A legal argument that could alter the landscape of state mental health policy is headed for the state Supreme Court.
The debate started in Pierce County Superior Court 14 months ago. It revolves around a practice called psychiatric boarding: holding people with mental illness in hospital emergency departments for indefinite periods without mental-health treatment.
Is boarding legal? Court Commissioner Craig Adams answered with a qualified no in February 2013, ruling from the bench of civil commitment court at Western State Hospital in Lakewood. Adams found that holding people in emergency rooms solely because of overcrowding at mental-health treatment centers violates state and federal law.
“I don’t think you can do psychiatric boarding just because there is no room at the inn,” Adams said at the time.
Superior Court Judge Kathryn Nelson upheld Adams’ ruling last summer. That triggered an appeal to Division II of the Washington Court of Appeals and a string of briefings.
Wednesday, the appeals court kicked the argument to the state Supreme Court for direct review.
Psychiatric boarding has mushroomed across the state in recent years, following a series of deep budget cuts to the mental-health system and a corresponding reduction in psychiatric beds. The News Tribune reported on the ongoing issue as it wound through the courts.
As a result, mental patients languish in emergency departments for days, weeks and sometimes months against their will, without the mental-treatment guaranteed to them under state and federal law. Hospitals provide medical treatment when necessary, but they are generally not equipped to provide mental-health treatment.
Defense attorneys representing the patients argue that boarding violates the civil rights of patients. Attorneys for the state and Pierce County argue that hospitals provide a safe, secure place for people with mental illness, despite the lack of direct treatment. The state’s attorneys also suggest that if boarding is restricted, patients would be forced onto the streets with no care at all.
Wednesday’s decision sets the stage for several possible outcomes, yet to be determined. The Supreme Court could call for oral arguments and additional briefing, issue a ruling without waiting, or decline to rule, among other options.