For lawmakers who thought the next legislative session would be all about satisfying the McCleary mandate on education funding, the Supreme Court gave them another big-ticket item to consider: mental health care.
In a unanimous decision announced Thursday, the court cracked down on “warehousing” mental health patients at hospital emergency departments while seeking involuntary commitment orders. The practice is known as “psychological boarding,” and it occurs nationwide. It’s one of the symptoms of a national health care system that gives mental illness short shrift.
In this particular case involving Pierce County patients, the court ruled against the Department of Social and Health Services, which argued that boarding was in accordance with the state’s Involuntary Commitment Act. The state said the law allowed boarding when there’s no room to be found at mental health institutions for people who may be a danger to themselves or others.
In practice, state or county authorities would ask Western State Hospital for permission to board a patient at a hospital not certified for mental health care. From 2007 to 2013, the number of requests rose from 1,221 to 3,412, according to a Seattle Times investigation.
But the court determined this permission would be granted “without knowing whether there was a medical justification for involuntarily detaining that individual patient outside of a certified facility.” In addition, there was no follow-up from Western officials to see how patients were doing.
The court also pointed out that the law requires mental health treatment for detained patients as they wait for judges to decide on whether they should be committed. But as an attorney for two Pierce County hospitals told the court, “We have no psychiatrists. We have no psychiatric nurses. We have no orderlies. We have no ability to provide any of the treatment that is mandated under the statute.”
Instead, psychiatric patients are confined in hospital rooms – sometimes chained to beds – and left to linger for days at a time.
Boarding has become widespread, due in part to the fact that Washington ranked 47th in the number of psychiatric treatment beds per capita. The feds are also to blame, because a misguided Medicaid rule excludes some mental health facilities from eligibility for reimbursement.
It’s not as simple as blaming DSHS and the counties, because there aren’t any good options when psychiatric beds are full and you’re dealing with a highly volatile person. DSHS and health care officials have warned the Legislature that there aren’t enough beds. Hospital and medical associations filed briefs in the case in favor of ending the practice.
So now what? Release seriously unstable people to the streets? It’s a question officials will have to answer fast because the court ruled that a lack of money from the Legislature is no excuse for boarding.
This issue should’ve been resolved before lawmakers passed the Involuntary Commitment Act. Now they’ll have a second chance to fund the bill, whether they like it or not.