Mental health care in Washington was among the worst casualties of the Great Recession, but the last two legislative sessions – and the passage of the Affordable Care Act – have turned the tide and will result in a total of over $700 million in new investment since the low point. This includes funding that both the state House and Senate proposed in the 2015 legislative session. Even more will be added in the state capital budget for construction of facilities.
Part of this investment is driven by three court cases. One case prohibits “psychiatric boarding,” in which severely mentally ill people are held – often for days at a time, and sometimes in restraints – in hospital emergency rooms because there is no room for them in psychiatric wards.
Another case, settled out of court, requires the state to provide care for severely mentally ill children, who were ending up in juvenile detention or being sent out of state because of the lack of available care.
The third requires the state to provide faster evaluation of mentally ill jail inmates to determine whether they are competent to stand trial and faster treatment to restore their competency when possible.
It is a very sad commentary on the state of our state when courts must push legislators into addressing the cruel neglect of people who are mentally ill. It’s also a sad commentary on the stigma of mental illness. Even in the depth of the recession, no one proposed eliminating medical care for heart attacks, asthma, or diabetes, but mental health care, including addiction treatment, was seen as expendable.
One result is that Mental Health America, a national non-profit advocacy organization, rates Washington 48th among states in access to mental health care. We hope that these recent, encouraging investments raise us from this dismal position.
Federal funding is also improving the outlook for better mental health care. The Affordable Care Act added half a million very low-income Washington residents to the Medicaid program. This, coupled with a federal rule that requires all insurers to cover mental and physical health treatments, dramatically expands access.
But daunting problems remain. As in medical care, our mental health system has tended to treat people mostly when conditions become acute. This means underfunding of prevention and early interventions that may forestall immense suffering, shattered lives, and enormous public expense for jails, courts, and hospitals.
The Legislature is edging up to addressing this need with E2SHB 1450, which provides for court-ordered involuntary outpatient mental health treatment for people who can function if they stay on medications and/or get regular care, but would otherwise get sicker and be committed to hospitals. This bill has passed the House, and an amended version passed in the Senate. It is modeled on a successful New York program in existence since 1999.
An even bigger step forward is the coming integration of mental health care and substance abuse treatment. People have been talking about this for donkey’s years, and it’s no small task to converge two such separate professional cultures. Currently, it’s not uncommon for people to be evicted from inpatient drug or alcohol treatment because their mental illness is out of control, and conversely, to wash out of mental health treatment because their addiction is out of control.
The first step to solving this common problem is to integrate state and federal funding for these two systems, which is scheduled to begin next April. The bigger challenge – to actually create integrated treatment systems – will take longer. The good news is that the House and Senate have both proposed to invest $50 million in this important effort.
There’s much to laud in the bipartisan recognition that behavioral health is a top legislative priority, even if it took a push by the courts. When the courts and the Legislature act, it’s likely they are reflecting an increased public understanding of how much this matters.