OLYMPIA – Lawmakers have come up with dozens of ways to fix Washington’s failing mental health care system, including better services at county jails and psychiatric hospitals and a housing program that could keep some people off the streets. But those policies will amount to little without adequate funding.
Courts have ordered the state to make vast improvements in many areas of its mental health care system.
“The state of Washington is violating the constitutional rights of some of its most vulnerable citizens,” U.S. District Court Judge Marsha Pechman wrote in an April 2 decision involving mentally ill defendants who were kept in solitary confinement for more than a month.
Other lawsuits involve severe overcrowding, or “warehousing,” at Eastern and Western state psychiatric hospitals. Legal rights advocates have raised concerns about forcing more patients into an overburdened system that can’t provide proper care.
Among the key legislation debated in the regular session was a bill to require faster competency evaluations for jailed defendants awaiting trial, another to provide smoother transitions into involuntary treatment and a third to create options for comfortable housing that would make treatment less restrictive.
The court rulings follow the period between 2009 and 2013, when the state slashed $90 million from the mental health care system as state officials struggled to balance budgets during the recession. The House and Senate added about $100 million and $90 million, respectively, to their 2015-17 budget proposals but still are working to reconcile the differences as the legislative session goes into overtime.
“It’s hard to say how much progress has been made before we pass a budget,” said Rep. Laurie Jinkins, D-Tacoma.
Friends, family could seek involuntary treatment
Last month, both chambers approved a proposal called Joel’s Law, which, if signed by Gov. Jay Inslee, would enable friends and family to petition courts for a person’s involuntary psychiatric treatment.
Under state law, someone who presents a physical threat or is “gravely disabled” by mental illness can be detained for treatment without the person’s consent. But if experts say the person is stable, courts can’t order involuntary treatment, even if friends and family say the person poses a threat.
Joel’s Law would require a judge to review a person’s psychiatric history and nurse evaluations if friends or family believe the person needs treatment. The judge could then order another evaluation or place that person in treatment.
Joel Reuter, for whom the proposal is named, was fatally shot during an armed standoff with Seattle police in 2013. He was diagnosed with severe bipolar disorder, and his parents had tried for weeks to have him committed to a psychiatric hospital. Testifying in Olympia, Doug and Nancy Reuter said involuntary treatment could have saved their son’s life.
Law enforcement could get experts’ opinion
Another proposal, called Sheena and Chris Henderson’s Law, would allow law enforcement officers to get mental health experts involved more quickly when they encounter someone who appears suicidal or mentally ill. It’s named after the couple killed in a murder-suicide last July at Deaconess Hospital in Spokane. A separate bill stemming from the same incident resulted in a new law involving gun notification.
The shooter in that incident, Chris Henderson, was evaluated as a suicide risk by sheriff’s deputies less than 24 hours before he killed his wife and himself.
Under this proposal, officers could alert mental health professionals when someone raises safety concerns. Even if a person doesn’t meet the criteria for placement in protective custody, officers could mention concerns in their incident reports. Agencies would have 48 hours to send those reports to a designated health care facility.
The proposal passed the House but didn’t get a vote in the Senate. It was sent back to the House and could come to a floor vote in the special session.
Housing, freedom could help treatment
In giving feedback to legislators this session, mental health experts agreed the state should be more proactive in treating people with mental illness – before they end up in crisis situations.
One proposal, awaiting Inslee’s signature, would create an outpatient treatment program in which patients receive housing if they participate in therapy and take prescribed medications. The goal is to allow patients to heal by interacting within their communities.
“It stabilizes them,” said Jinkins, the state representative from Tacoma, who sponsored the legislation. “It stops them from getting to a place where they’re a threat to themselves or others.”
Patients would live in 16-bed care facilities and would be assigned a case manager who would create tailored treatment plans. The program would be involuntary, but patients would be allowed to come and go from the facility as they please. Similar programs in New York and California have been shown to alleviate crowding in psychiatric wards.
“What they found is that access to housing was more effective than access to medication,” Jinkins said.
Patients, not prisoners
When Pechman, the federal judge, issued an injunction last month against the state for failing to provide timely court-ordered competency evaluations, she cited several cases in which mentally ill defendants deteriorated while in solitary confinement.
Under state law, the Department of Social and Health Services has seven days to evaluate defendants to see if they’re mentally able to appear in court. But due to a severe shortage of nurses, that deadline is rarely met. At Eastern State Hospital in Medical Lake the average wait time for competency evaluations was 50 days in the third quarter of 2014, according to a state study.
“Jails are not hospitals, they are not designed as therapeutic environments, and they are not equipped to manage mental illness or keep those with mental illness from being victimized by the general population of inmates,” Pechman said.
Inslee signed a bill allowing a seven-day extension on wait times, for a total of 14 days, when DSHS is short on resources. The state House of Representatives and Senate want to spend $27 million and $29.8 million, respectively, for competency evaluation beds, staff and programs. Both plans call for 45 new beds at Western State Hospital in Lakewood and 15 new beds at Eastern State.
It’s unclear whether that will satisfy the courts. Pechman gave the state nine months to fix the problem and appointed a monitor to oversee the process. House Democratic Leader Pat Sullivan said legislators will need to address the ruling in the special session, as they resume heated budget negotiations.