Having money to purchase gasoline won’t help you get anywhere without a vehicle to put the fuel in.
Yet, that’s the catch-22 assistance the 2014 Legislature provided to the problem of boarding people suffering acute mental illness episodes in hospital emergency rooms.
Due to our state’s severe shortage of community psychiatric beds, severely sick people languish without treatment for days, even weeks, sometimes strapped to a gurney in a hallway. It’s a tragedy occurring nearly every day of the week in South Sound hospitals and across the state.
Lawmakers approved an additional $7.3 million this year to operate more beds, although some of it will fund home-based services and housing needs. But they did not provide any capital funds to build or renovate spaces to put any new beds.
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It’s a cruel joke to say, “Here’s money for gas, kid, but you can’t buy a car.”
A portion of the allocated operating funds was designated to operate three new 16-bed Evaluation and Treatment (E&T) facilities, including one serving Thurston and Mason counties. But without the capital funds, it’s unlikely they will open.
This misstep is just the latest in a decades-long public policy failure to adequately care for people suffering from psychoses.
As a result of several lawsuits by civil libertarians in the 1960s to liberate mental patients and the development of anti-psychotic drugs, allowing some people to live independently, the nation moved toward deinstitutionalization. In 1960, there were more than 550,000 patients in public psychiatric beds. By 2010, there were only 43,318.
Where did all those people go?
Thurston County Health Director Don Sloma says, “It’s sort of a widely shared community shame in this state and in many states that our largest mental health facilities are our jails and prisons.”
Locked up in facilities without treatment programs is an inhumane way to handle severely sick people, and it’s outrageously expensive for taxpayers. And those not incarcerated are walking the streets, sleeping in doorways and probably self-medicating with drugs to alleviate ranges of mental suffering.
While it has worked for some people, deinstitutionalization has been a dismal failure for most patients. That’s primarily because neither federal or state governments ever provided an adequate number of community-based facilities and treatment programs.
Congress could help by amending the federal funding rule known as the Institutions for Mental Disease exclusion. It restricts Medicaid – which the state relies on for mental health funding – from paying for care in hospitals with more than 16 beds.
If the Legislature had passed a capital budget this year, and funded the three additional 16-bed treatment facilities, that would have taken pressure off Western State Hospital in Lakewood and Eastern State Hospital in Medical Lake. Both struggle with lean operating budgets, causing safety concerns for staff.
Washingtonians and other Americans now live with the results of an optimistic but not well-implemented policy devised 50 years ago for treating and housing people with mental health issues.
It’s time to change direction. That’s going to take money, but more importantly it will require a collective will to treat the mentally ill with compassion and priority.