The state Supreme Court unanimously ruled that the practice of warehousing mentally ill patients in hospital emergency rooms without treating their illness is unlawful. It was a swift and succinct decision, putting the state on a very tight deadline — Aug. 27 — to remedy the problem.
It will be a Herculean task to meet the deadline and find acceptable treatment, housing and beds for the some 200 psychiatric patients parked in hospital emergency rooms.
Last week, Gov. Jay Inslee’s administration announced plans to add a total of 50 mental health beds at the Eastern State Hospital near Spokane, Western State Hospital in Steilacoom and private psychiatric hospitals in Kirkland and Tukwila.
It’s a modest start toward addressing a bed shortage that has been building for years due to state budget cuts for mental health programs and years of downsizing state hospital capacity. Our state ranks near the bottom of states in the number of psychiatric beds by population.
As recently as 2013, more than 3,400 mental health patients cycled through hospital emergency rooms, waiting for adequate housing and treatment, or in the worst case scenario, were released back into communities ill-equipped to help them.
It came as no surprise to anyone that the state Supreme Court ruled the way it did. The swiftness with which the justices ruled — just 43 days after hearing oral arguments in the case — and the tight deadline for compliance, did catch many involved in the issue off guard.
The ruling was inevitable and just. But it’s a huge challenge for the state to comply with the court ruling without simply sending mentally ill patients back into the community without care. Time is running short to meet the court order. The state Department of Social and Health Services is scrambling to accommodate more of the patients currently housed in hospitals without the proper psychiatric care.
State officials estimate the cost of meeting the requirements of the court ruling at “tens of millions of dollars, which means any long-term fix will require action by the state Legislature.” This is the same Legislature already under another court order to fully fund K-12 public education.
There’s a pattern developing here: A Legislature careening from one crisis to the next, under the grip of the court rulings that point to their failure to fund essential human services and public education. But it isn’t just the Legislature’s failure. Voters have passed so many anti-tax initiatives that legislators despair of raising the revenue needed to meet the demands of court rulings.
Inslee hasn’t ruled out calling a special session to address the bed shortage. Expecting DSHS officials to shuffle money around within their many programs until the Legislature convenes in January risks robbing social service programs for the poor and disabled that have already been cut to the bone.
Warehousing people who are having mental health crises in emergency rooms is the legacy of Reagan-era policies intended to deinstitutionalize the mentally ill and substitute robust community-based programs that would give them greater freedom and dignity. A lot of people were released and mental hospitals were downsized or closed, but the promise of an adequate community mental health care system was never kept. One obvious result has been the growth in our homeless population.
The state Supreme Court ruling should serve as a clear reminder that business as usual in the mental health care field is not only inadequate, it is sometimes illegal and frighteningly inhumane.