Guest: How to help patients after the end of psychiatric boarding
How to get mental-health patients the care they need after the state Supreme Court ruled the practice of psychiatric boarding is illegal, according to guest columnist Cassandra Ando
Special to The Times
The discussion on mental health continues this week. Look for:
Thursday: Join a video chat at: seati.ms/mental-health-video-chat
See entire series at: seati.ms/opinion-mental-health
IT is long past time to begin treating those among us who have mental illnesses compassionately and responsibly. In the wake of the Washington Supreme Court’s ruling that our current boarding practices are illegal, it is no longer possible to ignore the lack of system capacity that created that situation.
Boarding is a Band-Aid approach to handling the appalling inadequacy of the mental-health system in Washington. It is the practice of temporarily placing individuals with mental illnesses who have been detained under the Involuntary Treatment Act in hospital beds that are not in psychiatric units.
Those who are boarded receive little or no psychiatric care and often languish for long periods of time before getting necessary treatment. In this opinion, the Supreme Court held that patients “may not be warehoused without treatment because of lack of funds.”
The crisis-driven, fragmented mental-illness system was insufficient in 1963 when the federal Community Mental Health Act began moving people out of mental-health facilities with the now-defaulted promise of funding for community-based services to accommodate their needs. It resulted in a large homelessness population, overutilized emergency services, a dearth of mental-health beds, and jails and prisons that are de facto mental-health facilities.
Unless Washington state finds ways to provide additional appropriate places to treat people committed for psychiatric care, this already dire situation might be further exacerbated because patients can no longer be boarded until an appropriate bed opens up.
This should concern all Washington citizens because more than a quarter of all adults have a diagnosable mental illness and 6 to 9 percent have serious mental illnesses such as bipolar disorder, schizophrenia or severe depression. So people with mental illnesses are not some amorphous “other” — they are our family members, friends, neighbors, co-workers, employers or acquaintances. Failure to provide them proper and timely care is a serious breach of social responsibility that touches all of us.
The Supreme Court’s opinion puts the responsibility squarely on the state to provide appropriate treatment in appropriate facilities for people detained for involuntary mental-health treatment. Because the infrastructure of our state’s mental-health system has been so long neglected and even further decimated by budget cuts across the years, curing its faults would require significant funding.
There are innovative ideas that could help lessen the financial impact of creating an adequate mental-health system. For instance, telemedicine might be appropriate for rural areas where services are otherwise unavailable.
Earlier intervention could reduce the number who require later and much more expensive hospitalization. Properly funded assisted outpatient treatment has been successfully used in some states to deliver involuntary mental-health services in the community for suitable individuals. It provides case and medication management and other social safety-net services to help people stabilize before they decompensate to the point that they need hospitalization.
While such innovations promise eventual savings, they require initial investment. Moreover, they would not relieve the state of the responsibility to provide sufficient inpatient hospital beds for those who still need them.
Finding funding requires political and institutional will. One possible source might be the marijuana taxes that Washington is now collecting. Another might be a universal implementation of an existing discretionary one-tenth of 1 percent sales tax across all jurisdictions of the state.
The citizens of Washington state must let their legislators and governmental officials know that they want a fully functioning mental-health system. Citizens should expect the Legislature to fund it and the state Department of Social and Health Services to implement it.
Each and every Washington citizen must stand up to say, “These are not throwaway people. They are ours. Embrace them and provide the help they need and deserve. Mental health care gets our votes.” In doing that, Washington would grant these individuals entrance back into the world in which we all deserve a place. All of our lives would be richer for it.
Cassandra Ando is the Public Policy Committee chairwoman of the National Alliance on Mental Illness Washington. She is based in Spokane.