Federal certification years off for Western State Hospital despite improvements

One of the major issues to plague Western State hospital has been violent attacks on staff and patients.

They surged last summer, but trended down in the first several months of 2019,  a trend that leaders at the state’s largest psychiatric facility are working hard to ensure continues.

“In my view, one injury to staff is one too many, or patient to patient injury, that’s one too many,” said David Holt, who took over as CEO of Western State Hospital in 2018. “It’s a new day, we have new opportunities to improve and I have a new plan.”

Some of that new plan will be the result of hundreds of millions of dollars in new investments to the state’s mental health system approved by the Legislature in 2019.

Among other things, those investments include money for additional staff, more competitive pay, a new specialized ward, building upgrades and more.

Staff training at Western State Hospital

The funding includes money for additional training staff and expanded training, key to Holt’s plan.

“We have what’s called Crisis Prevention Training that is done on helping reduce tensions in our patients when they’re very anxious, calm patients down, [and] prevent them from getting worse and having assaults, etcetera,” Holt explained.

“We’ve now added advanced Crisis Intervention Training,” he added. “It is intensive training. It’s state of the art. We’re going to put that in the first two weeks so they get the best practice training from across the country before they even step foot on a ward.”

The training covers everything from how to deescalate a situation to how to interact with patients, that focuses on treating patients with respect, a theme being stressed from the top down, starting with DSHS Secretary Cheryl Strange.

Holt says their patient population is changing and Western State has to adapt.

“Our patients are younger, they’re stronger, they’re sicker, [and] mental illnesses are more complex,” Holt explained. “They have multiple substance use disorder problems, so where maybe it used to be one drug now [we have] poly-substance abuse – using multiple drugs.”

“So they come in aggressive,” he added.

Hospital safety

Holt has also instituted many of his own policy changes in recent months aimed at increasing safety and improving care. That includes a nurse proctor program, where veteran staff in each ward volunteer to mentor the new hires, show them the ropes, and be there to answer any questions they may have.

Other changes include creating Ward Safety Committees led by ward administrators.

“Those folks are tasked with making sure from each discipline that’s on that ward – because you’ve got nursing, you’ve got psychology — all those disciplines come together, connect with the three shifts and just give them an opportunity to look at data in regards to safety and violence,” said Deputy Western State CEO Charles Sutherland.

“They’re going to have these conversations that are centered on those two topics and help me and Dave and the rest of the leadership here at the hospital, to figure out what it is we can be doing on those wards to make it a safer place for folks to work,” Sutherland added.

The new funding will also allow the hospital to expand on some existing safety measures.

“One of the things we’ve found here as we’ve looked at the data about our assaults is we have some of our nurse’s stations that are open, and we’ve had some of our younger, tougher patients who jump over those nurse’s stations,” Holt explained.

“So the Legislature funded us to go back and replace all of the nurse’s stations with enclosures – unbreakable glass, or plexiglass, carbon fiber – to prevent anymore assaults of staff while they’re back in a nurse’s station,” Hold added.

Funding from the state will also help create the new Specialized Treatment Assessment and Recovery — or STAR ward — set to open in the fall.

“It’s a socialized unit that allows us to take some of our most challenging patients — those are the most highly assaultive – allows us to get them in off their regular ward into an area that’s larger — it’s not as compressed — and allows us to get them stabilized on medications,” Holt said.

Once they’re stabilized, those patients can move to what Holt calls a “step-up” unit.

“Moving them into a very intensively, heavy treatment modality type of environment where they get evidenced-based, practiced therapies,” Holt said.

That includes therapies like DBT, or Dialectic Behavioral Therapy, which have proven successful in treating patients dealing with borderline personality disorder, PTSD, or who self-harm.

Asked if Western State is a safe place to work?

“Western State Hospital is improving in its safety,” Holt said. “One injury is one injury to many, and we have injuries.”

But, pointing the various initiatives already in place or on the way, he added, “We’re going to get safer and were going to continue that trajectory [of assaults] downward,” Holt said.

As for when Western State might be able to get federally certified again after certification was stripped last year by the Centers for Medicare and Medicaid Services, along with millions in federal funding, Holt said it will take some time.

“It’s going to be a multi-year process and we are making headway,” Holt said.

“One of the most critical pieces of this — that the Legislature, the department, and us all recognized after that survey — was that these buildings as they exist can never pass a survey, it’s the age of the buildings,” he explained, pointing out it was one of the reasons for the big funding increases from the Legislature this year.

“Look what the Legislature did,” Holt said. “They gave us design money to design a brand new 250-300 bed hospital. They recognize that we can get that [certified] without it. This year we got the pre-design money and we’ll work through that process in future years, but that’s the way we will get our accreditation.”

Trueblood settlement

He says that new building, along with the new beds coming online, mixed with improvements to the clinical side of things will help address both the accreditation issue and meet the requirements of the Trueblood settlement.

The Trueblood settlement was reached last year in an ongoing federal lawsuit against the state after it was determined people accused of crimes with behavioral health issues were unconstitutionally being warehoused in jails awaiting competency services.

That case led to a court ordering the state to provide competency evaluations within 14 days, and sending someone for competency restoration services within seven days of a judge ordering it.

The challenge, of course, was the lack of beds.

The state is now is now implementing the first of three phases of a settlement agreement in the Trueblood lawsuit.

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