August 27, 2014
Vol: 21 No: 35

Community & Editorial

Recent state court ruling means people who have mental illness will get better treatment

By Mike DeFelice / Guest Writer. Edited By Rosette Royale / Interim Editor

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This piece was updated by staff to reflect changes to the law after the story went to print.

A deplorable practice in Washington is on its way out, thanks to the state supreme court.

In a unanimous decision handed down on Aug. 7, the high court ruled that “psychiatric boarding” —the practice of housing people in need of involuntary psychiatric treatment in a community hospital, where staff are neither trained nor equipped to treat such patients — violated the state’s Involuntary Treatment Act (ITA).

Instead, the court noted, such individuals should be placed in certified mental health facilities where they can get appropriate and individualized treatment. Boarding occurs when the beds at certified mental health facilities are full, an unfortunately common scenario in our state’s underfunded mental health system. 

The court decision was to become final Aug. 27, but a motion to stay, or delay, the decision, was made. The high court is expected to consider that request Sept. 4.

Declaring this practice a violation of the ITA was a bold move for the court. And it’s been greeted by those of us who advocate on behalf of people facing potential involuntary commitment with both enthusiasm and relief. The reason is because many of our clients were experiencing what amounted to a dirty double-cross: They lost their liberty when committed against their will, only to be placed in a hospital ill-equipped to meet their needs.

The practice, in a nutshell, unfolded like this: Once a county designated mental health professional determined an individual met the legal criteria to be detained as a danger to himself or others, the person was put on an involuntary hold so a court could later determine if longer involuntary mental health treatment was needed. If no mental health facility beds were available, clients landed in community hospitals, sometimes strapped to a bed in a windowless room for days and forced to take powerful antipsychotic medications. In the most egregious cases, patients “decompensated” as a result — in other words, they grew more delusional or psychotic.

This horrible situation was not due to indifference of hospital staff or county employees. Many of them have also expressed dismay over the way their hospitals were warehousing people in need of treatment. The situation grew out of the legislature’s failure over the years to adequately fund the state’s mental health system. In short, we simply don’t have enough beds in mental health facilities to treat people with mental illness.

Even before this ruling, many in King County knew this practice had to end. In fact, County Executive Dow Constantine and county staff were already working with a range of partners to find solutions when the state’s supreme court issued its ruling. The good news is that we now have the force of a high court decision behind us.

In the weeks since the Aug. 7 decision, county officials have responded appropriately, working quickly to line up additional beds. Discussions among the various players in the system — from mental health officials to prosecutors to public defenders — continue to take place in an effort to find some immediate and short-term solutions. But more important, the focus is now expected to shift to Olympia, where state and local officials will have to work with lawmakers to address a situation they’ve ignored for far too long. My hope is that in the process of addressing our overburdened civil commitment system, we begin to think more creatively about how to help people with mental illness. And one significant way happens to also be the most cost-effective: boosting community-based treatment resources so that county mental health officials can turn to less restrictive alternatives rather than to inpatient treatment.

To be successful, some of those placed in community-based programs will have to be monitored. In such cases, courts will also have to balance the individual’s due process rights with community concerns to place a person in a community setting. But if done correctly, community-based treatment is a win-win. It’s less costly. It’s often highly effective. And it’s far less disruptive to an individual’s life.

In any crisis comes opportunity. And so it is with this. If we’re smart, we’ll use this crisis to take what is now considered one of the most underfunded systems in the country and turn it into one of the best. Thanks to the court, we’ve ended psychiatric boarding. Now, let’s build a system that is a national model and that gives some of our most vulnerable residents the help they need.




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