The team behind the scenes of historic behavioral health budget
Three years ago, in spring 2018, Judy Fitzgerald and Bob Hubenthal were sitting in an office discussing the state of the buildings at Western State Hospital — a campus that is about to turn 150 years old — when the idea of asking for an unprecedented investment began to take form.
“We were sort of pondering the ancientness of our facilities, and we both just said, ‘Well, is it time to ask for something,’” said Fitzgerald, the assistant secretary for the Facilities, Finance and Analytics Administration.
While Western had undergone several upgrades and renovations over the years, the layouts and underlying infrastructure didn’t support modern therapeutic models.
“We realized that to fix up the existing facility would be so expensive and so disruptive and so feasibly difficult in a fully occupied hospital, and then would give us kind of re-freshened spaces that don’t work programmatically. We looked at each other and said, ‘Maybe it’s time to ask for a new hospital,’” said Hubenthal, FFA’s chief of the Office of Capital Programs.
That conversation was just the start of a year and a half of research to submit a request for funds, to include site visits to modern psychiatric hospitals in Massachusetts and Oregon.
“It helped reinforce the value of a therapeutic environment and what could be achieved in new construction that would not be possible in a remodel of existing facilities,” said Hubenthal, highlighting designs that allow for closer proximity between wards and active treatment areas such as group rooms; for the design of spaces such as gyms, art and music rooms specifically developed for the entire population; and for outdoor courtyards that provide perimeter security without the need for big fences.
The team putting together and presenting the request spanned FFA (including the capital projects team and the maintenance and operations division), the Behavioral Health Administration, and former Department of Social and Health Services Secretary Cheryl Strange.
“We just had all hands on deck for a long time to get the request solidified … everybody was pretty energized by the hope that we would get something,” said Fitzgerald.
While the $51 million for the new forensic hospital design — which brings with it the promise of funds for construction — is a key cornerstone of the historic 2021–2023 biennium budget of $400 billion for behavioral health transformation across Washington, the impact of the behavioral health investments included a much broader scope such as funds for new civil community facilities, purchasing behavioral health care, providing affordable community housing, and offering other services to behavioral health clients. Outside of DSHS, the budget also provided funds for the Health Care Authority and the Department of Commerce to support housing and other projects. Of course, Gov. Jay Inslee’s prioritizing of behavioral health transformation laid the groundwork for the budget to even be possible.
“I believe it’s historic because it’s a significant investment in the mental health system to move it towards community-based care, and I feel like it’s the first step into really turning that vision into reality,” said Ginger Stewart, BHA’s finance director; her office is the cornerstone for developing all BHA budget requests.
The team needed to make this historic budget happen is broad.
“The goal of bringing 21st century care to our statewide behavioral health system is paramount to behavioral health transformation, and it doesn’t happen in silos in one administration or overnight. It takes years of hard work by dedicated teams of compassionate people who all come together in the interest of patients across the state,” said Devon Nichols, continuum of care policy administrator for the FFAA.
She explained that while BHA plays an obvious role in running the state psychiatric hospitals, residential treatment facilities and leading the charge on program and policy changes; the Aging and Long-Term Support Administration and Developmental Disabilities Administration played large roles in building out foundational residential supports for those discharging from inpatient psychiatric care; the FFAA brings the capital and facility maintenance and operations expertise for the department; and DSHS also partners with many other state agencies such as HCA, the Department of Health, Commerce and the University of Washington, all with the same goal of transforming the behavioral health system.
“It truly is a team effort in the fact that it’s across agencies … it definitely has to be a collaborative, coordinated effort to move a system,” said Stewart. “It’s all-encompassing to really see this come to fruition at the end of the day.”