Opinion

Mental health system fails to meet the needs of public and patients

In August 2011, Laura Sorensen’s mother sent a plea to Gov. Chris Gregoire predicting a “tragedy” in her daughter’s future. Earlier this month, that frightful prediction came true when Laura Sorensen walked into a store on the Key Peninsula and started shooting.

Jennifer and Reno Sorensen’s wrenching letter of sympathy and explanation, published Aug. 15 by The News Tribune, spoke eloquently to what individuals suffering from the most severe mental illnesses and their families routinely face in Washington and elsewhere.

What happened at that store was not an isolated incident. The Treatment Advocacy Center tracks violence involving untreated mental illness in our Preventable Tragedies Database. In the past two years alone, we have recorded at least 23 incidents across Washington involving an individual with a severe mental illness (usually untreated) as a victim or perpetrator of a violent episode.

Research indicates that timely and effective treatment for illnesses such as schizophrenia and bipolar disorder would greatly reduce the number of these incidents. Yet the Washington mental health system is not meeting this undeniable need.

Individuals with severe mental illness in Washington are 3.1 times more likely to be incarcerated for behaviors associated with their illness than to be hospitalized for treatment. There are only 18.1 public psychiatric beds per 100,000 people – roughly one-third the number considered to be necessary to provide minimally adequate inpatient treatment. As a result, people like Laura Sorensen who need intervention don’t get it, and they and their families and communities suffer.

The public should be outraged as well as saddened by these preventable tragedies and the dysfunctional mental health system that makes them far too common. We should demand that state officials make much-needed improvements to the civil commitment system that exists to prevent them.

With reform, citizens with severe mental illness could get treatment before deteriorating to a point of dangerousness or criminal conduct. They could receive continuous, effective treatment while living in the community. For the acutely or chronically ill, critically needed beds and adequate staffing would be available.

Here are three improvements that would make stories like Laura Sorensen’s less commonplace:

 • Change Washington’s civil commitment law so that family members and responsible adults can directly petition a court for an order to inpatient hospitalization or a less restrictive alternative.

Currently the state authorizes only county-designated mental health professionals to petition for needed treatment. Psychiatrists, law enforcement officers, caregivers and others who are often in a better position to observe whether someone needs treatment cannot take the issue to a judge for consideration. Only four other states so severely restrict the ability to initiate court-ordered care.

 • Make better use of the Lesser Restrictive Alternative, the name given to Washington’s assisted outpatient treatment law.

Washington was among the first states to permit the use of court-ordered treatment in the community, but the mechanism is drastically underused. In states that effectively use this option, research has found increased medication compliance and reduced consequences of nontreatment such as violence, arrest, homelessness, victimization and repeated hospitalization.

 • Place an immediate moratorium on public hospital bed closures until a sufficient number of psychiatric beds for acutely and/or chronically ill individuals are available, either in the state hospitals or community facilities.

Many people with severe mental illness can be safely and effectively treated in the community. For those who cannot, involuntary hospitalization can be a lifeline. Providing only one-third of the hospital beds that are minimally necessary to meet these needs guarantees that our Preventable Tragedies Database will continue to fill with Washington tragedies.

Doris A. Fuller is executive director of the Seattle-based Treatment Advocacy Center; Gerald R. Tarutis is a member of its board.

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