Mental health is a top policy and budget priority for WSHA this year, and for legislators as well. The Supreme Court case on psychiatric boarding helped bring the issue to the forefront, and a record number of bills on the subject have been introduced.
However, funding all the new policy bills is a big challenge: combined, the price tag is about $50 million when fully implemented. This is on top of the $50 million that WSHA strongly supports already contained in the Governor’s budget for new inpatient community beds and a new ward at Western State Hospital, among other changes. WSHA is also strongly supporting a capital budget request to help pay for the construction cost of new mental health facilities.
Here is our take on some of the major mental health bills.
HB 1713: Crisis substance abuse services. This bill represents a significant shift in crisis services. It creates a new category of people who can be detained under the Involuntary Treatment Act (ITA): people who are a danger to themselves or others as a result of their substance use disorder. Currently, our state has pieces of a substance abuse crisis system in law, but because secure detoxification facilities have not been funded, the laws go unused.
By April 1, 2017, the bill would essentially replicate the mental health crisis system for at-risk substance abuse patients. WSHA supports improvements to crisis substance abuse services, but we have been raising serious concerns that, unless it is properly funded and adequate capacity is developed, the state is creating a system that will not work. Emergency departments would be a critical entry point into this new system and underfunding will result in the boarding of substance abuse patients.
WSHA advocated strongly that the fiscal note be analyzed given the difficulties identifying this population, and in fact, the fiscal note was doubled to accommodate 6 to 7 facilities statewide.
Total two-year funding when fully phased in 2018: $22.8 million state and $24.4 million federal matching dollars (low range). The House passed the bill, 63-35. This is one to watch in the Senate.
HB 1450/SB 5649: Assisted outpatient treatment. These bills allow an individual to be ordered to participate in outpatient assisted treatment if the person is determined to be at-risk based on past behavior and other criteria. The intent of the bill is to serve the acute mental health population before they decompensate and need involuntary treatment. There was a lack of clarity about what happens when a patient is detained to outpatient treatment; WSHA successfully supported an amendment that clarifies that once a person is found to be in need of outpatient evaluation, emergency departments can discharge the patient when EMTALA obligations are met.
WSHA supports the bill as amended.
The fiscal note for the bill assumes court-related costs and intensive management and services for those individuals who meet criteria. The bill also assumes fewer people will be detained under the ITA as a result of receiving earlier interventions.
Total funding 2015-2017: $12.3 million state and $7.8 million federal matching dollars. The House passed the bill, 90-8.
SB 5649: Psychiatric boarding (previously SB 5644). The first version of this bill authorized psychiatric boarding by giving broad authorization to single bed certifications. WSHA strongly opposed it, but worked with the sponsor to create a framework that allows workable, short-term psychiatric care in hospitals.
The bill now requires the Department of Social and Health Services to create rules governing single bed certifications and makes technical corrections to allow for medical clearance in designated mental health professional evaluations. Much of the language in this bill started in another bill, SB 5644, but the two bills have been combined. The bill passed the Senate, 46-3.
SB 5645: Mental health data collection. In the wake of the Supreme Court case on psychiatric boarding, SB 5645 requires the state to keep records of patients who need psychiatric detention, but who cannot get access to a bed and are dependent on a single bed certification. The Senate passed the bill, 48-0. SB 5649 also contains the data collection language.
HB 1258/SB 5269: Family involvement. Known as “Joel’s Law,” the bill allows an immediate family member to petition the court if a designated mental health professional makes the decision to not detain an individual in a mental health crisis. If the court finds after reviewing all the information that there is probable cause to support detention, the court may order it.
WSHA is neutral on the bill, but the budget impact is worth watching. The fiscal note assumes more people will be detained as a result of the bill. Funding needed for 2015-2017: $13.6 million state and $7.1 million federal. The House passed the bill, 98-0 and the Senate, 46-3.
WSHA Legislative Testimony: March 16-20
WSHA staff or lobbyists will testify on the following bills.
Monday, March 16
HB 1645: Vaping (House Committee on Commerce & Gaming). WSHA supports Governor Jay Inslee’s requested legislation which, among many things, aims to regulate the sale of vapor or “e-cigarette” products to individuals under 18 years of age while establishing a tax on e-cigarettes that is comparable to other tobacco products. Public health and health care have worked hand-in-hand for years to reduce smoking rates and tobacco use. E-cigarettes threaten our success and represent an emerging public health crisis. (Ian Corbridge, 206/216-2514)
SB 5477: Vaping (House Committee on Commerce & Gaming). While not as comprehensive as HB 1645, SB 5477 places stricter requirements on the sale and distribution of vapor products and requires that all liquid nicotine containers have child-resistant packaging. With more than 7,000 unique vapor flavors, including cotton candy and bubble gum, stricter requirements are needed to keep children safe and away from tempting, yet poisonous products. (Ian Corbridge, 206/216-2514)
HB 1625: Prescription Drugs for Ambulances (Senate Committee on Health Care). Gives hospitals the ability to provide drugs to ambulance or aid services. WSHA supports the concept of the bill and is exploring options to enhance and simplify the bill while creating a pathway for immediate adoption. (Ian Corbridge, 206/216-2514)
Tuesday, March 17
SB 5593: Suspect and Inmate Guarding (House Committee on Judiciary). Protects workers and other patients by requiring adequate guarding by law enforcement of patients who are suspected or convicted of a violent or sexual crime. Ensures that payments for care to inmates cover the cost of their care while giving law enforcement a predictable and fair payment schedule. WSHA worked with law enforcement associations to draft agreed-upon language. Passed Senate unanimously. (Andrew Busz, 206/-216-2533)
Wednesday, March 18
SB 5460: Pharmacy Pre-Packs (House Committee on Health Care & Wellness). Allows practitioners to prescribe and distribute prepackaged emergency medications to emergency room patients when a community pharmacy is not available. WSHA was able to secure a title amendment in the Senate and is working on amendment language to address hospital pharmacy licensure issues. (Ian Corbridge, 206/216-2514)