SEATTLE — UW Medicine will lay off 32 employees at its newest behavioral health facility, citing a shortage of new patients being referred to the long-term treatment center.
Twenty-two probationary and 10 permanent employees, nearly all of them nursing staff, will be laid off this week.
The layoffs mark the latest hiccup for the $244 million UW Center for Behavioral Health and Learning, which opened last May. Half the spots in the 150-bed facility were supposed to offer long-term care for patients committed under Washington’s Involuntary Treatment Act — those who haven’t been charged with a crime but have severe enough mental illness that they can’t meet their own basic needs or they pose a danger to themselves or others.
The facility previously halted admissions in November due to a shortage of public defenders to represent patients in their court cases, which prevented the hospital from keeping them long-term. The hospital reopened admissions on a limited basis in January. At the time, UW Medicine leaders said they feared pausing admissions would make it difficult to retain staff.
Even as the public defender issue was resolved, the UW facility said it struggled to bring in new patients. It’s currently staffed to serve 66 patients, but on an average day has around 35, according to UW Medicine spokesperson Susan Gregg. The center has 287 staff members, with 127 of them working in the long-term civil commitment unit.
Jürgen Unützer, the chair of UW Psychiatry and Behavioral Sciences, said the facility hasn’t received as many referrals as they anticipated from hospitals. He said that could be due in part to the earlier admissions pause, when hospitals were forced to send patients elsewhere. But he said the facility has also had to turn some patients away.
“When you’re bringing a facility like that online, you’re staffing up gradually as patients come in, and you’re adjusting to the acuity of patients that you need,” he said. “So we were not able to accept every single patient that got referred to us because sometimes you’d have a patient that was so agitated or violent that we weren’t yet staffed to be able to handle that level of acuity.”
Unützer said with the state’s current budget shortfall, the facility’s overstaffing is not a good use of public funds. He said if patient numbers increase, the university will hire more staff.
Ian Goodhew, the associate vice president for medical affairs at UW Medicine, said all the permanent employees who were laid off will be offered other jobs. Probationary employees, he said, will have to apply for new jobs.
Unützer said despite the layoffs, the center has had relative success treating the patients it has admitted.
Forty-two of the 77 patients admitted since the facility opened have since been discharged, he said. That’s a positive step, he said, as many of those patients had previously waited in other inpatient facilities for months.
Goodhew said since the center began accepting patients in July, it has received 140 referrals. It has accepted 77 patients. Another 27 were accepted to a different facility before UW, he said. Of the 36 the center has declined to admit, he said, half were too violent or assaultive for the center to handle. The other half, he said, weren’t violent but had more serious developmental or cognitive disabilities and needed longer-term support than the facility was meant to provide.
“They were essentially people who needed long-term supportive housing with intense or semi-intense clinical care,” Goodhew said. “We specifically designed this facility to be for patients who need the 90 or 180 days,” he said. But the goal for patients who come to the facility, he said, is that after three to six months of treatment, they improve to the point that they can be released.
Still, the layoffs mark the latest challenge in the state’s ongoing struggle to treat civil commitment patients — from making space for them, to determining who should be responsible for them.
For years, most patients were sent to the state’s two psychiatric hospitals for involuntary commitment — either Western State in Lakewood or the smaller Eastern State in Medical Lake.
In 2018, then-Gov. Jay Inslee announced a five-year plan to revamp the state’s mental health system, which included closing the civil wards at the state hospital. His plan called for using that space for patients coming out of the criminal court system instead. Civil patients were to be sent to smaller, community-based facilities.
But those facilities were not built at the rate they were needed, and many patients were left cycling through emergency room stays, homelessness and stints in jail.
Facilities have since been opened, including the state-owned Olympic Heritage Behavioral Health facility in Tukwila and the new UW Center for Behavioral Health and Learning. But the question of who should represent UW’s patients also delayed some from getting treatment. UW Medicine officials thought that because the new facility was in King County, the cases should go to the King County Department of Public Defense. But the agency disputed that, saying they were already overwhelmed with cases and short on staff and funding.
The dispute led UW Medicine to halt admissions at the new facility in November for more than two months.
In February, Gov. Bob Ferguson directed the state’s office of public defense to begin taking on cases. A bill that just passed both legislative chambers would offer a more long-term solution, allowing counties to contract with third-party law firms if they can’t take on cases themselves.
