18 MONTHS: $22 MILLION?

The changes now postponed until 2015 would have added up to an extra 2,700 short-term commitments a year, on top of the 7,500 in 2009, according to the study by the Washington State Institute for Public Policy. That would require up to 168 more short-term beds across the state and up to 25 beds at Western and Eastern state hospitals.

One estimate had put the cost to the main state budget at $22 million for the first year and a half.

The Washington chapter of the National Alliance on Mental Illness advocacy group disputes the state cost estimates as too large, and wants to implement the changes sooner. So do lawmakers such as Democratic Rep. Tami Green, whose district includes Western State.

“We’re seeing heavier and heavier demand for services with nothing for people to go to unless they’re in crisis,” said Sandi Ando, chairwoman of NAMI Washington’s public policy committee.

PAYING FOR THE EXTRA BEDS

Lawmakers like Green and Puyallup Rep. Dawn Morrell, who chairs a panel on human-services funding, see an opportunity in new federal money that is about to flow to Washington if their fellow Democrats have their way.

Many previously ineligible psychiatric patients will suddenly be eligible for Medicaid health insurance if the Legislature decides to accept the funding in President Barack Obama’s health law. But the strings attached to the funding worry many Republicans, including responsibility for matching a fraction of the money in the future.

That funding would free up state money going to the same patients now. Depending on decisions legislators make, the two-year savings for mental health could top $60 million, the Legislature’s staff estimates.

“The fight is going to be: I’m going to want to keep that $60 million in mental health, and other people are probably going to want it to go other places,” Green said.

In her final budget proposal before leaving office, Gregoire proposed devoting about $52 million in new state and federal funding to mental health. She called for getting ready for the 2015 rules by restoring two 30-bed state-hospital wards and opening several new facilities, including three 16-bed facilities for mental evaluations and short-term commitments, and 42 beds spread among multiple small facilities that would be alternatives or follow-ups to hospital commitment.

The Legislature long ago authorized, but never funded, those alternative sites.

Gregoire’s successor, Democrat Jay Inslee, is developing his own budget plan. Health officials in his administration’s Department of Social and Health Services are rethinking the call for new wards, they told lawmakers at a briefing Wednesday, considering responding to the increased need with more outpatient treatment instead.

Similarly, Cheri Dolezal, director of the mental-health network that serves Pierce County — one of 11 throughout the state but the only one run by a private company, Minnesota-based OptumHealth — told lawmakers Wednesday that they should spend money on alternatives to involuntary commitments. She said her network would like another triage unit like the one it operates in Fife that mostly serves voluntary patients.

Green wants to focus on outpatient care that doesn’t require more hospital beds, but does involve detaining potentially dangerous patients. She calls for creating a new category of court-ordered care, this one for outpatient treatment and modeled on those of other states including New York, whose so-called Kendra’s Law is named for a woman who was pushed to her death in front of a subway train.