“The mission of the Mental Health Division is to promote recovery and safety.”
Expanding Community Services
Project Overview
June 2, 2003
Background
At the national and state level, there is continued pressure to assure that individuals residing in institutions have the option for community living. These efforts have been highlighted through litigation such as the Olmstead lawsuit in Georgia where the Supreme Court found that the state was violating the rights of two plaintiffs by keeping them in a state psychiatric hospital despite their desire to live in the community.
As part of the 2001-2003 budget process, DSHS developed a proposal included in the Governor’s budget for serving state hospital patients in community settings. The 2001-2003 Operating Budget supported this proposal by providing for the development and operation of community support services for long term Western State Hospital (WSH) patients who no longer required active inpatient psychiatric treatment. The 2002-2003 Supplemental Budget increased the scope of the project to include patients from Eastern State Hospital (ESH) and residents of the Program for Adaptive Living Skills (PALS) on the grounds of WSH. In accordance with the proviso, the Department of Social and Health Services ( DSHS) formally implemented the Expanding Community Services (ECS) initiative.
Planning to implement the transition of long term state hospital patients to community support services was conducted through the combined efforts of a number of DSHS entities and other partners. Individuals transitioned from WSH resided on wards of the Adult Psychiatric Unit (APU), Gero-Medical Unit (GMU), and PALS. Individuals transitioned from ESH resided on wards of the Gero-Psychiatric Unit (GPU). In accordance with the budget proviso, DSHS placed individuals as close to their home communities as possible.
The ECS initiative helped to strengthen DSHS efforts to assure services are provided in the community whenever appropriate. DSHS is closely monitoring and conducting a formal evaluation of these efforts to assess outcomes of the individuals served and assure that their needs are safely met in the community.
Nisqually Earthquake
An unforeseen event that affected the ECS initiative was the February 2001 earthquake in Western Washington. The earthquake damaged buildings and reduced capacity at WSH. To maintain the reduced capacity, efforts were undertaken to develop alternative placements and diversion for patients and individuals who would otherwise have been served at WSH. As a result of these efforts, there were no additional transitions required in order to accomplish the ward closures scheduled for December, 2001 and October 2002.
Implementation Efforts
An implementation committee including representatives from various stakeholders developed and monitored progress of the ECS work-plan. Key accomplishments included:
- Identification and assessment of ECS patients
- Improvements in state hospital discharge processes
- Development of a consumer preference survey
- Development of a transition best practices guide
- Development of cross system teams to improve services to multiple needs clients
- Development of RSN plans for serving APU and PALS patients
- Development of contracts with long term care settings and mental health providers to serve GMU/GPU patients and others at risk of hospitalization
- Training for long term care facilities in accessing mental health and crisis services
- Training of County Designated Mental Health Professionals (CDMHPs) to increase consistency in implementation of involuntary treatment laws
- Research into other states efforts at serving state hospital patients in community settings
- Development of geriatric pharmacy residency programs
- Communication with the Center for Medicaid and Medicare Services (CMS) to assure optimum utilization of federal funding
- Collaboration on a successful $1.4 million CMS grant toward systemic improvements towards community options for individuals in state hospitals and other facilities
- Evaluation of the ECS Initiative with a final report completed by June, 2004
Initiative Goals
The transition of state hospital patients took place in phases with approximately 30 patients transitioned in each phase. The development of new and enhanced programs and services in the community allowed for the reduction of wards at the state hospitals concurrent with each of the phases. State hospital wards were closed according to the following schedule:
Phase 1: Dec. 2001, WSH APU Ward Phase 4: Dec. 2002, ESH GPU Ward
Phase 2: July 2002, WSH APU Ward Phase 5: Jan. 2003, WSH PALS Ward
Phase 3: Oct. 2002, WSH GMU Ward Phase 6: April 2003, WSH GMU Ward
Program Contacts:
For additional information regarding ECS, please contact:
Traci Adair
Home and Community Services Division
Aging and Disability Services Administration
Phone: (206) 341-7653
Email: AdairT@dshs.wa.gov
or
Andy Toulon
Mental Health Division
Health and Rehabilitative Services Administration
Phone: (360) 902-0818
Email: touloan@dshs.wa.gov
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For more ways to get in touch with the Department of Mental Health Services, go to the DSHS Contact Information Web page. Mental Health Related Questions Contact:
