Tim Osborn: Long struggle for mental health system

Our state’s system of treating mental illness has been in the news, and not in a good way. It needs help – short term and long term. It is our shame and our opportunity.

Short term, Western State Hospital is constantly teetering on the brink of federal decertification. Washington’s population has grown by over 500,000 since 2008, but according to state figures, Western State’s staffing has decreased by 393 during that time, and 120 beds have been eliminated.

Hospital staff compensation is significantly less than comparable positions, and there are serious issues with how state hospitals are managed. Department of Social and Health Services officials have been hauled into court for violating criminal defendants’ civil rights by allowing mentally ill people to languish untreated in jail for weeks or months, instead of going to a state hospital for competency evaluation and restoration.

Gov. Jay Inslee and the state Legislature have agreed on certain bills to address some of the most urgently needed improvements to Western State’s problems, but the fate of all bills is in limbo, pending resolution of the budget. The governor requested $250,000 to develop a long-term plan to evaluate if “our state hospital system is built correctly,” and to bring in a national expert to improve hospital performance and partner with the University of Washington to implement a psychiatric residency program. There are only 650 psychiatrists in the entire state, most in the Seattle area.

Fundamental changes are needed. For example, we rely on someone who is psychotic and delusional to voluntarily seek treatment, even though a symptom of the very illness they need treated is the inability to recognize the existence of illness (“anosognosia”). Hence, the refusal to seek or agree to treatment.

It is only when one is an imminent danger to themselves or others or “gravely disabled” that limited treatment can be required. And those standards are strictly enforced. The welfare of the individual is not considered. Jobs, housing and friends are lost. Like other illnesses, mental illness gets worse untreated.

Many people suffering from a mental illness use drugs or alcohol to self-medicate, a “dual diagnosis” that exacerbates their illness. It’s not until crisis or tragedy, often involving law enforcement, that anything changes – usually not for the better (mentally ill people are about nine times as likely to be the victims of violence rather than perpetrators). Hence, our jails, prisons and streets become the destinations of “last resort” for people with untreated mental illness.

The individual may then end up in the criminal justice system, a system singularly unsuited to treat disease. It is the criminalization of an illness, with a high cost for the taxpayer and a poor outcome for the person.

There are many good people trying to make a difference within the confines of our flawed system. The National Alliance on Mental Illness, Washington chapter is in the process of creating a comprehensive plan for mental health in our state, with a focus on effectiveness and accountability as keys to recovery.

Changes in our laws, more and better managed facilities, more professionals, proven, innovative community approaches and training of first responders are all within our ability. Mental illness is treatable and recovery is possible.

Tim Osborn is president of the National Alliance on Mental Illness, Washington chapter.