The crisis-driven response to failures in the mental-health system are missing the big picture. Where is the plan to fix the state’s rickety mental health system?
The failures of Washington’s mental-health system have been targeted with increasing precision and vitriol over the past two years by local, state and federal courts.
But the state’s response to the drip-drip-drip of judicial orders and fines — and to outcries from patients and their families — has been to treat each as its own drop of bad news, and throw money at the leak.
What’s needed instead is for Gov. Jay Inslee and the Legislature to take a step back, view the welling pool at their ankles, and collaborate on a big picture reform of the state’s rickety mental-health system.
The need for a broader view was on display just last week. Federal Judge Marsha Pechman held the state in contempt after trying for a year to hold the state responsible for failing to get mentally ill defendants who are held in jails to be more quickly evaluated and treated. She imposed fines of up to $1,000 a day, per patient.
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The state has thrown tens of millions at this problem, opening new facilities in Yakima and Centralia and hiring evaluators. But Pechman noted that the state Department of Social and Health Services was slow to divert mentally-ill defendants out of the criminal justice system in the first place — a bigger-picture reform that would be better for patients and better for the system.
Instead, the state “prioritized business as usual over the type of systemic reform required to address the constitutional crisis at the heart of this case,” Pechman wrote.
There are other examples of the state’s whack-a-mole approach. The state Supreme Court in 2014 noted that the inpatient mental-health system “has been regularly overwhelmed since it was first enacted by the Legislature in 1979.” More beds were created, but the Legislature did not significantly add outpatient services intended to head off more psychiatric hospitalization.
A similar narrow, crisis-driven response is now occurring at Western State Hospital, where an inability to discharge patients has clogged up the front door, leading to more vitriol from the judiciary, and suffering for patients. Again, the state has thrown millions at the problem but is not focused on systemwide reform.
Earlier this month, the federal watchdog group Disability Rights Washington gave the state and a wide group of law enforcement and health care officials an ultimatum. Negotiate that big-picture reform, or face another expensive lawsuit against the mental-health system.
“Complaining about the current system’s failures will not fix our problems. Nor will convening a group to make recommendations in a piecemeal fashion or come up with ideas ‘someone’ should implement. What we need is a plan,” wrote Disability Rights Washington’s legal advocacy director, David Carlson, in a letter to the group.
Carlson is right, and Disability Rights Washington’s track record of winning similar lawsuits gives the threat validity. Inslee should take Carlson up on the invitation for a meeting in August, and encourage others to do so.
Money is part of the problem, but it’s not the only answer. The state mental-health budget is $2.3 billion (including federal funds), and the Legislature throws more in every year. What’s lacking is a holistic understanding of how the money is spent, what is not working, and what could work better.
The question for Inslee and the Legislature: Where is the big-picture plan to fix this systemic, endemic problem?