Betty Wright knew her son was “seriously mentally ill.” Yet no one would listen to her. (Due to the sensitivity of the medical history involved, she asked Real Change to use a pseudonym.)
Wright took her son to a psychologist who said he was fine. She took him to a hospital; the institution released him, and he spent a week living on the street. She got her ex-husband to come to Eastern Washington and get a motel room for himself and their son. After arriving, her ex stashed their son in the motel and came over to tell Wright that everything was OK.
Meanwhile her 23-year-old son began to have delusions that white slavers were trying to kidnap his girlfriend. He punched out all the windows in the motel room, went outside to the sidewalk, slashed his wrists and lay down to die. Wright called an ambulance, and her son was taken to a psychiatric hospital.
In one of the next emergencies, Wright wasn’t so lucky. She said her son “was seriously delusional. He was really paranoid.”
Wright got him admitted to the emergency room of a local general hospital. Once admitted, he stayed in the ER for 36 hours because there were no vacancies at local psychiatric hospitals. In short, there was nowhere for him to go. He got no treatment, he could not have visitors and he could have walked out at any time.
“We could have lost him,” said Wright.
Due to a recent state supreme court decision that mandated how mentally ill people in crisis should be treated, the issue has moved center stage for legislators, mental health professionals, patients and their families.
In Washington, people with mental illness who are a threat to themselves or others, or lack the capacity to take care of themselves, can be confined against their will.
Too often in the past, they ended up in jail, prison or the ERs of general hospitals, said Sandi Ando, public policy committee chair of the National Alliance on Mental Illness, Washington (NAMI).
When mentally ill people are confined to ERs it is called “psychiatric boarding” or “warehousing.”
But Ando said that psychiatric boarding isn’t a healthy solution. In order to get better, patients need treatment in a psychiatric hospital, she said.
The Seattle Times reported that from October 2012 to October 2013, 4,566 mental-health patients were boarded in Washington. Sometimes, mentally ill people in ERs are tied to hospital gurneys or beds, said Ando.
Psychiatric boarding, she said, “is a symptom of the lack of capacity in the mental-health system.”
On Aug. 7, the Washington State Supreme Court unanimously declared psychiatric boarding unconstitutional. “Patients may not be warehoused without treatment because of lack of funds,” wrote Justice Stephen Gonzalez for the court. Subsequently, the court ruled that state and local governments and hospitals must end psychiatric boarding entirely by Dec. 26.
The big question is how.
“We need a whole continuum of services,” said Ando. “There is no substitute for creating and maintaining a proper [mental-health] system.”
Ando said more community based treatment is needed in order to prevent mentally ill people from having emergencies. She advocates for day treatment that includes making sure people are taking their medication.
“We have to step up and come to them,” she said.
State Rep. Ross Hunter, D-Medina, said another solution to boarding
is to add more beds to the public psychiatric hospitals like Western State Hospital near Tacoma and Eastern State Hospital near Spokane.
More beds could also be rented at private psychiatric hospitals such as Seattle’s Navos and Kirkland’s Fairfax Hospital.
“We have to fund this,” said Hunter, chair of the House Appropriations Committee.
But the cost could be a sticking point.
Hunter said the Washington State Department of Social and Health Services (DSHS) has asked for $300 million for improvements to the mental health system over the next two years. A DSHS spokesperson said, “We are not ready to discuss dollar amounts at this point.”
Hunter said, “You have to put [mentally ill people] in some place where they can get treatment.”
Ando agreed. “Mental illness does not go away simply because you ignore it. [Legislators] are going to have to pay the piper,” she said.
To find the money, legislators may have to overcome party divisions.
“Three hundred million dollars, when money is tight, that’s a lot of money,” said Chris Vance, former chair of the Washington State Republican Party. Vance said he hadn’t spoken to Republican senators about funding mental health specifically. “The only thing you can count on is no new taxes,” said Vance. “Senate Republicans are not going to support new revenue.”
State Sen. Karen Keiser, D-Des Moines, ranking Democrat on the Senate’s Ways and Means Committee, said Republicans are keeping their “no new taxes” refrain. “I’m not sure how all this is going to pass,” said Keiser.
Wright cannot believe that the state legislature might balk at funding mental-health treatment. “Everybody who has any kind of conscience should be absolutely incensed,” said Wright. “No one chooses to have mental illness.”