The Washington State Supreme Court ruled Thursday that boarding psychiatric patients temporarily in hospital emergency rooms and acute care centers because there isn’t space at certified psychiatric treatment facilities is unlawful.
The court ruled unanimously that patients held temporarily in settings that don’t provide individualized psychiatric treatment violates the state’s Involuntary Treatment Act.
“It’s always been inhumane not to provide treatment, now it’s clearly illegal,” said Ross Hunter, D-Medina, Chair of the State House Appropriations Committee. Hunter said the state will have to respond sooner than the Legislature can act, which might not be until a new budget can be approved next spring.
He said the state must add short-term capacity by opening new beds at Western and Eastern State Hospitals, but should also try to add less-expensive beds at community treatment facilities which also allows patients to remain closer to home with more continuity of care. Hunter said beds at state psychiatric hospitals can cost $600 a day while the care in a community clinic may cost half as much and be eligible for Medicaid reimbursement.
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He said the state’s mental health treatment system faced devastating cuts during the recession and is now seeing the consequences in the big increase in psychiatric patients boarded in hospital emergency rooms or acute care centers rather than certified psychiatric treatment facilities.
He noted that a state task force made up of representatives from the Department of Social and Health Services, King County, the Governor’s Office and the King County Executive’s Office is working on the issue.
“We don’t know how many patients we’re talking about because the hospitals don’t keep good data on boarding, but the cost to the state could be in the tens of millions,” Hunter said.
A lawyer representing mentally ill clients praised Thursday’s ruling and said it could lead to better treatment.
“The decision is the court recognizing that when our clients are involuntarily committed, they need to be placed in a setting where they can get proper psychiatric treatment,” said Mike De Felice, who supervises public defenders who represent involuntarily committed patients in King County.
He said certified psychiatric care facilities can provide monitoring of medications, staff trained to treat mentally ill patients and a therapeutic setting where clients can be diagnosed and treated to improve their condition.
“If a client is strapped to an emergency bed rather than being in a psychiatric treatment environment, it can be traumatic for the patient and can certainly delay healing,” De Felice said. Effective outpatient treatment can also be less costly, he said.
The court noted that Washington State’s involuntary civil commitment system has been regularly overwhelmed since it was first enacted by the Legislature in 1979. By 1981, it said, Western State Hospital, an evaluation and treatment center for psychiatric patients, was filled to capacity and refused to accept more patients until ordered by the court to do so.
Thursday’s ruling arose from a 2013 Pierce County case. Ten patients retained under the involuntary treatment act were placed in emergency rooms or acute care facilities. None of the sites were certified as evaluation and treatment facilities for psychiatric treatment, and the patients did not receive psychiatric care. The 10 sued to dismiss the county’s involuntary treatment petitions, and the trial judge found the practice, known as psychiatric boarding, illegal.
Pierce County and the state Department of Social and Health Services appealed the cases.
The Supreme Court said in its ruling that patients may not be warehoused without treatment because of a lack of funds nor can it justify the state’s failure to provide the treatment necessary for recovery.
The ruling quotes the Involuntary Treatment Act which says, “Each person involuntarily detained or committed pursuant to (the Act) shall have the right to adequate care and individualized treatment.”