies.
>>
>> The waiting list to get into Oregon State Hospital now often swells to 20
>> or
>> more people who have been evaluated as needing the level of psychiatric
>> care
>> available only at a state institution, he said, noting that some patients
>> wait months for admission.
>>
>> Western State Hospital CEO Jan Gregg recalls hearing grumbles that the
>> institution was too big years before she became its leader. She now
>> argues
>> that size isn't its problem. She says it's actually three separate, large
>> and
>> well-run hospitals -- one for adults, one for geriatrics and one for the
>> criminally insane -- sharing the same real estate.
>>
>> But Gregg concedes that for too many years, hospital staff viewed it as a
>> place where the mentally ill lived indefinitely. "This should not be the
>> place where they live," Gregg said. "They should come here when they need
>> care."
>>
>> "Psychiatric hospitals have changed," she added. "They're no longer
>> warehouses. And the perceptions of our staff about patients' ability to
>> live
>> in the community has changed."
>>
>> A stroll around Western State Hospital can feel like a time warp. From
>> many
>> vantages, the institution looks remarkably unchanged from the early
>> 1900s, or
>> at least from its peak year -- 1955 -- when it housed 3,067 patients and
>> electric-shock therapy was routine.
>>
>> Criminal wards get money That's why the new $50 million building for the
>> criminally insane stands out.
>>
>> Built with sledgehammer-proof windows, bedecked with colorful hall
>> stripes
>> and wall art, and outfitted with red "duress" buttons throughout, the
>> Center
>> for Forensic Services holds as many as 230 patients sent by the courts.
>>
>> The big investment in criminal wards when the state is also trying to cut
>> its
>> mental health tab is testament to the growing overlap between criminal
>> justice and mental health services in Washington and nationwide. The
>> hospital's staff conducts about 1,600 psychiatric evaluations of
>> criminals a
>> year -- five times as many as it did in 1990.
>>
>> Not surprisingly, the forensics wards are the only ones seemingly immune
>> to
>> closures. The closure of one adult psychiatrics ward is almost complete.
>> A
>> geriatric ward is scheduled to be closed in December, an "adapted living
>> skills" ward in January and yet another geriatrics ward next April.
>>
>> Hospital CEO Gregg hopes to minimize layoffs, but she isn't on a crusade
>> to
>> stop ward closures. Her primary goal, she says, is to de-stigmatize
>> mental
>> illnesses.
>>
>> Walk across Steilacoom Boulevard from Western State into the hospital's
>> old
>> cemetery and it becomes clear how far public acceptance and understanding
>> of
>> the mentally ill has come in 50 years.
>>
>> The brown grass covers the graves of 2,763 patients who died between 1876
>> and
>> 1952. Many of the graves are unmarked. Most of them are simply defined by
>> small stones with four-digit numbers etched into them.
>>
>> During the 76 years that patients were buried there, mental illnesses
>> were
>> considered so embarrassing that families didn't want their names on the
>> stones. In recent years, however, several numbered stones have been
>> replaced
>> with name-engraved granite.
>>
>> Some of the numbered stones are getting attention too, such as "2288,"
>> which
>> recently had a plastic sunflower planted next to it.