Housekeeping in Washington State Behavioral Health Facilities: A Historical and Safety-Oriented Perspective

1850s–1880s – County Care and Institutional Origins

In the mid-19th century, mental health care in Washington Territory was rudimentary at best. Counties bore the responsibility of supporting residents labeled as “insane,” typically housing them in county jails, poorhouses, or even private residences. These makeshift accommodations were generally unsafe, overcrowded, and unsanitary. No designated spaces existed for those experiencing mental illness, and as a result, hygiene was deprioritized.

By 1871, counties began sending individuals to Monticello for evaluation. Some were institutionalized at the Washington Territorial Asylum, later renamed Western State Hospital. During this early period, no formal cleaning standards were enforced. Institutional cleaning often relied on patients themselves, who performed chores with minimal oversight. This practice resulted in persistent filth, infection risks, and an environment of neglect. Housekeeping staff, if present at all, were untrained and largely unsupported, working in unhygienic and dangerous conditions.

1890s–1910s – Institutionalization and Unsafe Labor Conditions

The transition from decentralized county care to state-run psychiatric institutions began in 1875, culminating in the opening of the Fort Steilacoom asylum in 1878. By 1891, Washington established two main hospitals—Western and Eastern State Hospitals. These institutions quickly became overcrowded and neglected. Cleaning was still primarily done by patients, often under duress or as a condition of their confinement. They had little access to proper tools, protective gear, or supervision.

At this time, housekeeping was not recognized as a specialized or professional role. There were no infection control policies, no safety training, and no consideration of chemical exposure or physical risks. Aesthetic appearance took precedence over sanitation, and the safety of patients and workers alike was compromised. Reports from this era include accounts of physical abuse, escapes, and even deaths linked to poor conditions.

1920s–1940s – Expansion of State Hospitals and Harsh Institutional Environments

Washington’s state hospitals grew rapidly between the 1920s and 1940s. By 1930, Western and Eastern State Hospitals housed thousands of patients, many of whom lived in appalling conditions. Despite the increased scale, there was no corresponding improvement in cleaning practices or worker protections. Institutional housekeeping remained a custodial function assigned to patients or underpaid staff without training.

Cleaning methods focused on visible tidiness rather than microbial safety. Chemical use was unregulated, and tools were rudimentary. Staff and patients were exposed to pathogens, toxic substances, and unsafe physical environments. There were no systems for reporting workplace injuries or exposures. Institutional goals prioritized containment over care, and the human dignity of workers and residents was largely ignored.

1950s–1960s – Deinstitutionalization and Fragmented Care Models

Federal initiatives like the 1946 National Mental Health Act and the 1963 Community Mental Health Act catalyzed deinstitutionalization. Many long-term patients were released into the community with minimal support systems, while inpatient facilities like Western State Hospital remained overcrowded. Although the population in institutions began to decline, cleaning practices stagnated.

Housekeepers, often underpaid and minimally trained, continued to work without adequate protection. At newly emerging community mental health centers, cleaning routines were improvised and poorly regulated. Personal protective equipment (PPE) was rarely available. No standardized protocols for infection control, chemical safety, or worker training existed, leaving housekeepers vulnerable to illness, injury, and violence.

1970s–1980s – Beginnings of Regulation and the Rise of Community-Based Care

The emergence of outpatient services in the 1970s led to the proliferation of community clinics, mobile crisis units, and day treatment programs. The Washington State Department of Social and Health Services (DSHS) began to impose basic safety and sanitation standards. These included minimal PPE use (e.g., gloves) and rudimentary cleaning policies.

However, enforcement was inconsistent, and resources were limited. Custodial roles remained largely un-professionalized. Many cleaning staff were low-wage workers with no formal training, and turnover was high. The lack of institutional support translated into frequent exposure to hazardous environments. While some facilities attempted to adopt better practices, overall change was slow and sporadic.

1990s – Accreditation, Oversight, and Formal Training

In the 1990s, regulatory agencies such as The Joint Commission began enforcing national safety and infection control standards for behavioral health facilities. Accreditation now required documentation of housekeeping procedures, chemical handling protocols, and incident response plans.

Cleaning roles became more professionalized. Housekeeping staff began receiving training in bloodborne pathogen exposure, chemical safety, and ergonomic practices. Color-coded systems helped prevent cross-contamination, and safer cleaning chemicals were introduced. Equipment was modernized to reduce strain and risk of injury. These reforms marked the beginning of a systemic shift toward protecting housekeeping staff and elevating their role in patient care environments.

2000s – Standardization and Evidence-Based Sanitation Practices

The early 2000s saw a move toward evidence-based protocols across behavioral health environments. Cleaning procedures became standardized across inpatient and outpatient settings, aligning with broader healthcare standards. EPA-registered disinfectants, microfiber cleaning technology, and routine audits became commonplace.

Training expanded to cover proper PPE usage, hazard recognition, and environmental hygiene. Facilities implemented regular performance reviews, tracked supply usage, and maintained documentation of exposure incidents. Even community mental health centers began adopting hospital-grade sanitation policies. However, underfunding in some public facilities continued to challenge compliance.

2010s – Workplace Violence Prevention and Trauma-Informed Cleaning

By the 2010s, rising reports of workplace violence prompted major safety reforms. Housekeeping staff were trained not just in cleaning protocols, but also in de-escalation strategies and trauma-informed care. Psychiatric Emergency Response Teams (PERTs) were created to handle crisis situations, and housekeepers were included in safety drills and emergency planning.

Facilities developed violence prevention plans, conducted risk assessments, and documented staff injuries and exposure incidents. For the first time, the psychological safety of cleaning staff was formally recognized. Training curricula now included behavioral cues, personal safety tactics, and respectful interactions with residents experiencing psychiatric crises.

2020s – COVID-19, Innovation, and Long-Term Transformation

The COVID-19 pandemic drastically altered the landscape of behavioral health facility sanitation. High-touch surfaces were disinfected multiple times daily, and EPA-approved cleaning agents were widely used. Electrostatic sprayers and ultraviolet light disinfection became standard in many inpatient settings.

PPE protocols became stringent, with routine training in donning, doffing, and hygiene procedures. Facilities improved ventilation systems and began using detailed cleaning logs and checklists. The Washington State Department of Health released specific technical guidance to ensure chemical safety and air quality during disinfection.

Though burdensome, the pandemic accelerated innovation and raised the profile of housekeeping work. Many of these heightened protocols have remained in place, fundamentally reshaping expectations for health and safety in both inpatient and outpatient behavioral health facilities.

Facility Types in Washington State

Washington has developed a diverse network of behavioral health facilities:

            •           State Psychiatric Hospitals: Large institutions like Western and Eastern State Hospitals provide long-term inpatient psychiatric care, often with comprehensive cleaning and safety protocols due to accreditation requirements.

            •           Private Psychiatric Hospitals: Smaller facilities with variable levels of oversight and compliance, depending on funding and organizational standards.

            •           Community Mental Health Centers: Emerging in the 1960s, these provide outpatient services, crisis stabilization, and short-term care, often in underfunded environments that may struggle with sanitation standards.

            •           Outpatient Clinics: Linked to hospitals or nonprofits, these offer therapy, medication management, and supportive services. Cleaning standards can vary widely based on provider resources and facility management.

Cleaning Workforce Evolution and Safety Reforms

Historically marginalized and underpaid, the housekeeping workforce has undergone a profound transformation. The role has shifted from one of invisible custodial labor to a critical component of patient care and safety. Today’s housekeepers in behavioral health settings are trained professionals equipped with the knowledge and tools to prevent infection, manage chemical risks, and maintain therapeutic environments.

Regulations now require documented training in PPE, chemical use, and emergency protocols. Staff are educated in trauma-informed approaches, workplace violence prevention, and ergonomic practices. The recognition of housekeeping as a vital support service has increased, though disparities remain based on funding, oversight, and facility type.

References (APA 7th Edition)

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