It has been, for decades now, a classic example of ignoring a problem and hoping it goes away. Yet the issue of mental illness is one that continues to grow, even as states and the federal government have attempted to avoid dealing with the issue.
Now, following a ruling last week from the state Supreme Court, Washington will be forced to face the problem head on. The issue has come home to roost, as a method frequently employed for housing mentally ill patients has been deemed illegal in a unanimous ruling.
With a shortage of beds and a shortage of treatment options available for those suffering from mental illness, facilities often would house patients in hospital emergency rooms. The practice, called “psychiatric boarding,” would leave patients to linger for days or weeks in facilities that are unable to provide them with the necessary services. “(State law) does not authorize psychiatric boarding as a method to avoid overcrowding certified evaluation and treatment facilities,” reads the court’s decision, which was written by Justice Steven Gonzalez and which confirmed lower-court decisions.
The ruling noted that the state’s civil commitment system has been “regularly overwhelmed” since the Legislature enacted the Involuntary Treatment Act in 1979, which governs procedures for people with mental illness. Washington ranks 47th among the states in terms of psychiatric beds per capita, leading to psychiatric boarding being viewed as a viable alternative for housing the mentally ill. An investigation by The Seattle Times found that the number of requests for such placements rose from 1,221 in 2007 to 3,412 in 2013.
The situation highlights the difficulties society faces in dealing with mental illness — and the often shameful ways in which those difficulties manifest themselves. The basic guideline for having an ill person involuntarily committed is whether or not they are a danger to themselves or to others, yet that can be a difficult standard to meet. As many families and friends of the mentally ill have discovered, seeking help for somebody who requires it can be a frustrating and fruitless endeavor.
In this regard, mental illness is treated differently from other illnesses, often stigmatized, shunned, and ignored. While somebody suffering from heart disease typically would be greeted with empathy and have a wide range of services at their disposal, the mentally ill are shunted to a hospital bed where no help is available. Washington is not the only state that employs such a strategy, but the cruelty of it was emphasized when an attorney for two Pierce County hospitals testified before the court: “We have no psychiatrists. We have no psychiatric nurses. We have no orderlies. We have no ability to provide any of the treatment that is mandated under the statute.”
The state Supreme Court rightly has ruled against this practice, yet the decision raises an entirely new set of issues. The state Legislature, already facing difficult questions next year about funding K-12 education in the wake of the court’s McCleary decision, now also is faced with bolstering funding for mental health care. And, in a more immediate sense, hospitals and care providers must be concerned about releasing patients who are, indeed, potentially dangerous.
Solutions will not come easily, but they must be found. The state Supreme Court has ruled on the side of a humanitarian solution for patients, and that is a reasonable start to approaching the issue.
