Helping the seriously mentally ill
Eastern State adds beds, but struggles to fill staff positionsMay 19th, 2016
Though public attention now swirls around its West Side counterpart, Eastern State Hospital has navigated recent capital projects, adding 30 beds for inpatient care of adults with serious or long-term mental illness as it seeks to meet growing needs here.
Established in 1891, the Medial Lake psychiatric hospital serves a 20-county Eastern Washington region. Today, it’s also a large Spokane-area employer, with 780 full-time-equivalent workers.
Eastern has a $72.9 million budget for the fiscal year that ends June 30. Its 2015 average patient occupancy was 280, while Western State Hospital in Lakewood, Wash., is an 800-bed psychiatric hospital.
However, year-end improvements grew capacity at Eastern State, which is now a 317-bed facility after the retrofit of older spaces for two separate wards.
T.W. Clark Construction LLC, of Spokane, built the two wards at a combined cost of $1.5 million. The contractor also recently finished a third $1.2 million project to renovate 6,300 square feet for an anticipated 2017 opening of a new eight-bed psychiatric intensive care unit.
Hiring for the initial two wards added about 45 employees, but because of a lengthy process to find qualified professionals, one of the two wards only became fully operational this month, says Eastern State Hospital CEO Dorothy Sawyer.
“Part of our challenge was the ability to recruit staff,” says Sawyer, who also described a shortage of industry professionals. Sometime next year, the PICU is expected to add at least 25 employees.
“The demand for psychiatrists nationwide is at an all-time high,” Sawyer adds. “That’s related to the growth in population; it’s related to the Affordable Care Act, or Obamacare, with increased access for patients, which has increased demand, yet the supply (of psychiatrists) has not increased proportionally. We’re experiencing the same challenges as anyone else trying to provide psychiatric services.”
The hospital has received state funds to cover opening two beds in the PICU, but it’s still taking steps toward fully developing the program.
“It’s for patients who will benefit from short-term intensive psychiatric programming,” says Sawyer, who adds the ward will follow an evidence-based practice showing success in other states. “It will be the only such unit like this in the state of Washington. The purpose is short-term intensive treatment so patients can return to normal treatment areas of the hospital.”
“Even though the (PICU) construction is completed and came in on time, we’re holding off on opening until we can staff appropriately,” she adds. “We don’t anticipate announcing any kind of opening until 2017.”
Also, Sawyer says the hospital recently hired 10 employees full time for a new psychiatric emergency response team, a group of responders handling situations in the hospital when patient behavior accelerates because of mental illness.
Psychiatric emergency response team members who started in November include registered nurses and institutional counselors intensively trained on how to decelerate incidents. They also have extensive training in mental health and security, Sawyer says. Administrators are considering ways PERT also might offer training to other providers in the Spokane area.
“They’re trained in verbal communication responses to decelerate the situation,” Sawyer says. “We’d like to make them available to talk to other providers in the community who might be interested in learning about our approach, perhaps emergency providers, emergency room personnel, or those working with patients who have mental illness.”
In recent weeks, Western State has drawn public scrutiny over that facility’s security, escapee record, and oversight. In April, the attention spilled into Spokane when Western State escapee Anthony Garver fled here, forcing a widespread manhunt for two days before he was found by a search dog. The governor later fired Western’s administrator, and sweeping changes now are planned at the Lakewood hospital.
Based on recent news reports, the Eastern facility has had relatively low numbers of incidents, mainly described by officials as police calls in response to assaults by patients on staff and other patients.
However, in late 2012, Eastern had its accreditation status temporarily suspended after a routine inspection, but also a month after an incident when one patient strangled another. Eastern’s previous CEO eventually took another position within the Washington state Department of Social and Health Services. Within a few months, the hospital passed a review to receive reaccreditation, and Sawyer was hired as administrator to start in August 2013.
Addressing recent improvements at Eastern, Sawyer says the Medical Lake facility has multiple, ongoing projects to enhance both safety and security.
“We’re continually updating security,” she says, including retrofitted environments to decrease risks of people harming themselves in areas such as showers, restrooms, and closets. Other measures have included adding cameras, fire doors, and handheld radios for employees.
Regarding the two projects for Eastern State’s newly opened wards, one converted older space into a 27-bed, 14,600-square-foot area for patients determined not to be competent to stand trial, “so they come here for competency restoration treatment,” Sawyer says.
The other project, within space most recently used for offices, prepared a 30-bed, 11,700-square-foot ward for criminal defendants deemed “not guilty by reason of insanity,” or NGRI ward. Between the two retrofits, Eastern had a net gain of the 30 new beds.
“We renovated totally for our not-guilty-by-reason-of-insanity population,” Sawyer says. “We took an existing space that had been a ward and became offices over time, so it was updated to make sure it met standards for safety and current regulations for patient care.”
The NGRI ward opened with patients in November, while the competency restoration space filled only a few beds near year-end 2015 until the hospital could hire enough employees to open fully this month. Sawyer says the hospital had some competency restoration beds before, “but we didn’t have enough for the demand.”
All three newly renovated wards are on the Eastlake Campus, while another hospital area called the Westlake Campus has a geriatric unit for patients over 50.
The hospital defines three units: adult psychiatric, with 91 beds; forensic (legal) services, with 125 beds; and geropsychiatric unit, with 101 beds. Ten of those beds, however, are in an area for patients dually diagnosed with mental illness and developmental disability.
Under another update this fall, the hospital plans to implement fully an electronic health record system.
Adds Sawyer, “It’s a major undertaking to transition from paper to electronic records for a psychiatric hospital. It’s not like your private hospital. What we’re required to have in our records is intensive.”
As an inpatient psychiatric hospital, Eastern is owned and operated by the state of Washington under the administration of the Department of Social and Health Services and the Behavioral Health Administration. It’s licensed and accredited under requirements of The Joint Commission and the Centers for Medicare and Medicaid Services.
The hospital provides evaluation and treatment for individuals referred to the hospital by partner behavioral health organizations, through civil court order for involuntary treatment, and from the criminal justice system.
Meanwhile, the ability to hire additional psychiatrists remains a challenge, Sawyer says.
“We currently have five vacancies just for our hospital for psychiatrists,” she adds. “We use interim, trained psychiatrists, who are professionals willing to travel to a setting for three to 12 months. They are filling some of those vacancies. Even they are difficult to recruit because of the demand.”
Eastern, located 20 miles southwest of Spokane, employs a wide range of professionals for patient care, similar to any regional medical hospital. Sawyer, who is originally from Spokane, came to the hospital after working more than 30 years in the health care industry. For about 25 of those years, she was in senior leadership, most recently as a CEO in Arizona at Carondelet St. Mary’s Hospital.
She says Eastern occasionally might receive a patient from the West Side, but primarily people are admitted from its 20-county service area. “In 2015, we had 622 admissions and 628 discharges,” Sawyer adds. “How long people are here varies significantly.”
Eastern also offers programs as active treatment for patients who have reached certain levels in recovery, including horticulture, a woodshop, and exercise programs.
The National Institutes of Health reports that in 2014, the U.S. had an estimated 9.8 million adults aged 18 or older with serious mental illness. For this side of Washington, Eastern State is the core institution geared to serve that population, Sawyer says.
“We are the only provider for patients with serious long-term mental illness,” she adds.