In the seven hours Linea spent waiting for a psychiatric bed to open up, she witnessed patients tied to gurneys in the hallways and others sedated for acting out in a psychotic episode.
Cinda Johnson remembers the first time her daughter Linea, 19 at the time, was committed to the Harborview emergency room in Seattle for her suicidal thoughts. She can sum it up in only one word: “traumatic.”
“It was overwhelming and frightening,” remembers Cinda. She and her daughter would go on to advocate nationally for greater awareness about mental illness and patient rights.
In August, patients like Linea found some relief in a historic ruling. The Washington state Supreme Court determined that the long-running practice of boarding psychiatric patients — holding them involuntarily in emergency rooms and acute care centers until a bed and treatment became available at a psychiatric facility — was a violation of patient rights. By some accounts up to 200 patients were being “boarded” at one time because of a severe shortage of psychiatric beds.
The decision set into motion a series of reforms. And after the court granted a temporary postponement until Dec. 26, Gov. Jay Inslee authorized using $30 million in un-budgeted mental health funding to meet capacity needs. He also announced a targeted goal of 145 beds before the December deadline.
While most resolved that the 145 beds pledged by the governor, closed this chapter in Washington litigation, mental health professionals and lawmakers say there’s still much to be done. The reform of Washington’s mental health system will compete with costly other items this legislative session.
“The Legislature has some difficult decisions to make,” said David Johnson, director of Navos, a local network of mental health clinics. “K-12 funding is needed, as is psychiatric and mental health care, housing and transportation…There are many legitimate needs and there has not been enough to go around…Those of us [mental health] advocates have to continue to make a case of urgency around this because if we don’t, other competing interests will eclipse our need.”
In late September, the federal government approved a two-year waiver that would allow psychiatric hospitals of more than 16 beds to use Medicaid dollars for patient services. The waiver went into effect earlier this month and Johnson called it critically helpful as the state begins to address the court’s ruling on boarding. It will truncate initial estimates of $100 million or more for the 2015-2017 biennium.
Though even that development presents problems. The money could just as easily disappear with a new administration and the short two-year window may lessen the chances of costly long-term investments, like the construction of new evaluation and treatment facilities, most of them with multi-million dollar price-tags.
Cinda points out that efforts have to be made beyond building capacity, by ensuring preventative care and deferring people from hospitalization in the first place: “It has to be addressed. There also has to be some really strong support to assure that we’re not putting people in jail instead of the hospital. We need more treatment facilities and beds and nurses.”
But while the Supreme Court ruling addresses only one antiquated practice, mental health professionals across the state agree this should be the warning it needs galvanize more change. According to one recent study by the American College of Emergency Physicians, Washington ranked 47th in the nation for the number of psychiatric beds per capita. The neglect and steep costs associated with the state’s inefficient mental health system have big implications for it down the road. Amnon Shoenfeld, former director of King County’s Mental Health, Chemical Abuse and Dependency Services Division estimates that $4 million is spent annually on the legal costs of representing involuntary psychiatric patients.
There are also major discrepancies in the cost of bedding somebody at a state hospital versus in a community facility — $550 as compared to $120, estimates Dr. David Stone.
“We know what works and how to take care of people so that they can get better,” says Johnson, “it just requires more money.”
10/20/14 – This post has been updated to clarify the court delaying its ruling until Dec. 26, and Inslee’s authorization of emergency funding.
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