State Hospitals.  There are three state hospitals in Washington under the administration of the Department of Social and Health Services (DSHS):  Western State Hospital and the Child Study & Treatment Center in Lakewood, and Eastern State Hospital in Medical Lake.  The Child Study & Treatment Center treats minors aged 5 to 17 who are committed or referred for up to six months of inpatient treatment through the Children's Long-Term Inpatient Program, by managed care organizations or behavioral health administrative services organizations, or by the courts.  The remaining two state hospitals treat adult involuntary patients who are either civilly committed for treatment through the Involuntary Treatment Act, or forensically committed for treatment related to criminal insanity or competency to stand trial through the criminal courts.

Psychosis REACH.  Psychosis REACH is a family intervention for psychosis co-developed by faculty at the University of Washington Department of Psychiatry and Behavioral Sciences that delivers psychoeducation and illness management skills training to family caregivers in the community.  The training, which is based in cognitive behavioral therapy principles, is currently offered to participants with an on-demand virtual training component followed by a live training event.  Individuals who complete the training are provided access to a community board to connect with other caregivers who have completed the training.  A family ambassador program offers family members who have completed the Psychosis REACH training program a structured opportunity to share their experiences, tips, and strategies with other families.

Family Bridger Program.  The Family Bridger Program uses a model whereby families with lived experience with a loved one who has experienced psychosis are trained to provide support and resources to other families when their loved one with psychosis enters an emergency department, outpatient treatment, or inpatient care.  The Family Bridger Program was developed at the University of Washington Department of Psychiatry and Behavioral Sciences using focus groups and a small-scale research study with support from anonymous donors, scheduled for dissemination in 2022.

Each state hospital must establish a Bureau of Family Experience (Bureau) by January 1, 2024, devoted to enhancing engagement between state hospitals and a patient's family or natural supports.  The mission of the Bureau is to provide information, guidance, and support to family and caregivers to help them be effective in supporting the patient's recovery, and to provide a source of training for state hospital staff using cognitive behavioral therapy principles and the Psychosis REACH model.

The Bureau must establish contact with at least one family member or natural support identified by the patient and provide them with systems navigation information, education, and training, including a overview of state hospital systems, discharge process information, information about patient privacy, information about legal processes, and preparation to support the patient in the community. The Bureau must provide these persons with access to the Psychosis REACH training program and to family-to-family peer support from a family bridger.  If the patient consents to the involvement of the family member or natural support in their care, the family member or natural support must also receive orientation to visitation policies, guidance for communicating with the treatment team and the patient, and development of a family crisis support plan.

DSHS must contract with the University of Washington Department of Psychiatry and Behavioral Sciences to assist with the development of the Bureau.  The staffing in each Bureau must include a director, one or more individuals licensed to provide social work or counseling services, and one or more individuals qualified to provide family peer specialist services.  DSHS must develop a staffing ratio in consultation with the University of Washington.

The University of Washington must develop a training curriculum for family peer specialists by December 31, 2022.

Technical amendments clarify that the three state hospitals are Western State Hospital, Eastern State Hospital, and the Child Study & Treatment Center and update statutes to use respectful language.

PRO:  Families are the missing link.  Encouraging hospitals to engage with patient's family members will lead to better care for everyone.  I am confident we can work through the privacy concerns.  In the Family Bridger model, family peers are trained to support other families during times of crisis.  It brings support during a critical time.  We heard many stories interviewing families indicating how desperately they need support.  The University of Washington is willing and able to work with state hospitals to implement this bill.  These interventions can help families even when patients do not consent to their involvement in their care.  These solutions are sustainable and empirically supported.  Psychosis REACH is founded on cognitive behavioral therapy.  It is a radically different, respectful approach, and was a lifesaver for our family.  All stakeholders benefit when families, patients, and care teams work together using evidence based-treatments.  This would place Washington at the vanguard of whole-person care to state hospital patients and their caregivers.  Family members know their loved ones best, but feel shut out when their family members are hospitalized.  They rarely receive recovery-oriented or hope-generating information.  Medication is only part of the solution, and using it as a sole strategy increases family conflict.  Shorter hospital stays put increased pressure on families.  The emergency room can feel like an alien planet.  No one should ever have to do this alone.  This bill will help families to not endure this alone without hope.  Families are effective and important in recovery from mental illness.  Please consider aligning the Bureau with the Office of Consumer Partnerships created in legislation last year.  A child in crisis is a family in crisis, and a family in treatment is a child in treatment.  Our family's experience shows that the strategies in this bill can succeed.

OTHER:  Please remove language that creates an implication that state hospital patients typically shut out their family members.