Washington legislators struggle with ‘boarding’ mentally ill when space is already slim

OLYMPIA – As they try to address multiple court orders on Washington’s mental health system, legislators struggle with a conundrum: How can the state care for more people with mental illness when there’s not enough room or money to treat existing patients?

“We’ve got a broken mental health system – it’s not working,” Rep. Jay Rodne, R-North Bend, told the House Judiciary Committee Wednesday. “We’ve got mentally ill people who do not realize they’re mentally ill, and under our warped version of civil liberties, we are allowing them to walk the streets.”

At the core of the issue is severe overcrowding at the state’s two psychiatric hospitals, often attributed to a tight budget. The lack of beds and qualified staff has forced many patients to wait days, even months, for treatment – often handcuffed to gurneys in chaotic emergency-ward hallways.

State and federal judges call the practice psychiatric “boarding”; mental health advocates call it “warehousing.” The state is under orders to stop it.

“There’s nothing humane about letting our citizens suffer under a disability,” said Rodne, the prime sponsor of a bill to expand the criteria for involuntary mental health treatment. “We have diverted a lot of our chronically mentally ill folks to our jails in Washington state.”

The committee heard several bills Wednesday that aim to fix small pieces of the system. Rodne’s would add “persistent or acute disability” to the list of reasons a court may commit someone for involuntary care, allowing a person to be committed for any illness that might cause mental, emotional or physical harm.

Rodne also supports “Joel’s Law,” a bill that would enable friends and family to petition courts for a person’s involuntary commitment. It’s named after Joel Reuter, a Seattle man with severe bipolar disorder who was shot and killed in 2013 during a standoff with police. Reuter’s parents had tried for weeks to have him committed.

Currently, someone who poses a “likelihood of serious harm” can be committed for up to 72 hours after an initial evaluation. After that, psychiatrists can request commitments of up to 14 days, then up to 90 days, then up to 180 days.

Rep. Tina Orwall, D-Des Moines, wants to allow commitments of up to a year for patients in severe cases. Her bill would require judges to consider more of a patient’s mental health background and allow outpatient programs as a less restrictive treatment option.

Supporters of each bill said people should receive treatment before their conditions worsen to tragic ends.

The opposition

But some legal advocates for the mentally ill warned the bills could have huge up-front costs to the state. Others, including patients, said increasing involuntary commitments would do more harm than good.

The state doesn’t need more grounds for involuntary commitments, said Mike De Felice, of the Washington Defender Association. “New grounds would simply compound existing problems and spread thin existing resources, which would result in reduced quality of care.”

De Felice said the state should stress outpatient treatment, which could help cut demand for inpatient beds. But he opposed Orwall’s bill, saying hospitals and treatment facilities in the state are overwhelmed.

“There’s clearly an impression that it’s hard to get somebody committed in Washington state, and that’s just not the case,” he said.

Several mental health advocates urged lawmakers to consider the system as a whole when voting on the bills. Shankar Narayan, of the American Civil Liberties Union, said the state shouldn’t force the mentally ill into a system that doesn’t provide adequate treatment.

Paying for it all

Sen. Steve O’Ban, R-Pierce County, wants to use 22 percent of the state’s marijuana tax revenue for inpatient mental health treatment, including long-term housing programs.

Before the Affordable Care Act took effect and Medicaid was expanded in Washington, low-income residents could receive subsidized health care through the Basic Health Plan. Initiative 502, which legalized recreational marijuana statewide, required that a portion of the taxes on that drug be deposited into that account.

Now that the Basic Health Plan is gone, those funds are in limbo. The state projected that pot taxes would provide $96.5 million over the next two years and another $173.5 million through 2019. In comparison, the Legislature set aside about $80 million in the 2013-15 budget for the state’s mental health system.

O’Ban’s bill was sent to the Senate this week.