Much work remains on psychiatric boarding

The day after Christmas was the deadline for hospitals to make drastic changes in how they manage psychiatric patients under their care.

It’s been more than four months since the state Supreme Court ruled it was unconstitutional to warehouse involuntarily committed mentally ill patients in a hospital emergency room while they wait for a psychiatric bed to become available. This practice, called “psychiatric boarding” was to end on Dec. 26, the day the state Supreme Court ruling went into effect.

Since the court’s wake-up call, the state has added 134 beds, and it plans to add another 64 next year. But some of the additional beds could sit empty if the state can’t hire enough trained staff to care for the patients. And even if they do find funding for staff, are nearly 200 new beds enough to comply with the court order? Mental health experts aren’t so sure.

One thing is certain: The practice of psychiatric boarding is cruel and inhumane. It’s a symptom of a broken mental health system. It’s occurring all across the country, and has grown in frequency as the number of available psychiatric beds nationwide fell from 400,000 in 1970 to 50,000 in 2006. Then the Great Recession descended, and states cut even deeper into their mental health care budgets.

Cuts to mental health care programs must end. Funding must be restored for a continuity of care that doesn’t end with someone strapped to a gurney in a hospital emergency room hallway or turned back out onto the streets.

State mental health and hospital officials in this state appear to be taking the psychiatric boarding problem much more seriously since the state Supreme Court ruling. Working with hospitals and other health agencies, the state Department of Social and Health Services has adopted an emergency rule that allows hospitals to use vacant hospital beds for psychiatric care, even if that bed isn’t certified for such use. The hospital must have an approved care plan tailored to the individual. This is a stopgap measure, fraught with potential abuse. In the past, single bed certification has been a rubber stamp for boarding and something the court in its decision wanted to avoid. However, if the standard of treatment called for in the rule is adhered to, it’s an improvement over past practices.

The long-term responsibility rests with the Legislature. If the solution requires additional revenue from some sort of tax, so be it. Taxes are the price of civilization, and decent care for people with mental illness is certainly among the minimum qualifications for any civilized society.

The status quo is not just uncivilized; it’s illegal. And it often leaves people with chronic and acute mental health problems vulnerable to self-harm, homelessness and victimization. We hope the state court ruling on psychiatric boarding will truly hold legislators, the mental health community and hospitals more accountable for humane care of this underserved population.