“‘Boarding’ the mentally ill” in today’s News Tribune examines a series of incidents and legal arguments tied to the practice of detaining people with mental illness in hospital emergency departments.
Some of the incidents, based on public records and testimony in open court, describe statements and actions by OptumHealth, the private company that provides mental health services to Pierce County under a contract with the state.
The News Tribune sought further information from Optum leaders, which led to a June 24 interview with Cheri Dolezal, OptumHealth Pierce Regional Support Network executive director.
Q: Does Optum reject people with mental illness if they arrive from outside Pierce County?
A: During the June 24 interview, Dolezal said no. Court testimony on June 17 said the opposite. The truth is somewhere in between.
The allegation stems from an involuntary commitment hearing in Pierce County Superior Court. The patient, D.P., had been airlifted from Grays Harbor County to Tacoma General Hospital after a suicide attempt. Two mental health professionals, Dane Christensen and Thomas McNeely, testified that Optum refused to accept D.P. into a local evaluation and treatment center, though four beds were available.
“Out-of-county clients typically don’t go to our ET beds,” Christensen said.
“They were reserving them for their detentions,” McNeely said. He added that Optum required specific approval before accepting out-of-county patients.
The shortage of psychiatric beds is a statewide problem, not limited to Pierce County. A 2011 study by the state Institute for Public Policy found that Washington ranks 47th or 51st in the nation for available psychiatric beds, depending on the measure.
State law doesn’t set a hard and fast policy for placement of mentally ill people in their county of origin. In practice, mental health providers throughout the state will search for any available bed and seek placement where they can find it. D.P. eventually landed at a mental health hospital in Kirkland.
According to Dolezal, Optum regularly accepts out-of-county patients. During the June 24 interview, she said Optum had accepted five such individuals over the weekend.
Q: Did Optum have four available beds when D.P. arrived in Pierce County on the weekend of June 14?
A: On June 24, Dolezal said no. In court on June 17, McNeely said yes. The reality is unclear.
McNeely testified that mental health professionals seeking beds for patients rely on a statewide list that’s constantly updated. While seeking a bed for D.P., he checked the list, which said that Optum had four beds. He underlined the point in court, saying it was rare.
Dolezal said that in fact Optum had only one available bed at the time, which was not slated for a female.
“We didn’t have four beds,” she said.
Q: Why did one of Optum’s subcontractors refuse to testify in a June 17 court hearing?
A: On June 17, D.P. waited outside the courtroom for five hours while officials tried to find a bed for her. During the wait, a separate hearing involving another patient took place. That patient had been detained at Recovery Innovations, a 16-bed “crisis triage” facility in Fife. The facility contracts with Optum to provide local mental health services.
During the June 17 hearing, a Pierce County prosecutor seeking continued detention of a patient sought testimony from a Recovery Innovations manager, who declined to testify.
Statements in court suggested that was a matter of philosophy: Recovery Innovations prefers not to testify for or against its patients.
Dolezal said Optum doesn’t dictate such decisions by Recovery Innovations.
“There isn’t anything in our contract that they have to testify,” she said.
The Fife facility is meant for crisis diversion, not detention, Dolezal said. Broadly, she supports the Recovery Innovations approach to treatment.
“I hired them because of their values,” she said.
Q: How does Optum view the practice of “psychiatric boarding,” referring to detaining people with mental illness in hospital emergency departments?
A: The problem stems from the statewide bed shortage, Dolezal said. Psychiatric boarding of patients “kind of breaks our hearts,” she added.
“We have no arguments with the idea that it’s not a good place for them.”