By conservative estimates, one American out of 20 suffers from a severe psychiatric illness.
Seven million people live in Washington. That translates into 350,000 men, women and children who face schizophrenia, chronic depression, disruptive bipolar disorder and other potentially crippling illnesses of the brain.
Lawmakers should consider that number every time they make decisions about funding psychiatric hospitals, community mental health services, competency hearings and the like.
Over the past 50 years, both the federal and state governments have closed hospital wards and released patients “to the community” to be treated in the “least restrictive setting.”
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The mentally ill were theoretically going to be cared for as outpatients, in group homes and small, friendly residential facilities. Instead, lawmakers found other uses for much of the money they had been spending on the big hospitals.
Washington was especially enthusiastic about closing hospitals. It now has fewer beds per capita than nearly all other states. This was a triumph of libertarian values: The patients were “freed” and the government spent less on them.
Libertarian values don’t work very well in the world of mental illness. Many of the mentally ill who would previously have been hospitalized now wind up adrift, untreated, and often homeless. Some run afoul of the law and end up in jail. A bitter irony: The least restrictive setting turns out to be the most restrictive setting of all.
Sometimes untreated delusions, irrational anger or paranoia contribute to violence. The most recent horror story is Aaron Rey Ybarra, who is accused of shooting a 20-year-old student to death at Seattle Pacific University last month and attempted to kill others before being tackled by a student security guard.
The Seattle Times last week detailed Ybarra’s long journey through family chaos, depression, alcoholism and drug abuse. It was impossible to get him committed to a hospital. He heard voices in his head. He had a violent streak and he’s culpable for what he did – still, it’s possible a young SPU student might be alive today if Washington’s mental health system had the capacity and the legal tools to handle someone like him.
In a starker case of system failure, Jonathan Robert Meline of Tacoma failed to get adequate therapy for his paranoid schizophrenia despite his history of violence, his disconnection from reality and his mother’s repeated attempts to get him committed for long term care.
He needed confinement, but Western State couldn’t or wouldn’t hold him. He wound up hatcheting his father to death in 2012. Now he’ll get treatment. In June, he pleaded guilty by reason of insanity and was committed permanently to Western State.
One factor underlies most of the system’s problems: inadequate funding. Sometimes this is a matter of open discrimination against people who suffer an illness in their brain rather than another organ. The federal government, for example, refuses matching Medicaid funding for most adults in psychiatric hospitals with more than 16 beds.
This has led to the elimination of many psychiatric beds. How many non-psychiatric patients lose their Medicaid when they are admitted to a general hospital?
Washington lawmakers have actually made modest improvements in funding over the last couple years. Next year, though, they’ll again be under intense pressure to economize on psychiatric care.
If they look at the jails, though, and listen to the families of the mental ill, they’ll realize that doing mental health on the cheap is intolerably expensive.