Washington state and the federal government are placing a huge financial burden on hospitals, county and city jails, and state prisons by not allocating sufficient resources to caring for the mentally ill.
THE treatment of mentally ill patients has undergone radical changes in the past 150 years, and not always for the better. Care is fragmented and places a huge social burden on American communities. Unfortunately, public-health treatment remains grossly underfunded. But that hopefully is about to change.
The U.S. House recently passed H.R. 2646 to make the federal government accountable, on an outcomes basis, for the $130 billion spent annually on mental-health treatment. Multiple mental-health organizations and media outlets, including The Seattle Times, support the bill, called the Helping Families in Mental Health Crisis Act.
The U.S. Senate is expected to pass similar legislation. Gov. Jay Inslee and King County Executive Dow Constantine, taking the recommendations from a dedicated task force, are now making mental-health treatment a priority.
People with mental illnesses range from well-functioning individuals to those with severe disabilities. 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.
Institutionalizing the mentally ill became popular in the mid-19th century, and the federal government funded psychiatric hospitals, or asylums. Community and home-based treatment began in the 1950s and was placed into federal law in 1963 with the Community Mental Health Centers Construction Act.
Federal action caused existing psychiatric hospitals to rapidly close. From 1955 to 1995, the number of institutionalized patients dropped by 90 percent, and many of these mentally-ill people became homeless. From 1955 to 2000, state psychiatric beds per 100,000 people plummeted from 339 to 22. There is now a shortage of available psychiatric beds both nationally and in Washington state.
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 are underfunded by federal, state and county governments. Just like basic services, such as police, fire and emergency, the fundamental role of government here is the treatment and protection of the mentally ill. 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 percent of the Washington state prison population today suffers from significant mental illnesses. This compares to just 6 percent 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 percent of patients with severe psychiatric problems have been incarcerated at some point in their lives.
Last year, a federal judge ruled that prisoners in Washington state must have a competency evaluation within seven days of incarceration. Many patients had been waiting weeks, or even months, in jail before receiving a professional mental examination, let alone caring and constructive treatment for their conditions.
Unfortunately, last month fewer than one-third of prisoners ordered to receive evaluations and possible treatments were given them within seven days. The judge is currently holding the state Department of Social and Health Services in contempt for not complying with last year’s ruling. The agency (in other words, the state taxpayers) is now required to pay $500 to $1,000 per day per patient not evaluated within one week.
There has been a tragic and growing trend in the use of regular hospital emergency rooms for “psychiatric boarding” or “warehousing.” This is not only costly but, more important, can exacerbate the patient’s mental problem.
In 2014, the Washington State Supreme Court ruled that emergency-room boarding is illegal. Because of the psychiatric-bed shortage in the state, many mentally ill people wind up back on the streets, living homeless and abandoned. This is one reason that simply building more subsidized housing does not solve one of the root causes of homelessness.
Both Washington state and the federal government currently are placing a huge financial burden on regular hospitals, county and city jails, and state prisons by not allocating sufficient resources to caring for the mentally ill.
The fact that elected officials now recognize the underfunding issue is a promising start to effectively treat mental illnesses. This is good public policy and will immediately make our communities safer. It will help reverse the mistakes of the past and benefit the state prison system, hospitals and, most important, people living with mental illnesses.