Year After Ruling, Mentally Ill Still Waiting for Care in Washington State

by | September 8, 2015

By Jordan Schrader

More than a year ago, a state Supreme Court ruling spurred a full-court press by state government to find space for patients with mental illness. Detentions outside the psychiatric units intended to treat those patients became more rare.

Now such detentions are back on the rise and happening as frequently as they did just before the court decision.

Overcrowding of psychiatric units continues even after an addition of about 160 beds with more on the way. Staff turnover is one cause, according to the state Department of Social and Health Services.

"Hospitals with psychiatric units have a difficult time recruiting and retaining staff, leaving consumers no other options but to stay in a regular hospital ward, where the hospital makes arrangements for them to get mental health treatment," Chris Imhoff, a DSHS division director, said in a statement.

Hospitals aren't warehousing -- "boarding" -- patients with no treatment, DSHS insists. A state rule created in response to the ruling forbids it.

"Definitely they are waiting for a bed," Imhoff said in an interview, "but they are getting some level of specialty care while they're doing it."

The agency says a better understanding by hospitals that patients can be detained while they wait as long as they receive care is another reason for the increase.

An advocate for people with mental illness says the state's bed expansion is inadequate, as is the care being provided to people waiting for a bed.

Even with regular visits from mental-health professionals, patients still mostly see staff without specialty training, said Sandi Ando, who leads public-policy work for the Washington chapter of the National Alliance on Mental Illness. It's boarding by another name, she said.

"I call them fake beds because they're really not psych beds," Ando said. "They're make-do beds. They're pretend-we're-doing-the-right-thing beds."

HUNDREDS WAITING

The official term is "single-bed certification."

In by-the-book detentions, people deemed by mental-health officials and the courts to be a danger to themselves or others are sent for short-term stays at psychiatric units certified as evaluation and treatment facilities. They may go on to longer stays at either Western or Eastern state hospitals.

In single-bed certifications, state officials allow patients to be placed somewhere else, usually in a community hospital.

The Supreme Court declared that single-bed certifications were only for patients who needed them for some reason -- because of a medical condition or proximity to home, for example. Patients couldn't be kept waiting just because there's no room.

But the DSHS rule, later ratified in a law passed by the Legislature, allowed single-bed certification to continue in cases of overcrowding as long as a hospital provides mental-health treatment.

From what officials can tell, the total number of detentions hasn't changed much in recent months, yet the number of people waiting has shot upward.

There were 552 single-bed certifications in July, roughly the same as a year earlier -- before the August 2014 court ruling. The certifications are also up 83 percent since January, the first full month the state had to comply with the ruling.

The state's biggest county, King, accounted for most of the rebound.

In 401 of the cases, no medical or location needs were cited, meaning they were likely caused by overcrowding. That's 139 percent more than in January.

Patients wait a median of two days for a bed, DSHS said.

Gov. Jay Inslee's administration freed up money after the court ruling and the Legislature added more, aimed at expanding bed capacity and helping hospitals handle their new responsibilities. A 30-bed ward at Western State Hospital is due to open later this month.

Lawmakers also added money to deal with court rulings related to inmates waiting for mental-health care.

"They have a long way to go," said Glenn Morrison, a psychiatrist at Western State Hospital, "to catch up with a system that hasn't been expanding for many, many years now."

Lawmakers, too, say it will take time to put the changes into effect.

"We are in a transition phase from what was patently unacceptable," said Sen. Bruce Dammeier, R-Puyallup, "to that which we really desire, which is a lot more capacity."

(c)2015 The Olympian (Olympia, Wash.)