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Washington state’s vision of transforming behavioral health includes constructing a therapeutically designed hospital on the Western State Hospital campus with 350 beds to care for forensic patients in a modern facility. The hospital will also serve as a Forensic Center of Excellence and focus on providing state-of-the-art care for forensic patients, operating in an environment of care that supports safety and the delivery of evidenced-based and proven practices, and working hand in hand with local academic institutions to support research and innovation. Although hospital construction requires demolishing some existing buildings on the WSH campus, the new hospital facility will augment, not replace, the majority of the existing WSH structures. The new hospital is slated for construction to be complete between 2027 and 2029.
Conceptual design for the new forensic hospital by HOK with Architecture +
Latest updates
As a part of the construction of the new forensic hospital, trees south of Bldg. 5, north of Bldg. 21 and near the parking lots south of Bldg. 21 will be removed between March 25 and mid-April. Trees will be felled away from all roadways and spotters will be in place for pedestrians. Some of the lumber from these trees will be repurposed for use in the construction of the new hospital.
Our patients
The 350-bed facility will only serve patients who enter care through the criminal court system. Our state government is required to care for forensic patients, and as a part of the behavioral health transformation, we will continue to care for forensic patients at our state psychiatric hospitals while the majority of our civil patients will transfer to community-based facilities with oversight by the Washington Health Care Authority. Outside of the new hospital, the Western State Hospital campus will continue to care for both civil and forensic inpatients. When the new hospital is complete, WSH expects to serve primarily forensic patients and continue to serve a small population of civil patients whose needs are difficult to meet in the community. This expected total patient population is less than the current number of patients served at WSH.
Our program
Patients in the new forensic hospital will receive treatment, therapy, and services activities similar to those offered in our current forensic program. As the new hospital progresses toward becoming a Forensic Center of Excellence, the best practices developed will be shared with other forensic programs at both Western and Eastern state hospitals.
At the forensic hospital, a team of psychiatrists, psychologists, social workers, nurses and other trained professionals will work together to provide individualized care and treatment. Working with the patient (or patient representative), the team will develop a treatment plan addressing individual psychiatric treatment needs, social and family supports, medical care needs, and vocational and legal issues. Families will be encouraged to participate with the patient's consent.
We will continue to provide services and activities that are respectful to people across all cultures and backgrounds. These services include:
- Initial intake and evaluation
- Medical screening, psychiatric screening, and risk screening
- Psychological, biological, and social evaluation
- Treatment and therapy
Our goal is to stabilize psychiatric symptoms and improve the person’s mental status and behavior.
Patients who are discharged will receive discharge plans that are individualized with the supports to meet their needs in the community. These include wraparound supports such as medication management, case management and medical care. Discharged patients will be given a well-coordinated handoff to their next locations.
Security
The new hospital building will be a fully locked facility. Staff will control all entrances and exits. Outdoor spaces for patients will be enclosed by fencing and buildings, as the new facility will take advantage of its three-story building perimeter to enclose outdoor courtyards. Staff will be trained in de-escalation strategies and emergency management processes to provide a safe, secure, and therapeutic environment. The new hospital facility will be covered by new agreements similar to current WSH agreements with local law enforcement to provide assistance as needed.
WSH master plan
The WSH master plan, submitted to the city of Lakewood in April 2021, incorporates several facility improvements to the existing Western State Hospital campus. The 350-bed hospital building is just one project addressed in the master plan. Other projects include:
- Demolition of some existing buildings on the west side of campus to accommodate the new hospital.
- Construct a new 18-bed residential cottage for the Child Study and Treatment Center.
- Set aside space for a potential new 48-bed community residential treatment facility (contingent on completion of a parallel study to site community facilities throughout the region). With or without the community RTF, this master plan projects a significant decrease in civil commitment patients served at WSH.
Learn more about the master plan here.
Frequently asked questions
Q: Why is the new hospital being built in Lakewood?
A: The new forensic hospital structure is being built to serve current and future Western State Hospital patients. The new facility will be a part of the larger WSH campus, and will integrate into WSH’s programs, services and logistical support. As a part of WSH, the new hospital facility is well-positioned to serve patients requiring treatment and services, and to attract qualified physicians and staff. In addition, the Washington State Legislature directed that the new hospital be built on the current WSH campus.
Q: Will the new hospital expand the number of patients served at Western State Hospital?
A: The master plan does not call for an expansion of care at Western State Hospital. While there is a planned shift in focus from civil to forensic patients, the overall patient numbers will be less than the current number of patients served at WSH. Also, as noted in the master plan (Table 8), over 500,000 square feet of existing facilities are planned to be demolished, roughly offsetting the area of the planned new building. However, the master plan does include an increase of 18 beds at the Child Study and Treatment Center, and the potential for an additional 48-bed residential treatment facility onsite.
Q: What will the facility look like?
A: While the design of the hospital is not yet finalized, the master plan establishes development standards like setbacks and height of facilities (see page 29). The building height is limited to a maximum of five stories/100 feet, and the building will be set back at least 75 feet along Steilacoom Boulevard and 100 feet along Sentinel Drive. The design will also feature good access to daylight and views, with built-in courtyards, to help establish a more therapeutic environment.
Q: What measures are being taken for patient and community safety?
A: The new 350-bed forensic hospital design and programs are being designed with a focus on creating therapeutic, safe environments. The hospital will be a fully locked facility, with staff controlling entrances and exits. Outdoors spaces for patients will be enclosed by fencing and buildings, as the new facility will take advantage of its three-story building perimeter to enclose outdoor courtyards. Staff will be trained in de-escalation strategies and emergency management processes to minimize calls to law enforcement and the fire department. The new hospital facility will be covered by new agreements similar to current WSH agreements with local law enforcement to provide assistance as needed.
Q: What is the timeline for this project?
A: Depending on when funding is allocated, the new hospital is slated for construction to be complete between 2027 and 2029. The design for the hospital should be complete in spring 2023, and construction should start in summer 2023.
Q: What is the process for public notification about this project?
A: The master plan had two comment periods. The first period ran from June 10 - July 10, 2020. Based on comments received in this period, the plan was revised and a second comment period ran from June 7 - July 9, 2021. The city of Lakewood also gave notice to all WSH neighbors within 1,000 feet of the property, reaching out more than three times the required distance to ensure even more community members were notified of the master plan. Finally, DSHS is scheduling community information sessions to address questions about the plan in person.
Q: How will traffic be affected by construction?
A: WSH will work with the City of Lakewood and the Historical Steilacoom School District to minimize negative traffic impacts created by the access and egress of construction vehicles. The City of Lakewood is working to make improvements to Steilacoom Boulevard independent of the WSH construction. DSHS will work with the city to ensure construction traffic does not impede these improvements to Steilacoom Boulevard, and to ensure any changes to entrances to WSH fit into city plans.
State hospital discharge frequently asked questions
Q: What types of patients are served at Western State Hospital?
A: We serve two forensic populations (competency evaluation/restoration and not guilty by reason of insanity) and long-term civil commitment patients.
Q: What are competency evaluation and restoration patients?
A: Competency evaluation/restoration patients are committed under RCW 10.77. They enter the hospital through the criminal court system. Competency is the ability of the person to understand and participate in the court processes. If it appears a person may be unable to do so due to mental illness, the court can order a competency evaluation. If patients are determined to be not competent, the court can order competency restoration treatment.
Q: Could you explain not guilty by reason of insanity?
A: A person who pleads not guilty by reason of insanity will be court ordered to have a competency evaluation and, if the court deems necessary, competency restoration treatment. The individual must be found competent to participate in their court process in order for the plea of not guilty by reason of insanity to move forward. If the court accepts the plea, the person can be ordered to receive treatment for the time they would have served for the crime, usually in a state hospital.
The person is provided treatment and as they recover, they are given opportunities to demonstrate increasing levels of independence, such as staff escorted community outings. These opportunities require a court order. As treatment and independence progress the person may be granted a court order that allows them to return to the community.
Q: What are short-term civil commitments?
A: To answer this, it is helpful to understand the civil commitment process. The civil commitment process begins in the community when someone is referred to a designated crisis responder. The criteria for civil commitment are that the person is determined to be an imminent danger to themselves or to others or meet the criteria for grave disability under RCW 71.05.
A designated crisis responder can commit a person for up to 120 hours. During this time, a professional will evaluate and help stabilize the person. After the 120 hours passes, the treating professional may petition the court for 14 days of involuntary commitment if the person continues to meet criteria for a civil commitment. The 14-day commitment usually occurs in a community evaluation and treatment facility.
Q: What are long-term civil commitments?
A: A long-term civil commitment occurs if the person still meets criteria for civil commitment after 14 days. At that point, the treating professional may petition the court for a 90-day commitment. This process repeats at the end of 90 days and the next petition would be for 180 days. These patients are treated either at a state psychiatric hospital (Western or Eastern State hospitals) or in community long-term civil commitment facilities. Treatment is provided until the person no longer meets civil commitment criteria.
Q: Where do Western State Hospital competency evaluation and restoration patients discharge?
A: About 85% of competency evaluation/restoration patients return to court to finish their legal processes. The court may sentence them, or the person might discharge from jail to the community. A small number of these people plead NGRI and return to the state hospital for treatment.
For those found not competent and not restorable, the court dismisses the charges (with or without prejudice). About 10% of them receive a court order for a civil commitment evaluation and subsequently, are court ordered a long-term civil commitment under RCW 71.05.280. These patients would go through the normal civil processes for discharge planning. The other 5% of individuals are released.
Q: What does dismissed with prejudice and dismissed without prejudice mean in relation to competency restoration patients?
A: Dismissed with prejudice means that the charges are dropped, and the prosecutor will not be refiling the charges.
Dismissed without prejudice means that the prosecutor may refile the charges after the person stabilizes under their civil commitment. The prosecutor is notified 30 days prior to the patient discharging from the hospital and determines whether charges will be refiled. If the prosecutor elects to refile, the discharge plan is stopped and the patient is typically returned to jail.
Q: Where do Western State Hospital not guilty by reason of insanity patients discharge?
A: An NGRI patient’s discharge is planned by the state hospital treatment team and the patient. Discharge plans are individualized and may include ongoing mental health treatment, medication management, substance use treatment, and medical care. NGRI patients usually release to their home county unless necessary resources are not available in that county. These are well-developed plans that consider community and patient safety.
The state hospital primary therapist is included in a transition team that supports the patient during their conditional release. Other members of the transition team are appointed by the court and may include a Department of Corrections Community Corrections Officer and the community behavioral health agency providing the behavioral health treatment. If an NGRI patient struggles to follow the court-ordered conditions of their conditional release, the court may rule that the person must return to the state hospital for inpatient treatment.
Q: Where do Western State Hospital civil patients discharge?
A: A civil commitment patient’s discharge is planned by the state hospital treatment team, the assigned managed care organization or behavioral health administrative services organization, and the patient. Discharge plans are individualized and may include ongoing mental health treatment, medication management, substance use treatment, and medical care. Discharge planning begins in their home county unless necessary resources are not available in that county or the person requests to relocate to a new county. These are well-developed plans that consider community and patient safety.
Civil patients may discharge on a less restrictive alternative court order with conditions they must follow to continue treatment in the community. They may also be released on a conditional release, which includes rules for ongoing treatment for the remainder of their 90 or 180-day order.
Q: Where do you discharge sex offenders and other high-risk patients?
A: We serve anyone who receives a court order for forensic or long-term civil treatment when they are ordered to a state hospital or facility. That may include a person who must register as a sex offender upon discharge from the state hospital, while others may have committed violent offenses. We use the same thorough discharge planning strategies as listed above that take into consideration behavioral health stability and community and patient safety.
The discharge planning begins in the home community but is dependent on ensuring the person has the right type of services and settings available to them. As in all cases, other communities that have those resources may be explored. A person who is integrated back into the community with the proper supports and services is less likely to decompensate and reoffend.
HB1114 civil commitment and discharge planning frequently asked questions
Q: I’ve heard there is a patient population referred to as “HB1114.” What does that mean?
A: Engrossed Substitute House Bill 1114 was signed into law in 2013, creating new criteria for civil commitment of patients who had previously received a competency evaluation and restoration services and were found not competent and not restorable.
After that determination is made, the court is able to order a civil commitment evaluation to determine if a person meets criteria for commitment under RCW 71.05.280. The hospital can then petition for civil commitment. We refer to most of these people as “civil conversion” patients.
In cases where a person has committed a serious violent felony as defined in RCW 9.94A.030, the court can make a special finding of violent felony and use the commitment criteria established under HB1114, which states that the person may be detained based on substantial likelihood of committing similar offenses (RCW 71.05.280 (3)(b)).
Q: What does “not restorable” mean?
A: Competency is in reference to a person’s ability to participate in the court process. “Not restorable” means that after competency restoration treatment, the person has not had their competency restored and it is not expected to be able to be restored.
Q: What did the legislature intend to happen with the passage of HB1114?
A: The legislative intent provided in the bill includes the following information:
- Finds small number of individuals that commit repeated violent acts while suffering the effects of mental illness or developmental disability
- In these cases the mental illness or developmental disability contributes to a person’s illegal behaviors while also rending them legally incompetent to be held accountable for the crimes
- Both incarceration and NGRI are unavailable (as they would need to be competent to participate in the court process)
- Civil short-term commitments are insufficient to protect the public
Q: How is this similar to or different from other civil patients or patients adjudicated as not guilty by reason of insanity?
A: Most civil commitments under RCW 71.05.280 are based on likelihood of causing serious harm or grave disability. For the Special Finding of Violent Felony population, they would be detained based on likelihood of committing acts similar to the initial offense.
The NGRI patients have had their competency restored, completed their court process, pleaded NGRI and were adjudicated.
Q: What are short-term civil commitments?
A: To answer this, it is helpful to understand the civil commitment process. The civil commitment process begins in the community when someone is referred to a designated crisis responder. The criteria for the initial civil commitment is that the person has been determined to be an imminent danger to themselves, to others or meets the criteria for grave disability under RCW 71.05.
The DCR can commit the person for up to 120 hours — during which a professional will evaluate and help the person stabilize. After 120 hours passes, the treating professional may petition the court for 14 days of involuntary commitment if the person continues to meet civil commitment criteria. The 14-day commitment usually occurs in a community evaluation and treatment facility. These initial detentions are considered short-term civil commitments.
Q: What are long-term civil commitments?
A: Long-term civil commitments occur if the person still meets criteria for civil commitment after 14 days. At that point, the treating professional may petition the court for a 90-day commitment. This process repeats at the end of 90 days and the subsequent petition would be for 180 days. These patients are treated either at a state psychiatric hospital (Western or Eastern state hospital) or in a community long-term civil commitment facility. Treatment is provided until the person no longer meets civil commitment criteria.
Q. Where do Western State Hospital competency evaluation and restoration patients discharge?
A: About 85% of competency evaluation/restoration patients return to court to finish their court processes. The court may sentence them, or the person might discharge from jail to the community. A small number of these plead NGRI and are returned to the state hospital for treatment or could be released from jail on a conditional release to community living.
For people found not competent and not restorable, the court dismisses the charges (with or without prejudice). About 10% of them receive a court order for a civil commitment evaluation and subsequently are court ordered for long-term civil commitment. These patients would go through the normal civil processes for discharge planning. The other 5% of people are released directly to the community.
Q: What do “dismissed with prejudice” and “dismissed without prejudice” mean in relation to competency restoration patients?
A: Dismissed with prejudice means that the charges are dropped, and the prosecutor cannot refile the charges.
Dismissed without prejudice means that the prosecutor may refile the charges once the person stabilizes under their civil commitment. The prosecutor is notified 30 days prior to the patient discharging from the hospital and determines whether they will refile. If they elect to refile, discharge planning terminates and the patient is returned to jail.
Q. Where do Western State Hospital not guilty by reason of insanity patients discharge?
A: NGRI patient discharges are planned by the state hospital treatment team, community partners and the patient. Discharge plans are individualized and may include ongoing mental health treatment, medication management, substance use treatment, and medical care, as needed. These are well-developed, thorough plans that consider community and patient safety.
Additionally, a hospital staff member is included in a transition team that supports the patient during their conditional release. The transition team also include a Department of Corrections community corrections officer and the behavioral health agency providing the behavioral health treatment, unless court omits either or both as part of the transition team. If an NGRI patient struggles to follow the court-ordered conditions of their conditional release, the transition team may determine to return the person to the state hospital and the court may modify or revoke the conditional release and require inpatient treatment.
Q. Where do Western State Hospital civil patients discharge?
A: Civil commitment patient discharges are planned by the state hospital treatment team, the assigned managed care organization or behavioral health administrative services organization, and the patient, their legal representative and/or their support system. Discharge plans are individualized and may include ongoing mental health treatment, medication management, substance use treatment, and medical care. Discharge planning begins in the patient’s home county unless necessary resources are not available in that county or the person requests to relocate to a new county. These are well-developed, thorough plans that consider community and patient safety.