HOUSE BILL REPORT
2SSB 5400
As Amended by the House
BYSenate Committee on Ways & Means (originally sponsored by Senators Niemi, West, Kreidler, Wojahn and Talmadge)
Regarding mental health systems.
House Committe on Human Services
Majority Report: Do pass with amendments. (10)
Signed by Representatives Bristow, Chair; Scott, Vice Chair; Moyer, Ranking Republican Member; Tate, Assistant Ranking Republican Member; Anderson, Brekke, Hargrove, Leonard, Raiter and Winsley.
House Staff:Jean Wessman (786-7132)
Rereferred House Committee on Appropriations
Majority Report: Do pass as amended by Committee on Appropriations and without amendment by Committee on Human Services. (25)
Signed by Representatives Locke, Chair; Grant, Vice Chair; H. Sommers, Vice Chair; Silver, Ranking Republican Member; Youngsman, Assistant Ranking Republican Member; Appelwick, Belcher, Braddock, Brekke, Bristow, Doty, Ebersole, Ferguson, Hine, Holland, May, McLean, Padden, Peery, Rust, Sayan, Spanel, Valle, Wang and Wineberry.
House Staff: Maureen Morris (786-7136)
AS PASSED HOUSE APRIL 18, 1989
BACKGROUND:
Deinstitutionalization, the advent of psychotropic medications and the expansion of civil rights protections for mentally ill persons during the 1960s and 1970s dramatically reduced state hospital populations. Washington might be housing as many as 10,080 persons in state hospitals had these trends not occurred.
In 1988, Washington's state hospital population averaged 1,700 and community hospitals about 750. In 1984, Washington ranked 39th in the nation in the number of psychiatric hospital beds per 100,000 population; 66.7 as compared to a national average of 112.9.
Nursing homes and other community residential programs house an additional 3,500 to 4,000 mentally ill persons. Community mental health centers provide outpatient services to an estimated 60,000, many of whom meet much broader eligibility criteria.
The federal Omnibus Budget Reconciliation Act will result in a loss of several hundred nursing home beds for the mentally ill.
A recent report to the Legislature documents the shortage of residences and describes the current administration and delivery of other mental health services as fragmented, and overly focused on providing expensive acute care.
The report recommends that the authority and responsibility for delivering mental health services be decentralized to the local communities along with adequate funding to expand residential facilities and supports.
SUMMARY:
It is the intent of the Legislature to encourage the development of county-based mental health services by encouraging counties to enter into regional systems of care which integrate planning, administration, and service delivery for community mental health and involuntary treatment services.
A county authority or a group of county authorities of no less than 40,000 persons, may enter into a joint operating agreement to form a regional support network (RSN). The RSN must develop and implement a plan to assume responsibility for planning, administering, and assuring the availability of mental health services for mentally ill persons within their areas no later than July 1, 1995. These responsibilities are to be assumed through contractual agreements with the Department of Social and Health Services (DSHS). The Department shall assure that a single authority within the network has final responsibility for resources and performance under the contract.
A RSN shall appoint a mental health advisory board to review and comment on all plans and policies developed under this act.
When RSNs are established, or on July 1, 1995, certain terms are redefined including "available resources," "community mental health program," "community support services," "mental health services," and "residential services."
Mental health services will be redefined to include all services provided by the RSN including residential services.
Regional support networks (RSN) are defined as a county authority or group of county authorities recognized by the Secretary of DSHS, who enter into joint operating agreements to contract with the secretary for the administration, planning, and delivery of mental health services.
Resource management services are defined as the responsibility of the RSN and mean the planning, coordination, and authorization of residential and community support services pursuant to an individual service plan for those who are acutely or chronically mentally ill, and for those seriously disturbed individuals that the RSN finds to be at risk of becoming acutely or chronically mentally ill.
The first wave of counties who are ready shall submit their intentions regarding participation in the RSNs by October 30, 1989. The second wave has until November 30, 1992. The implementation of the RSNs is to be included in all state and federal plans affecting the state mental health program. The first RSN may include a pilot project demonstrating the relationship between organic disease and mental illness.
The secretary shall begin implementation of the RSNs between January 1, 1990 and March 1, 1990, and complete implementation by June 1995. By July 1, 1993, he or she shall allocate 100 percent of available resources to the first wave of RSNs in a single grant. By July 1, 1995 allocation of funds shall be in a single grant for the second wave of counties. Up to that time, funds for establishing and operating evaluation and treatment facilities shall be allocated separately from other funds.
The secretary shall report to the Legislature on the effects of federal Title XIX funds and the 16-bed limit on Institutions for Mental Diseases, on services for acute and chronic persons and those at risk of becoming so by December 1, 1989.
The secretary shall have an adequate interim tracking system available for an RSN as it is established that will allow the RSN to perform its responsibilities. The secretary shall establish a task force on recruitment and retention of qualified community mental health professionals and report to the appropriate committees of the Legislature by January 1, 1990.
By July 1, 1993 the first wave of RSNs shall be responsible for at least 85 percent of the short-term acute care population within their boundaries who are subject to commitments of 17 days or less. Also by July 1, 1993, the first wave of RSNs shall administer a portion of the funds appropriated by the Legislature for the state hospitals for the care of those needing evaluation and treatment services for up to 17 days in residential services including the state hospitals. If state hospitals are used, the RSNs shall buy bed days at a rate equal to that assumed by the Legislature during that biennium. The duty of the state hospitals to accept persons for short term acute care is limited by the duties of the RSNs. The second wave of RSNs shall assume these responsibilities by July 1, 1995. RSNs with less than 150,000 may contract with neighboring RSNs for evaluation and treatment services.
Requests by the RSNs for the utilization of state-owned land that has ever been used for the care of the mentally ill shall be given first priority by the administering state agency.
The Legislature shall review proposals for a funding distribution formula in 1993, and administrative cost lids and reductions in detentions and short-term state hospital commitments in 1991.
Chapter 71.05 RCW, the Involuntary Treatment Act (ITA) is modified to require coordination between the county-designated mental health professional and resource management services.
Procedures are established which provide for the confidentiality of patient registration and treatment records, and which authorize the release of specific portions of these records to patients, families, courts, corrections officials and persons providing care and treatment under the authority of state law. These procedures take effect with the establishment of RSNs or on July 1, 1995.
Legislative intent is declared to change the role of state mental hospitals from short-term acute care to care of the most difficult populations including mentally ill offenders and long-term care patients.
Advisory boards are created at each state mental hospital to monitor and review operations of the hospitals and make recommendations to the Legislature and the Governor regarding implementation of the changing role of the state hospitals.
Institutes for the Study and Treatment of Mental Disorders are created at each state mental hospital to improve the skill levels and quantity of staff through joint operating agreements with state universities and institutions of higher education.
The Legislative Budget Committee is required to complete a study plan for an evaluation of the implementation of this act in order to determine the progress of the first wave RSNs in meeting the requirement to serve 85 percent of their short-term commitments by 1993. The Department of Health, if created, or the Office of Financial Management is required to complete a hospital rate review.
Representatives from underserved populations are included on the state hospital boards and shall participate in developing the state's mental health plan.
Fiscal Note: Available.
Effective Date:The bill contains an emergency clause and takes effect immediately.
House Committee ‑ Testified For: (Human Services) Kurt Sharar, Washington State Association of Counties; Maureen McLaughlin, King County Human Services; Christine Yorozu, Asian Counseling and Referral Services; Rose Bond, Well Mind Association; David Clumpner, Well Mind Association; Doris Davis, Well Mind Association; Gary Moore, Washington Federation of State Employees; Steve Reinig, Snohomish County; Ralph Hawley, Region III, Snohomish County; Ross Kane, Snohomish County Mental Health Board; Betty Brearly, Snohomish County Advocates for the Mentally Ill; Scott Bond, Director, Community Services Department, Spokane County; Jean Soliz, Office of Financial Management, and the Governor's Office; Sharon Stewart Johnson, Director, Department of Mental Health; Eleanor Owen, Washington Advocates for the Mentally Ill; Frank Winslow, (with concerns) Alzheimer's Society of Washington; Kay Day, Mother and Retired Nurse; Bernice Buchheit, South King County Alliance for the Mentally Ill; Elizabeth Muktarian; Pierce County; and Jeff Larson, Washington Osteopathic Medical Association.
(Appropriations) Representative John Moyer, Representative George Raiter and Bernice Bucheit, Washington Association for the Mentally Ill.
House Committee - Testified Against: (Human Services) None Presented.
(Appropriations) None Presented.
House Committee - Testimony For: (Human Services) Administration, planning and service delivery of the mental system is badly fragmented. No one entity is responsible, and in fact even identifying who is responsible is difficult. The client frequently gets lost in the current system since no one is responsible for overseeing the client's movement from institution to residential placement to outpatient services to the streets. Residential services have not been a mandated service, leaving a major gap between acute inpatient care and outpatient treatment. The state hospitals and the local authorities and providers end up "dumping" their clients on the other's area of responsibility. The state hospitals are continually on the verge of federal decertification due to understaffing, questionable patient care and overcrowding. Deinstitutionalization has relegated many of the mentally ill to the streets, jails, and hospital emergency rooms.
Residential services are badly needed for this population. The federal Omnibus Budget Reconciliation Act will further exacerbate this situation by requiring the displacement of hundreds of mentally ill persons from nursing homes. Local communities can best meet the needs of this population and should have the authority and responsibility as well as the financial resources to design programs suited to their own needs. The state of Washington is not over-bedded in its state hospitals but does need to provide community alternatives to hospital care so that only long-term difficult and complex cases are served in state institutions. The counties desire to take on the added responsibilities defined in this legislation since they feel they can best determine the appropriate treatment and services for their own population. This legislation, along with adequate funding, is necessary to provide badly needed additional residential capacity in the local community.
(Appropriations) The bill is the result of agreement among interested parties. It is necessary to address serious problems in our mental health system. The counties feel the bill is what they need. The education institutes at the hospitals will improve the quality of patient care.
House Committee - Testimony Against: (Human Services) No testimony was presented against the bill. But one neutral witness cautioned that any change should proceed very slowly, that the Legislature should be aware that moving the mental health program entirely to the community has not occurred smoothly in other states, and that there should be a stronger community-state relationship in community residential programs. Concerns were expressed about not including comprehensive physical examinations as a requirement within the Community Mental Health Services Act, the broad scope of the current definition of mental disorder, the underserved populations, having an adequate tracking system available as networks come on line, and adequate funding.
(Appropriations) No testimony was presented against this bill. However, concern was expressed that only so many networks are going to be able to become a part of the regional system during the first biennium.
VOTE ON FINAL PASSAGE:
Yeas 94; Nays 2; Excused 2
Voting Nay: Representatives Miller and Moyer
Excused: Representatives Gallagher and Wang