New rules set for ‘boarding’ psychiatric patients

SEATTLE – Washington’s Department of Social and Health Services said it complied with a Friday deadline set by the state Supreme Court to stop “warehousing” mentally ill people in emergency rooms and hospitals just because certified treatment facilities are already full.

“We are meeting the Supreme Court’s decision,” said Jane Beyer, the department’s assistant secretary.

The state’s involuntary treatment act allows counties to briefly detain people who present an imminent risk of harm for the purpose of evaluation and treatment.

But without an adequate number of beds available in certified facilities, the state had been keeping people in regular hospitals or emergency rooms without treatment while waiting for space to open up. The average length of such stays was about three days, according to the state.

The high court struck down that practice, called “psychiatric boarding,” in August. It gave the state until Friday to comply.

In response to the ruling, Gov. Jay Inslee authorized the spending of as much as $30 million, and Washington added 140 evaluation and treatment beds to its mental health system in private psychiatric hospitals, community hospitals, and free- standing evaluation and treatment facilities.

Thanks to those additional beds, as well as work by “regional support networks” responsible for local planning for inpatient psychiatric care, as of last week only three patients statewide were being “boarded” because of a lack of beds in certified facilities, the department said. That was down from 47 in October and 36 in November.

Inslee has also included an additional outlay of more than $37 million in his two-year budget proposal to address the issue, sustaining the increased number of treatment beds and opening a 30-bed civil ward at Western State Hospital.

As of Friday, the state could no longer approve the placement of patients at noncertified facilities just because there was no space at certified ones. Psychiatric patients, however, can continue to be held involuntarily at noncertified facilities under certain conditions, such as if they have a complex medical problem that also requires treatment, or if they’re getting the psychiatric care they need while at the hospital.

Under rules that took effect Friday, noncertified hospitals that offer a bed for a psychiatric patient must state that they’re willing and able to care for the patient, set up a mental health treatment plan and provide a mental health professional to see the patient daily.