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The Oxford English Dictionary recently updated its lists of words and phrases to include a “hot mess,” which is good because that’s probably the best way to describe the state of mental-health care most places.

It’s costly, there aren’t enough practitioners, many people who need it don’t have it and it’s still a taboo topic because of the stigma attached. But I think we are going to do better.

The state of mental-health care comes up frequently, but attention is lingering at the moment in Washington because officials are trying to comply with the state Supreme Court’s deadline to move patients with mental illnesses out of temporary spots in hospital emergency rooms, a practice called psychiatric boarding.

At the same time, the death of actor Robin Williams, who had depression, brought some national discussion of mental illness.

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The Williams case points out that anyone can have a severe mental illness and that it can be difficult to beat, even for someone who is open about his health and has access to the best care. What I had to take a moment to remember is that not everyone survives cancer or the flu either, but we have better systems in place to combat those diseases.

We still have a mental block about mental illnesses that affects how well those illnesses are addressed for the large numbers of people who would benefit from good care. If we can get past the block, we will make progress.

What experts know about mental illness keeps growing, but how institutions deal with it hasn’t kept pace.

You know the outlines of the history. People affected by serious mental illness were confined to large institutions that did not always meet their needs. That system was challenged and taken apart, but instead of being replaced with a more humane system, chaos and callousness followed. The state Supreme Court ruling was a reaction to current shortcomings.

The Seattle Times reported on those conditions last fall. The Times found growing numbers of people in crisis were being taken to emergency rooms, for lack of any other place to take them, and some were left strapped to beds while staff attended to emergency medical cases.

That is a significant problem nationally, because states didn’t have the money or didn’t allocate money to replace the lost beds or ensure treatment.

The court says fix it. But the will and the money has to come from an electorate that understands the situation.

I’ve been reading more about it myself.

According to the American Foundation for Suicide Prevention, 90 percent of the 38,000 suicides each year are mental-health related.

A significant number of people who have serious mental illnesses can’t work, so government payments help to support them.

Jails and prisons house many of the people who would once have been consigned to mental hospitals. That also costs taxpayers.

As is so often the case with the problems we face, doing the right thing upfront would cost less than trying to avoid spending money, in this case on care.

A more recent story in The Seattle Times identified three counties that have solved the psychiatric boarding problem, primarily by concentrating on intensive outpatient care and early-intervention programs.

USA Today cites a Georgia study that found, “providing comprehensive mental health services to mentally ill people involved in the criminal-justice system cut the number of days that participants spent in the hospital by 89%, and the number of days spent in jail by 78%. In all, the program saved more than $1 million in its first year.”

I don’t envy the people trying to quickly comply with the court ruling in Washington, but we do need a better system, we know it is possible and we should have been headed in that direction before now — toward a system that isn’t cold, isn’t a hot mess, but is caring and effective.

Jerry Large’s column appears Monday and Thursday. Reach him at 206-464-3346 or

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