Mental illness has many manifestations, including drug addiction, homelessness, and a range of behaviors from a person being fully functional in daily life to being outright psychotic and needing confinement. The role of government is to serve as a safety net and to help dysfunctional, impaired people who may do harm to themselves or others.
The treatment of mentally-ill patients has undergone radical changes in the past 150 years and not always for the better. Unfortunately, public-health treatment remains grossly underfunded, and consequently care is fragmented and places a huge social burden on American communities.
Because of the stigma associated with “asylum” care, federal action caused psychiatric hospitals to rapidly close. From 1955 to 1980, the number of institutionalized patients dropped by 75%, releasing many ill people into the community.
From 1955 to 2000, the number of state psychiatric beds per 100,000 people plummeted from 339 to just 22 nationally. There is now a shortage of available psychiatric beds both nationally and in Washington state, which now ranks close to the bottom of all states.
Community-based treatment over the past 60 years has included regional mental-health centers, supervised residential homes, psychiatric teams and improved medications. Research shows that both institutionalization and community treatment can be effective, depending on the patient’s specific needs. Both approaches have supporters among mental-health professionals.
The tragedy is that both treatment methods have been underfunded by federal, state and county government. Just like basic public services such as police protection, fire fighting and emergency medical care, the fundamental role of government here is the treatment and protection of the mentally incompetent. Unlike other areas of health care where patients can make rational choices and direct their own care, providing quality mental treatments for those with no other option is a public-health issue and should be a government priority.
Estimates show that 20 to 30% of the people in Washington state prisons suffer from significant mental illnesses. This compares to just 6% reported nationally in 1980. County jails in Washington are experiencing an alarming increase in prisoners with psychiatric problems. Some are drug-related, but for most of these people, drug abuse is often just one part of a larger mental illness. Studies confirm that 40% of patients with severe psychiatric problems have been incarcerated at some point in their lives.
The 2018 Washington state supplemental budget included funding for a study of behavioral-health needs. The study was released in January 2019. It found that despite huge increases in tax revenue, state officials have provided insufficient housing for longer-term and crisis care; have underserved certain areas, especially in rural communities; have underserved geriatric and pediatric populations; and have provided insufficient funding as well as too few qualified workers.
A second study commissioned by the Legislature confirmed that Washington lags behind other states in the number of treatment beds available per 100,000 people.
In 2019, the Washington Legislature invested heavily to add more behavioral health beds and provide operating funds for the next two years. The goal is to add 600 outpatient or residential home beds and 120 new beds in traditional medical hospitals. The budget also provides funds to build a new 150-bed behavioral-health teaching facility run by the University of Washington.
A controversy now exists about whether for-profit or not-for-profit organizations should build and staff behavioral-health facilities in the state. Regardless of who is in charge, the solution is to allocate sufficient resources to ensure a safe environment for mental patients and their caregivers. Along with adequate funding, dedicated oversight and appropriate staffing must be provided.
The fact that elected officials now recognize that they have underfunded needed services is a promising start to effectively treating mental illnesses. This is good public policy and will make our communities safer. It will help reverse the mistakes of the past and benefit all members of society, especially the penal system, hospitals and, most important, people living with mental illnesses.