HOUSE BILL NO. 2308
State of Washington 51st Legislature 1990 Regular Session
By Representatives P. King, Scott, R. King, Wood, K. Wilson and S. Wilson
Read first time 1/9/90 and referred to Committee on Human Services.
AN ACT Relating to mental health; amending RCW 71.05.230, 71.05.240, 71.05.320, 71.05.390, 71.05.430, 71.05.520, 71.05.525, 71.05.550, 71.05.560, 71.24.025, 71.24.035, 72.23.010, and 72.23.025; reenacting and amending RCW 71.05.020; and creating new sections.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1. The legislature finds that the department of social and health services has not effectively implemented legislative intent expressed in RCW 71.24.015 and 71.05.010 regarding: Development of county-based and county-managed mental health services; encouragement of counties to form joint operating agreements to operate regional systems of mental health care; and reduction in administrative layering and administrative costs. The legislature further finds that local initiatives to respond to the legislative intent have been thwarted by the department. The department has erroneously interpreted "least restrictive care appropriate to clients needs" to prohibit the development of inpatient care needed by some communities. The legislature has created the department of health with the mandated responsibility to support local efforts to develop programs to respond to their own needs. The intent of the legislature regarding community control for mental health services would be more effectively implemented by transferring mental health responsibilities to the department of health.
NEW SECTION. Sec. 2. All powers, duties, and functions of the department of social and health services pertaining to mental illness treatment under chapter 71.05 RCW, mental health services under chapter 71.24 RCW, and facilities for mentally ill persons are transferred to the department of health. All references to the secretary or department of social and health services in the Revised Code of Washington shall be construed to mean the secretary or department of health when referring to the functions transferred in this section.
NEW SECTION. Sec. 3. All reports, documents, surveys, books, records, files, papers, or written material in the possession of the department of social and health services pertaining to the powers, functions, and duties transferred shall be delivered to the custody of the department of health. All cabinets, furniture, office equipment, motor vehicles, and other tangible property employed by the department of social and health services in carrying out the powers, functions, and duties transferred shall be made available to the department of health. All funds, credits, or other assets held in connection with the powers, functions, and duties transferred shall be assigned to the department of health.
Any appropriations made to the department of social and health services for carrying out the powers, functions, and duties transferred shall, on the effective date of this section, be transferred and credited to the department of health.
Whenever any question arises as to the transfer of any personnel, funds, books, documents, records, papers, files, equipment, or other tangible property used or held in the exercise of the powers and the performance of the duties and functions transferred, the director of financial management shall make a determination as to the proper allocation and certify the same to the state agencies concerned.
NEW SECTION. Sec. 4. All employees of the department of social and health services engaged in performing the powers, functions, and duties transferred are transferred to the jurisdiction of the department of health. All employees classified under chapter 41.06 RCW, the state civil service law, are assigned to the department of health to perform their usual duties upon the same terms as formerly, without any loss of rights, subject to any action that may be appropriate thereafter in accordance with the laws and rules governing state civil service.
NEW SECTION. Sec. 5. All rules and all pending business before the department of social and health services pertaining to the powers, functions, and duties transferred shall be continued and acted upon by the department of health. All existing contracts and obligations shall remain in full force and shall be performed by the department of health.
NEW SECTION. Sec. 6. The transfer of the powers, duties, functions, and personnel of the department of social and health services shall not affect the validity of any act performed prior to the effective date of this section.
NEW SECTION. Sec. 7. If apportionments of budgeted funds are required because of the transfers directed by sections 3 through 6 of this act, the director of financial management shall certify the apportionments to the agencies affected, the state auditor, and the state treasurer. Each of these shall make the appropriate transfer and adjustments in funds and appropriation accounts and equipment records in accordance with the certification.
NEW SECTION. Sec. 8. Nothing contained in sections 2 through 7 of this act may be construed to alter any existing collective bargaining unit or the provisions of any existing collective bargaining agreement until the agreement has expired or until the bargaining unit has been modified by action of the personnel board as provided by law.
Sec. 9. Section 7, chapter 142, Laws of 1973 1st ex. sess. as last amended by section 2, chapter 120, Laws of 1989, section 8, chapter 205, Laws of 1989 and by section 13, chapter 420, Laws of 1989 and RCW 71.05.020 are each reenacted and amended to read as follows:
For the purposes of this chapter:
(1) "Gravely disabled" means a condition in which a person, as a result of a mental disorder: (a) Is in danger of serious physical harm resulting from a failure to provide for his or her essential human needs of health or safety, or (b) manifests severe deterioration in routine functioning evidenced by repeated and escalating loss of cognitive or volitional control over his or her actions and is not receiving such care as is essential for his or her health or safety;
(2) "Mental disorder" means any organic, mental, or emotional impairment which has substantial adverse effects on an individual's cognitive or volitional functions;
(3) "Likelihood of serious harm" means either: (a) A substantial risk that physical harm will be inflicted by an individual upon his or her own person, as evidenced by threats or attempts to commit suicide or inflict physical harm on one's self, (b) a substantial risk that physical harm will be inflicted by an individual upon another, as evidenced by behavior which has caused such harm or which places another person or persons in reasonable fear of sustaining such harm, or (c) a substantial risk that physical harm will be inflicted by an individual upon the property of others, as evidenced by behavior which has caused substantial loss or damage to the property of others;
(4) "Peace officer" means a law enforcement official of a public agency or governmental unit, and includes persons specifically given peace officer powers by any state law, local ordinance, or judicial order of appointment;
(5) "Judicial commitment" means a commitment by a court pursuant to the provisions of this chapter;
(6) "Public agency" means any evaluation and treatment facility or institution, hospital, or sanitarium which is conducted for, or includes a department or ward conducted for, the care and treatment of persons who are mentally ill or deranged, if the agency is operated directly by, federal, state, county, or municipal government, or a combination of such governments;
(7) "Private agency" means any person, partnership, corporation, or association not defined as a public agency, whether or not financed in whole or in part by public funds, which constitutes an evaluation and treatment facility or private institution, hospital, or sanitarium, which is conducted for, or includes a department or ward conducted for the care and treatment of persons who are mentally ill;
(8) "Attending staff" means any person on the staff of a public or private agency having responsibility for the care and treatment of a patient;
"Department" means the department of ((
social and)) health (( services))
of the state of Washington;
(10) "Resource management services" has the meaning given in chapter 71.24 RCW;
"Secretary" means the secretary of the department of ((
health (( services)), or his or her designee;
(12) "Mental health professional" means a psychiatrist, psychologist, psychiatric nurse, or social worker, and such other mental health professionals as may be defined by rules and regulations adopted by the secretary pursuant to the provisions of this chapter;
(13) "Professional person" shall mean a mental health professional, as above defined, and shall also mean a physician, registered nurse, and such others as may be defined by rules and regulations adopted by the secretary pursuant to the provisions of this chapter;
(14) "Psychiatrist" means a person having a license as a physician and surgeon in this state who has in addition completed three years of graduate training in psychiatry in a program approved by the American medical association or the American osteopathic association and is certified or eligible to be certified by the American board of psychiatry and neurology;
(15) "Psychologist" means a person who has been licensed as a psychologist pursuant to chapter 18.83 RCW;
(16) "Social worker" means a person with a master's or further advanced degree from an accredited school of social work or a degree from a graduate school deemed equivalent under rules and regulations adopted by the secretary;
"Evaluation and treatment facility" means any facility which can
provide directly, or by direct arrangement with other public or private
agencies, emergency evaluation and treatment, outpatient care, and short term
inpatient care to persons suffering from a mental disorder, and which is
certified as such by the department ((
of social and health services)):
PROVIDED, That a physically separate and separately operated portion of a state
hospital may be designated as an evaluation and treatment facility: PROVIDED
FURTHER, That a facility which is part of, or operated by, the department (( of
social and health services)) or any federal agency will not require
certification: AND PROVIDED FURTHER, That no correctional institution or
facility, or jail, shall be an evaluation and treatment facility within the
meaning of this chapter;
(18) "Antipsychotic medications," also referred to as "neuroleptics," means that class of drugs primarily used to treat serious manifestations of mental illness associated with thought disorders and currently includes phenothiazines, thioxanthenes, butyrophenone, dihydroindolone, and dibenzoxazipine.
(19) "Developmental disability" means that condition defined in RCW 71A.10.020(2);
(20) "Developmental disabilities professional" means a person who has specialized training and three years of experience in directly treating or working with persons with developmental disabilities and is a psychiatrist or psychologist, or a social worker, and such other developmental disabilities professionals as may be defined by rules adopted by the secretary;
(21) "Habilitative services" means those services provided by program personnel to assist persons in acquiring and maintaining life skills and in raising their levels of physical, mental, social, and vocational functioning. Habilitative services include education, training for employment, and therapy. The habilitative process shall be undertaken with recognition of the risk to the public safety presented by the individual being assisted as manifested by prior charged criminal conduct;
(22) "Psychologist" means a person who has been licensed as a psychologist pursuant to chapter 18.83 RCW;
(23) "Social worker" means a person with a master's or further advanced degree from an accredited school of social work or a degree deemed equivalent under rules adopted by the secretary;
(24) "Individualized service plan" means a plan prepared by a developmental disabilities professional with other professionals as a team, for an individual with developmental disabilities, which shall state:
(a) The nature of the person's specific problems, prior charged criminal behavior, and habilitation needs;
(b) The conditions and strategies necessary to achieve the purposes of habilitation;
(c) The intermediate and long-range goals of the habilitation program, with a projected timetable for the attainment;
(d) The rationale for using this plan of habilitation to achieve those intermediate and long-range goals;
(e) The staff responsible for carrying out the plan;
(f) Where relevant in light of past criminal behavior and due consideration for public safety, the criteria for proposed movement to less-restrictive settings, criteria for proposed eventual discharge from involuntary confinement, and a projected possible date for discharge from involuntary confinement; and
(g) The type of residence immediately anticipated for the person and possible future types of residences.
Sec. 10. Section 28, chapter 142, Laws of 1973 1st ex. sess. as last amended by section 3, chapter 439, Laws of 1987 and RCW 71.05.230 are each amended to read as follows:
A person detained for seventy-two hour evaluation and treatment may be detained for not more than fourteen additional days of involuntary intensive treatment or ninety additional days of a less restrictive alternative to involuntary intensive treatment if the following conditions are met:
(1) The professional staff of the agency or facility providing evaluation services has analyzed the person's condition and finds that said condition is caused by mental disorder and either results in a likelihood of serious harm to the person detained or to others, or results in the detained person being gravely disabled and are prepared to testify those conditions are met; and
(2) The person has been advised of the need for voluntary treatment and the professional staff of the facility has evidence that he or she has not in good faith volunteered; and
facility providing intensive treatment is certified to provide such treatment
by the department ((
of social and health services)); and
(4) The professional staff of the agency or facility or the mental health professional designated by the county has filed a petition for fourteen day involuntary detention or a ninety day less restrictive alternative with the court. The petition must be signed either by two physicians or by one physician and a mental health professional who have examined the person. If involuntary detention is sought the petition shall state facts that support the finding that such person, as a result of mental disorder, presents a likelihood of serious harm to others or himself or herself, or is gravely disabled and that there are no less restrictive alternatives to detention in the best interest of such person or others. The petition shall state specifically that less restrictive alternative treatment was considered and specify why treatment less restrictive than detention is not appropriate. If an involuntary less restrictive alternative is sought, the petition shall state facts that support the finding that such person, as a result of mental disorder, presents a likelihood of serious harm to others or himself or herself, or is gravely disabled and shall set forth the less restrictive alternative proposed by the facility; and
(5) A copy of the petition has been served on the detained person, his or her attorney and his or her guardian or conservator, if any, prior to the probable cause hearing; and
(6) The court at the time the petition was filed and before the probable cause hearing has appointed counsel to represent such person if no other counsel has appeared; and
(7) The court has ordered a fourteen day involuntary intensive treatment or a ninety day less restrictive alternative treatment after a probable cause hearing has been held pursuant to RCW 71.05.240; and
(8) At the conclusion of the initial commitment period, the professional staff of the agency or facility or the mental health professional designated by the county may petition for an additional period of either ninety days of less restrictive alternative treatment or ninety days of involuntary intensive treatment as provided in RCW 71.05.290; and
(9) If the hospital or facility designated to provide outpatient treatment is other than the facility providing involuntary treatment, the outpatient facility so designated has agreed to assume such responsibility.
Sec. 11. Section 29, chapter 142, Laws of 1973 1st ex. sess. as last amended by section 5, chapter 439, Laws of 1987 and RCW 71.05.240 are each amended to read as follows:
If a petition is filed for fourteen day involuntary treatment or ninety days of less restrictive alternative treatment, the court shall hold a probable cause hearing within seventy-two hours of the initial detention of such person as determined in RCW 71.05.180, as now or hereafter amended. If requested by the detained person or his or her attorney, the hearing may be postponed for a period not to exceed forty-eight hours. The hearing may also be continued subject to the conditions set forth in RCW 71.05.210 or subject to the petitioner's showing of good cause for a period not to exceed twenty-four hours.
conclusion of the probable cause hearing, if the court finds by a preponderance
of the evidence that such person, as the result of mental disorder, presents a
likelihood of serious harm to others or himself or herself, or is gravely
disabled, and, after considering less restrictive alternatives to involuntary
detention and treatment, finds that no such alternatives are in the best
interests of such person or others, the court shall order that such person be
detained for involuntary treatment not to exceed fourteen days in a facility
certified to provide treatment by the department ((
of social and health
services)). If the court finds that such person, as the result of a mental
disorder, presents a likelihood of serious harm to others or himself or herself,
or is gravely disabled, but that treatment in a less restrictive setting than
detention is in the best interest of such person or others, the court shall
order an appropriate less restrictive course of treatment for not to exceed
The court shall specifically state to such person and give such person notice in writing that if involuntary treatment beyond the fourteen day period or beyond the ninety days of less restrictive treatment is to be sought, such person will have the right to a full hearing or jury trial as required by RCW 71.05.310.
Sec. 12. Section 37, chapter 142, Laws of 1973 1st ex. sess. as last amended by section 15, chapter 420, Laws of 1989 and RCW 71.05.320 are each amended to read as follows:
(1) If the
court or jury finds that grounds set forth in RCW 71.05.280 have been proven
and that the best interests of the person or others will not be served by a
less restrictive treatment which is an alternative to detention, the court
shall remand him or her to the custody of the department ((
of social and
health services)) or to a facility certified for ninety day treatment by
the department (( of social and health services)) for a further period of
intensive treatment not to exceed ninety days from the date of judgment:
PROVIDED, That if the grounds set forth in RCW 71.05.280(3) are the basis of
commitment, then the period of treatment may be up to but not exceed one
hundred eighty days from the date of judgment in a facility certified for one
hundred eighty day treatment by the department. If the committed person is
developmentally disabled and has been determined incompetent pursuant to RCW
10.77.090(3), and the best interests of the person or others will not be served
by a less-restrictive treatment which is an alternative to detention, the court
shall remand him or her to the custody of the department (( of social and
health services)) or to a facility certified for one hundred eighty-day
treatment by the department. When appropriate and subject to available funds,
treatment and training of such persons must be provided in a program
specifically reserved for the treatment and training of developmentally
disabled persons. A person so committed shall receive habilitation services
pursuant to an individualized service plan specifically developed to treat the
behavior which was the subject of the criminal proceedings. Said treatment
program shall be administered by developmental disabilities professionals and
others trained specifically in the needs of developmentally disabled persons.
The department may limit admissions to this specialized program in order to
ensure that expenditures for services do not exceed amounts appropriated by the
legislature and allocated by the department for such services. The department
may establish admission priorities in the event that the number of eligible
persons exceeds the limits set by the department. An order for treatment less
restrictive than involuntary detention may include conditions, and if such
conditions are not adhered to, the designated mental health professional or
developmental disabilities professional may order the person apprehended under
the terms and conditions of RCW 71.05.340 as now or hereafter amended.
court or jury finds that grounds set forth in RCW 71.05.280 have been proven,
but finds that treatment less restrictive than detention will be in the best
interest of the person or others, then the court shall remand him to the
custody of the department ((
of social and health services)) or to a
facility certified for ninety day treatment by the department (( of social
and health services)) or to a less restrictive alternative for a further
period of less restrictive treatment not to exceed ninety days from the date of
judgment: PROVIDED, That if the grounds set forth in RCW 71.05.280(3) are the
basis of commitment, then the period of treatment may be up to but not exceed
one hundred eighty days from the date of judgment.
(2) Said person shall be released from involuntary treatment at the expiration of the period of commitment imposed under subsection (1) of this section unless the superintendent or professional person in charge of the facility in which he is confined, or in the event of a less restrictive alternative, the designated mental health professional or developmental disabilities professional, files a new petition for involuntary treatment on the grounds that the committed person;
(a) During the current period of court ordered treatment: (i) Has threatened, attempted, or inflicted physical harm upon the person of another, or substantial damage upon the property of another, and (ii) as a result of mental disorder or developmental disability presents a likelihood of serious harm to others; or
(b) Was taken into custody as a result of conduct in which he attempted or inflicted serious physical harm upon the person of another, and continues to present, as a result of mental disorder or developmental disability a likelihood of serious harm to others; or
(c) Is in custody pursuant to RCW 71.05.280(3) and as a result of mental disorder or developmental disability presents a substantial likelihood of repeating similar acts considering the charged criminal behavior, life history, progress in treatment, and the public safety; or
(d) Continues to be gravely disabled.
If the conduct required to be proven in subsections (b) and (c) of this section was found by a judge or jury in a prior trial under this chapter, it shall not be necessary to reprove that element. Such new petition for involuntary treatment shall be filed and heard in the superior court of the county of the facility which is filing the new petition for involuntary treatment unless good cause is shown for a change of venue. The cost of the proceedings shall be borne by the state.
The hearing shall be held as provided in RCW 71.05.310, and if the court or jury finds that the grounds for additional confinement as set forth in this subsection are present, the court may order the committed person returned for an additional period of treatment not to exceed one hundred eighty days from the date of judgment. At the end of the one hundred eighty day period of commitment, the committed person shall be released unless a petition for another one hundred eighty day period of continued treatment is filed and heard in the same manner as provided herein above. Successive one hundred eighty day commitments are permissible on the same grounds and pursuant to the same procedures as the original one hundred eighty day commitment. No person committed as herein provided may be detained unless a valid order of commitment is in effect. No order of commitment can exceed one hundred eighty days in length.
Sec. 13. Section 44, chapter 142, Laws of 1973 1st ex. sess. as last amended by section 8, chapter 67, Laws of 1986 and RCW 71.05.390 are each amended to read as follows:
The fact of admission and all information and records compiled, obtained, or maintained in the course of providing services to either voluntary or involuntary recipients of services at public or private agencies shall be confidential.
Information and records may be disclosed only:
(1) In communications between qualified professional persons to meet the requirements of this chapter, in the provision of services or appropriate referrals, or in the course of guardianship proceedings. The consent of the patient, or his or her guardian, must be obtained before information or records may be disclosed by a professional person employed by a facility to a professional person, not employed by the facility, who does not have the medical responsibility for the patient's care or who is not a designated county mental health professional or who is not involved in providing services under the community mental health services act, chapter 71.24 RCW.
(2) When the communications regard the special needs of a patient and the necessary circumstances giving rise to such needs and the disclosure is made by a facility providing outpatient services to the operator of a care facility in which the patient resides.
(3) When the person receiving services, or his or her guardian, designates persons to whom information or records may be released, or if the person is a minor, when his or her parents make such designation.
(4) To the extent necessary for a recipient to make a claim, or for a claim to be made on behalf of a recipient for aid, insurance, or medical assistance to which he or she may be entitled.
program evaluation and/or research: PROVIDED, That the secretary ((
social and health services)) adopts rules for the conduct of such
evaluation and/or research. Such rules shall include, but need not be limited
to, the requirement that all evaluators and researchers must sign an oath of
confidentiality substantially as follows:
"As a condition of conducting evaluation or research concerning persons who have received services from (fill in the facility, agency, or person) I, ............... , agree not to divulge, publish, or otherwise make known to unauthorized persons or the public any information obtained in the course of such evaluation or research regarding persons who have received services such that the person who received such services is identifiable.
I recognize that unauthorized release of confidential information may subject me to civil liability under the provisions of state law.
(6) To the courts as necessary to the administration of this chapter.
(7) To law
enforcement officers, public health officers, or personnel of the department of
corrections or the ((
board of prison terms and paroles)) indeterminate
sentence review board for persons who are the subject of the records and
who are committed to the custody of the department of corrections or (( board
of prison terms and paroles)) indeterminate sentence review board
which information or records are necessary to carry out the responsibilities of
their office: PROVIDED, That
(a) Only the fact, place, and date of involuntary admission, the fact and date of discharge, and the last known address shall be disclosed upon request; and
(b) The law
enforcement and public health officers or personnel of the department of
corrections or ((
board of prison terms and paroles)) indeterminate
sentence review board shall be obligated to keep such information confidential
in accordance with this chapter; and
(c) Additional information shall be disclosed only after giving notice to said person and his or her counsel and upon a showing of clear, cogent and convincing evidence that such information is necessary and that appropriate safeguards for strict confidentiality are and will be maintained: PROVIDED HOWEVER, That in the event the said person has escaped from custody, said notice prior to disclosure is not necessary and that the facility from which the person escaped shall include an evaluation as to whether the person is of danger to persons or property and has a propensity toward violence.
(8) To the attorney of the detained person.
(9) To the prosecuting attorney as necessary to carry out the responsibilities of the office under RCW 71.05.330(2) and 71.05.340(1)(b) and 71.05.335. The prosecutor shall be provided access to records regarding the committed person's treatment and prognosis, medication, behavior problems, and other records relevant to the issue of whether treatment less restrictive than inpatient treatment is in the best interest of the committed person or others. Information shall be disclosed only after giving notice to the committed person and the person's counsel.
(10) To appropriate law enforcement agencies and to a person, when the identity of the person is known to the public or private agency, whose health and safety has been threatened, or who is known to have been repeatedly harassed, by the patient. The person may designate a representative to receive the disclosure. The disclosure shall be made by the professional person in charge of the public or private agency or his or her designee and shall include the dates of admission, discharge, authorized or unauthorized absence from the agency's facility, and only such other information that is pertinent to the threat or harassment. The decision to disclose or not shall not result in civil liability for the agency or its employees so long as the decision was reached in good faith and without gross negligence.
The fact of admission, as well as all records, files, evidence, findings, or orders made, prepared, collected, or maintained pursuant to this chapter shall not be admissible as evidence in any legal proceeding outside this chapter without the written consent of the person who was the subject of the proceeding. The records and files maintained in any court proceeding pursuant to this chapter shall be confidential and available subsequent to such proceedings only to the person who was the subject of the proceeding or his or her attorney. In addition, the court may order the subsequent release or use of such records or files only upon good cause shown if the court finds that appropriate safeguards for strict confidentiality are and will be maintained.
Sec. 14. Section 48, chapter 142, Laws of 1973 1st ex. sess. and RCW 71.05.430 are each amended to read as follows:
this chapter shall be construed to prohibit the compilation and publication of
statistical data for use by government or researchers under standards,
including standards to assure maintenance of confidentiality, set forth by the
secretary of the department ((
of social and health services)).
Sec. 15. Section 57, chapter 142, Laws of 1973 1st ex. sess. and RCW 71.05.520 are each amended to read as follows:
of social and health services)) shall have the
responsibility to determine whether all rights of individuals recognized and
guaranteed by the provisions of this chapter and the Constitutions of the state
of Washington and the United States are in fact protected and effectively
secured. To this end, the department shall assign appropriate staff who shall
from time to time as may be necessary have authority to examine records,
inspect facilities, attend proceedings, and do whatever is necessary to
monitor, evaluate, and assure adherence to such rights. Such persons shall
also recommend such additional safeguards or procedures as may be appropriate
to secure individual rights set forth in this chapter and as guaranteed by the
state and federal Constitutions.
Sec. 16. Section 12, chapter 199, Laws of 1975 1st ex. sess. and RCW 71.05.525 are each amended to read as follows:
the judgment of the department ((
of social and health services)), the
welfare of any person committed to or confined in any state juvenile
correctional institution or facility necessitates that such a person be
transferred or moved for observation, diagnosis or treatment to any state
institution or facility for the care of mentally ill juveniles the secretary,
or his or her designee, is authorized to order and effect such move or
transfer: PROVIDED, HOWEVER, That the secretary shall adopt and implement
procedures to assure that persons so transferred shall, while detained or
confined in such institution or facility for the care of mentally ill
juveniles, be provided with substantially similar opportunities for parole or
early release evaluation and determination as persons detained or confined in
state juvenile correctional institutions or facilities: PROVIDED, FURTHER,
That the secretary shall notify the original committing court of such transfer.
Sec. 17. Section 60, chapter 142, Laws of 1973 1st ex. sess. and RCW 71.05.550 are each amended to read as follows:
of social and health services)), in planning and providing
funding to counties pursuant to chapter 71.24 RCW, shall recognize the
financial necessities imposed upon counties by implementation of this chapter
and shall consider needs, if any, for additional community mental health
services and facilities and reduction in commitments to state hospitals for the
mentally ill accomplished by individual counties, in planning and providing
such funding. The state shall provide financial assistance to the counties to
enable the counties to meet all increased costs, if any, to the counties
resulting from their administration of the provisions of this 1973 amendatory
Sec. 18. Section 61, chapter 142, Laws of 1973 1st ex. sess. and RCW 71.05.560 are each amended to read as follows:
of social and health services)) shall adopt such rules and
regulations as may be necessary to effectuate the intent and purposes of this
chapter, which shall include but not be limited to evaluation of the quality of
the program and facilities operating pursuant to this chapter, evaluation of
the effectiveness and cost effectiveness of such programs and facilities, and
procedures and standards for certification and other action relevant to
evaluation and treatment facilities.
Sec. 19. Section 3, chapter 204, Laws of 1982 as last amended by section 2, chapter 205, Laws of 1989 and RCW 71.24.025 are each amended to read as follows:
Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
(1) "Acutely mentally ill" means a condition which is limited to a short-term severe crisis episode of:
(a) A mental disorder as defined in RCW 71.05.020(2) or, in the case of a child, as defined in RCW 71.34.020(12);
(b) Being gravely disabled as defined in RCW 71.05.020(1) or, in the case of a child, as defined in RCW 71.34.020(8); or
(c) Presenting a likelihood of serious harm as defined in RCW 71.05.020(3) or, in the case of a child, as defined in RCW 71.34.020(11).
(2) "Available resources" means those funds which shall be appropriated under this chapter by the legislature during any biennium for the purpose of providing community mental health programs under RCW 71.24.045. When regional support networks are established or after July 1, 1995, "available resources" means federal funds, except those provided according to Title XIX of the social security act, and state funds appropriated under this chapter or chapter 71.05 RCW by the legislature during any biennium for the purpose of providing residential services, resource management services, community support services, and other mental health services. This does not include funds appropriated for the purpose of operating and administering the state psychiatric hospitals, except as negotiated according to RCW 71.24.300(1)(d).
(3) "Licensed service provider" means an entity licensed according to this chapter or chapter 71.05 RCW that meets state minimum standards or individuals licensed under chapter 18.57, 18.71, 18.83, or 18.88 RCW.
(4) "Child" means a person under the age of eighteen years.
(5) "Chronically mentally ill person" means a child or adult who has a mental disorder, in the case of a child as defined by chapter 71.34 RCW, and meets at least one of the following criteria:
(a) Has undergone two or more episodes of hospital care for a mental disorder within the preceding two years or, in the case of a child, has been placed by the department or its designee two or more times outside of the home, where the placements are related to a mental disorder, as defined in chapter 71.34 RCW, and where the placements progress toward a more restrictive setting. Placements by the department include but are not limited to placements by child protective services and child welfare services;
(b) Has experienced a continuous psychiatric hospitalization or residential treatment exceeding six months' duration within the preceding year;
(c) Has been unable to engage in any substantial gainful activity by reason of any mental disorder which has lasted for a continuous period of not less than twelve months. "Substantial gainful activity" shall be defined by the department by rule consistent with Public Law 92-603, as amended, and shall include school attendance in the case of a child; or
(d) In the case of a child, has been subjected to continual distress as indicated by repeated physical or sexual abuse or neglect.
(6) "Community mental health program" means all mental health services established by a county authority. After July 1, 1995, or when the regional support networks are established, "community mental health program" means all activities or programs using available resources.
(7) "Community support services" means services for acutely and chronically mentally ill persons and includes: (a) Discharge planning for clients leaving state mental hospitals, other acute care inpatient facilities, inpatient psychiatric facilities for persons under twenty-one years of age, and other children's mental health residential treatment facilities; (b) sufficient contacts with clients, families, schools, or significant others to provide for an effective program of community maintenance; and (c) medication monitoring. After July 1, 1995, or when regional support networks are established, for adults and children "community support services" means services authorized, planned, and coordinated through resource management services including, at least, assessment, diagnosis, emergency crisis intervention available twenty-four hours, seven days a week, prescreening determinations for mentally ill persons being considered for placement in nursing homes as required by federal law, screening for patients being considered for admission to residential services, investigation, legal, and other nonresidential services under chapter 71.05 RCW, case management services, psychiatric treatment including medication supervision, counseling, psychotherapy, assuring transfer of relevant patient information between service providers, other services determined by regional support networks, and maintenance of a patient tracking system for chronically mentally ill persons.
(8) "County authority" means the board of county commissioners, county council, or county executive having authority to establish a community mental health program, or two or more of the county authorities specified in this subsection which have entered into an agreement to provide a community mental health program.
"Department" means the department of ((
social and)) health (( services)).
(10) "Mental health services" means community services pursuant to RCW 71.24.035(5)(b) and other services provided by the state for the mentally ill. When regional support networks are established, or after July 1, 1995, "mental health services" shall include all services provided by regional support networks.
(11) "Mentally ill persons" and "the mentally ill" mean persons and conditions defined in subsections (1), (5), and (15) of this section.
(12) "Regional support network" means a county authority or group of county authorities recognized by the secretary that enter into joint operating agreements to contract with the secretary pursuant to this chapter.
(13) "Residential services" means a facility or distinct part thereof which provides food and shelter, and may include treatment services.
When regional support networks are established, or after July 1, 1995, for adults and children "residential services" means a complete range of residences and supports authorized by resource management services and which may involve a facility, a distinct part thereof, or services which support community living, for acutely mentally ill persons, chronically mentally ill persons, or seriously disturbed persons determined by the regional support network to be at risk of becoming acutely or chronically mentally ill. The services shall include at least evaluation and treatment services as defined in chapter 71.05 RCW, acute crisis respite care, long-term adaptive and rehabilitative care, and supervised and supported living services, and shall also include any residential services developed to service mentally ill persons in nursing homes.
(14) "Resource management services" mean the planning, coordination, and authorization of residential services and community support services administered pursuant to an individual service plan for acutely mentally ill adults and children, chronically mentally ill adults and children, or seriously disturbed adults and children determined by the regional support network at their sole discretion to be at risk of becoming acutely or chronically mentally ill. Resource management services include seven day a week, twenty-four hour a day availability of information regarding mentally ill adults' and children's enrollment in services and their individual service plan to county-designated mental health professionals, evaluation and treatment facilities, and others as determined by the regional support network.
(15) "Seriously disturbed person" means a person who:
(a) Is gravely disabled or presents a likelihood of serious harm to oneself or others as a result of a mental disorder as defined in chapter 71.05 RCW;
(b) Has been on conditional release status at some time during the preceding two years from an evaluation and treatment facility or a state mental health hospital;
(c) Has a mental disorder which causes major impairment in several areas of daily living;
(d) Exhibits suicidal preoccupation or attempts; or
(e) Is a child diagnosed by a mental health professional, as defined in RCW 71.05.020, as experiencing a mental disorder which is clearly interfering with the child's functioning in family or school or with peers or is clearly interfering with the child's personality development and learning.
"Secretary" means the secretary of ((
social and)) health (( services)).
(17) "State minimum standards" means: (a) Minimum requirements for delivery of mental health services as established by departmental rules and necessary to implement this chapter, including but not limited to licensing service providers and services; (b) minimum service requirements for licensed service providers for the provision of mental health services as established by departmental rules pursuant to chapter 34.05 RCW as necessary to implement this chapter, including, but not limited to: Qualifications for staff providing services directly to mentally ill persons; the intended result of each service; and the rights and responsibilities of persons receiving mental health services pursuant to this chapter; (c) minimum requirements for residential services as established by the department in rule based on clients' functional abilities and not solely on their diagnoses, limited to health and safety, staff qualifications, and program outcomes. Minimum requirements for residential services are those developed in collaboration with consumers, families, counties, regulators, and residential providers serving the mentally ill. Minimum requirements encourage the development of broad-range residential programs, including integrated housing and cross-systems programs where appropriate, and do not unnecessarily restrict programming flexibility; and (d) minimum standards for community support services and resource management services, including at least qualifications for resource management services, client tracking systems, and the transfer of patient information between service providers.
Sec. 20. Section 4, chapter 204, Laws of 1982 as last amended by section 3, chapter 205, Laws of 1989 and RCW 71.24.035 are each amended to read as follows:
(1) The department is designated as the state mental health authority.
(2) The secretary may provide for public, client, and licensed service provider participation in developing the state mental health program.
(3) The secretary shall provide for participation in developing the state mental health program for children and other underserved populations, by including representatives on any committee established to provide oversight to the state mental health program.
(4) The secretary shall be designated as the county authority if a county fails to meet state minimum standards or refuses to exercise responsibilities under RCW 71.24.045.
(5) The secretary shall:
(a) Develop a biennial state mental health program that incorporates county biennial needs assessments and county mental health service plans and state services for mentally ill adults and children. The secretary may also develop a six-year state mental health plan;
(b) Assure that any county community mental health program provides access to treatment for the county's residents in the following order of priority: (i) The acutely mentally ill; (ii) the chronically mentally ill; and (iii) the seriously disturbed. Such programs shall provide:
(A) Outpatient services;
(B) Emergency care services for twenty-four hours per day;
(C) Day treatment for mentally ill persons which includes training in basic living and social skills, supported work, vocational rehabilitation, and day activities. Such services may include therapeutic treatment. In the case of a child, day treatment includes age-appropriate basic living and social skills, educational and prevocational services, day activities, and therapeutic treatment;
(D) Screening for patients being considered for admission to state mental health facilities to determine the appropriateness of admission;
(E) Consultation and education services; and
(F) Community support services;
(c) Develop and promulgate rules establishing state minimum standards for the delivery of mental health services including, but not limited to:
(i) Licensed service providers;
(ii) Regional support networks; and
(iii) Residential and inpatient services, evaluation and treatment services and facilities under chapter 71.05 RCW, resource management services, and community support services;
(d) Assure that the special needs of minorities, the elderly, disabled, children, and low-income persons are met within the priorities established in this section;
(e) Establish a standard contract or contracts, consistent with state minimum standards, which shall be used by the counties;
(f) Establish, to the extent possible, a standardized auditing procedure which minimizes paperwork requirements of county authorities and licensed service providers;
(g) Develop and maintain an information system to be used by the state, counties, and regional support networks when they are established which shall include a tracking method which allows the department and regional support networks to identify mental health clients' participation in any mental health service or public program on an immediate basis. The information system shall not include individual patient's case history files. Confidentiality of client information and records shall be maintained as provided in this chapter and in RCW 71.05.390, 71.05.400, 71.05.410, 71.05.420, 71.05.430, and 71.05.440. The system shall be fully operational no later than January 1, 1993: PROVIDED, HOWEVER, That when a regional support network is established, the department shall have an operational interim tracking system for that network that will be adequate for the regional support network to perform its required duties under this chapter;
(h) License service providers who meet state minimum standards;
(i) Certify regional support networks that meet state minimum standards;
(j) Periodically inspect certified regional support networks and licensed service providers at reasonable times and in a reasonable manner; and
(k) Fix fees to be paid by evaluation and treatment centers to the secretary for the required inspections;
(l) Monitor and audit counties, regional support networks, and licensed service providers as needed to assure compliance with contractual agreements authorized by this chapter;
(m) Prior to September 1, 1989, adopt such rules as are necessary to implement the department's responsibilities under this chapter pursuant to chapter 34.05 RCW: PROVIDED, That such rules shall be submitted to the appropriate committees of the legislature for review and comment prior to adoption; and
(n) Beginning July 1, 1989, and continuing through July 1, 1993, track by region and county the use and cost of state hospital and local evaluation and treatment facilities for seventy-two hour detention, fourteen, ninety, and one hundred eighty day commitments pursuant to chapter 71.05 RCW, voluntary care in state hospitals, and voluntary community inpatient care covered by the medical assistance program. Service use and cost reports shall be provided to regions in a timely fashion at six-month intervals.
(6) The secretary shall use available resources appropriated specifically for community mental health programs only for programs under RCW 71.24.045. After July 1, 1995, or when regional support networks are established, available resources may be used only for regional support networks.
(7) Each certified regional support network and licensed service provider shall file with the secretary, on request, such data, statistics, schedules, and information as the secretary reasonably requires. A certified regional support network or licensed service provider which, without good cause, fails to furnish any data, statistics, schedules, or information as requested, or files fraudulent reports thereof, may have its certification or license revoked or suspended.
(8) The secretary may suspend, revoke, limit, or restrict a certification or license, or refuse to grant a certification or license for failure to conform to the law, applicable rules and regulations, or applicable standards, or failure to meet the minimum standards established pursuant to this section.
(9) The superior court may restrain any regional support network or service provider from operating without certification or a license or any other violation of this section. The court may also review, pursuant to procedures contained in chapter 34.05 RCW, any denial, suspension, limitation, restriction, or revocation of certification or license, and grant other relief required to enforce the provisions of this chapter.
(10) Upon petition by the secretary, and after hearing held upon reasonable notice to the facility, the superior court may issue a warrant to an officer or employee of the secretary authorizing him or her to enter at reasonable times, and examine the records, books, and accounts of any regional support network or service provider refusing to consent to inspection or examination by the authority.
(11) The secretary shall adopt such rules as may be necessary to effectuate the intent and purposes of this chapter, which shall include but not be limited to certification and licensing and other action relevant to certifying regional support networks and licensing service providers.
(12) Notwithstanding the existence or pursuit of any other remedy, the secretary may, in the manner provided by law, upon the advice of the attorney general who shall represent the secretary in the proceedings, maintain an action in the name of the state for an injunction or other process against any person or governmental unit to restrain or prevent the establishment, conduct, or operation of a regional support network or service provider without certification or a license under this chapter.
(13) The standards for certification of evaluation and treatment facilities shall include standards relating to maintenance of good physical and mental health and other services to be afforded persons pursuant to this chapter and chapter 71.05 RCW, and shall otherwise assure the effectuation of the purposes and intent of this chapter and chapter 71.05 RCW.
(14)(a) The department, in consultation with affected parties, shall establish a distribution formula that reflects county needs assessments based on the number of persons who are acutely mentally ill, chronically mentally ill, and seriously disturbed as defined in chapter 71.24 RCW. The formula shall take into consideration the impact on counties of demographic factors in counties which result in concentrations of priority populations as defined in subsection (15) of this section. These factors shall include the population concentrations resulting from commitments under the involuntary treatment act, chapter 71.05 RCW, to state psychiatric hospitals, as well as concentration in urban areas, at border crossings at state boundaries, and other significant demographic and workload factors.
(b) The department shall submit a proposed distribution formula in accordance with this section to the ways and means and health care and corrections committees of the senate and to the ways and means and human services committees of the house of representatives by October 1, 1989. The formula shall also include a projection of the funding allocations that will result for each county, which specifies allocations according to priority populations, including the allocation for services to children and other underserved populations.
(15) To supersede duties assigned under subsection (5) (a) and (b) of this section, and to assure a county-based, integrated system of care for acutely mentally ill adults and children, chronically mentally ill adults and children, and seriously disturbed adults and children who are determined by regional support networks at their sole discretion to be at risk of becoming acutely or chronically mentally ill, the secretary shall encourage the development of regional support networks as follows:
By December 1, 1989, the secretary shall recognize regional support networks requested by counties or groups of counties.
All counties wishing to be recognized as a regional support network on December 1, 1989, shall submit their intentions regarding participation in the regional support networks by October 30, 1989, along with preliminary plans. Counties wishing to be recognized as a regional support network by January 1, 1993, shall submit their intentions by November 30, 1992, along with preliminary plans. The secretary shall assume all duties assigned to the nonparticipating counties under chapters 71.05 and 71.24 RCW on July 1, 1995. Such responsibilities shall include those which would have been assigned to the nonparticipating counties under regional support networks.
The implementation of regional support networks, or the secretary's assumption of all responsibilities under chapters 71.05 and 71.24 RCW, shall be included in all state and federal plans affecting the state mental health program including at least those required by this chapter, the medicaid program, and P.L. 99-660. Nothing in these plans shall be inconsistent with the intent and requirements of this chapter.
(16) The secretary shall:
(a) Disburse the first funds for the regional support networks that are ready to begin implementation by January 1, 1990, or within sixty days of approval of the biennial contract. The department must either approve or reject the biennial contract within sixty days of receipt.
(b) Enter into biennial contracts with regional support networks to begin implementation between January 1, 1990, and March 1, 1990, and complete implementation by June 1995. The contracts shall be consistent with available resources. No contract shall be approved that does not include progress toward meeting the goals of this 1989 act by taking responsibility for: (i) Short-term commitments; (ii) residential care; and (iii) emergency response systems.
(c) By July 1, 1993, allocate one hundred percent of available resources to regional support networks created by January 1, 1990, in a single grant. Regional support networks created by January 1, 1993, shall receive a single block grant by July 1, 1995. The grants shall include funds currently provided for all residential services, all services pursuant to chapter 71.05 RCW, and all community support services and shall be distributed in accordance with a formula submitted to the legislature by January 1, 1993, in accordance with subsection (14) of this section.
(d) By January 1, 1990, allocate available resources to regional support networks for community support services, resource management services, and residential services excluding evaluation and treatment facilities provided pursuant to chapter 71.05 RCW in a single grant using the distribution formula established in subsection (14) of this section.
(e) By March 1, 1990, or within sixty days of approval of the contract continuing through July 1, 1993, provide grants as specifically appropriated by the legislature to regional support networks for evaluation and treatment facilities for persons detained or committed for periods up to seventeen days according to chapter 71.05 RCW. For regional support networks created by January 1, 1993, provide grants as specifically appropriated by the legislature to regional support networks for evaluation and treatment facilities for persons detained or committed for periods up to seventeen days according to chapter 71.05 RCW through July 1, 1995.
(f) Notify regional support networks of their allocation of available resources at least sixty days prior to the start of a new biennial contract period.
(g) Study and report to the legislature by December 1, 1989, on expanding the use of federal Title XIX funds and the definition of institutions for mental diseases to provide services to persons who are acutely mentally ill, chronically mentally ill, or at risk of becoming so. The study shall also include an assessment of the impact of Title XIX funds and the definition of institutions for mental diseases on the use of state funds to provide needed mental health services to the chronically mentally ill.
(h) Deny funding allocations to regional support networks based solely upon formal findings of noncompliance with the terms of the regional support network's contract with the department. Written notice and at least thirty days for corrective action must precede any such action. In such cases, regional support networks shall have full rights to appeal under chapter 34.05 RCW.
(i) Identify in its departmental biennial operating and capital budget requests the funds requested by regional support networks to implement their responsibilities under this chapter.
(j) Contract to provide or, if requested, make grants to counties to provide technical assistance to county authorities or groups of county authorities to develop regional support networks.
of social and health services)), in cooperation with the
state congressional delegation, shall actively seek waivers of federal
requirements and such modifications of federal regulations as are necessary to
allow federal medicaid reimbursement for services provided by free-standing
evaluation and treatment facilities certified under chapter 71.05 RCW. The
department shall periodically report its efforts to the health care and
corrections committee of the senate and the human services committee of the
house of representatives.
(18) The secretary shall establish a task force to examine the recruitment, training, and compensation of qualified mental health professionals in the community, which shall include the advantages and disadvantages of establishing a training academy, loan forgiveness program, or educational stipends offered in exchange for commitments of employment in mental health. The task force shall report back to the appropriate committees of the legislature by January 1, 1990.
Sec. 21. Section 72.23.010, chapter 28, Laws of 1959 as last amended by section 99, chapter 136, Laws of 1981 and RCW 72.23.010 are each amended to read as follows:
As used in this chapter, the following terms shall have the following meanings:
means the department of ((
social and)) health (( services)).
"Mentally ill person" shall mean any person who, pursuant to the definitions contained in RCW 71.05.020, as a result of a mental disorder presents a likelihood of serious harm to others or himself or is gravely disabled.
"Patient" shall mean a person under observation, care or treatment in a state hospital, or a person found mentally ill by the court, and not discharged from a state hospital, or other facility, to which such person had been ordered hospitalized.
"Licensed physician" shall mean an individual permitted to practice as a physician under the laws of the state, or a medical officer, similarly qualified, of the government of the United States while in this state in performance of his official duties.
means the secretary of ((
social and)) health (( services)).
"State hospital" shall mean any hospital operated and maintained by the state of Washington for the care of the mentally ill.
"Superintendent" shall mean the superintendent of a state hospital.
"Court" shall mean the superior court of the state of Washington.
"Resident" shall mean a resident of the state of Washington.
Wherever used in this chapter, the masculine shall include the feminine and the singular shall include the plural.
Sec. 22. Section 21, chapter 205, Laws of 1989 and RCW 72.23.025 are each amended to read as follows:
(1) It is the intent of the legislature to improve the quality of service at state hospitals, eliminate overcrowding, and more specifically define the role of the state hospitals. The legislature intends that eastern and western state hospitals shall become clinical centers for handling the most complicated long-term care needs. Over the next six years, their involvement in providing short-term and acute care shall be diminished in accordance with the revised responsibilities for mental health care under chapter 71.24 RCW. The legislature finds that establishment of the eastern state hospital board, the western state hospital board, and institutes for the study and treatment of mental disorders at both eastern state hospital and western state hospital will be instrumental in implementing the legislative intent.
(2)(a) The eastern state hospital board and the western state hospital board are each established. Members of the boards shall be appointed by the governor with the consent of the senate. Each board shall include:
(i) The director of the institute for the study and treatment of mental disorders established at the hospital;
(ii) One family member of a current or recent hospital resident;
(iii) One consumer of services;
(iv) One community mental health service provider;
(v) Two citizens with no financial or professional interest in mental health services;
(vi) One representative of the regional support network in which the hospital is located;
(vii) One representative from the staff who is a physician;
(viii) One representative from the nursing staff;
(ix) One representative from the other professional staff;
(x) One representative from the nonprofessional staff; and
(xi) One representative of a minority community.
(b) At least one representative listed in (a) (viii), (ix), or (x) of this subsection shall be a union member.
(c) Members shall serve four-year terms. Members of the board shall be reimbursed for travel expenses as provided in RCW 43.03.050 and 43.03.060 and shall receive compensation as provided in RCW 43.03.240.
(3) The boards established under this section shall:
(a) Monitor the operation and activities of the hospital;
(b) Review and advise on the hospital budget;
(c) Make recommendations to the governor and the legislature for improving the quality of service provided by the hospital;
(d) Monitor and review the activities of the hospital in implementing the intent of the legislature set forth in this section;
(e) Report periodically to the governor and the legislature on the implementation of the legislative intent set forth in this section; and
(f) Consult with the secretary regarding persons the secretary may select as the superintendent of the hospital whenever a vacancy occurs.
There is established at eastern state hospital and western state hospital,
institutes for the study and treatment of mental disorders. The institutes
shall be operated by joint operating agreements between state colleges and
universities and the department ((
of social and health services)). The
institutes are intended to:
(i) Promote recruitment and retention of highly qualified professionals at the state hospitals;
(ii) Improve clinical care by exploring new, innovative, and scientifically based treatment models for persons presenting particularly difficult and complicated clinical syndromes;
(iii) Provide expanded training opportunities for existing staff at the state hospitals;
(iv) Promote bilateral understanding of treatment orientation, possibilities, and challenges between state hospital professionals and community mental health professionals.
(b) To accomplish these purposes the institutes may, within funds appropriated for this purpose:
(i) Enter joint operating agreements with state universities or other institutions of higher education to accomplish the placement and training of students and faculty in psychiatry, psychology, social work, occupational therapy, nursing, and other relevant professions at the state hospitals;
(ii) Design and implement clinical research projects to improve the quality and effectiveness of state hospital services and operations;
(iii) Enter into agreements with community mental health service providers to accomplish the exchange of professional staff between the state hospitals and community mental health service providers;
(iv) Establish a student loan forgiveness program to retain qualified professionals at the state hospitals when the superintendent has determined a shortage of such professionals exists.
(c) Notwithstanding any other provisions of law to the contrary, the institutes may enter into agreements with the department or the state hospitals which may involve changes in staffing necessary to implement improved patient care programs contemplated by this section.
(d) The institutes are authorized to seek and accept public or private gifts, grants, contracts, or donations to accomplish their purposes under this section.
(5) The department shall review the diagnoses and treatment history of hospital patients and create a plan to locate inappropriately placed persons into medicaid reimbursable nursing homes or other nonhospital settings. The plan shall be submitted to the legislature by June 30, 1990.