Politics & Government

Mental illness common in Washington, but need for care is unmet

Washington has more known mental illness than in nearly every other state, according to a survey — yet Washingtonians with mental illness are less likely to be hospitalized.

But it’s not as though psychiatric wards are sitting empty. In many cases, they have been bursting at the seams.

So says a report finished last month to update the Legislature on mental health crisis services. While many of the figures predate court rulings last year that sent lawmakers and Gov. Jay Inslee scrambling to pay for more space for patients being detained against their will, they appear to show unmet need across the mental health system.

For example: Researchers found 2013 patient averages exceeded capacity in the psychiatric wards of St. Joseph Medical Center in Tacoma and Providence St. Peter Hospital in Olympia. The two South Sound hospitals take only voluntary psychiatric admissions, not detentions, so they aren’t sharing in the new state funding.

“We’ve had demand outpacing supply,” said Chelene Whiteaker, policy director for the Washington State Hospital Association.

Not all hospitals were as packed, but all but a few were more than 80 percent full, well above the typical occupancy rate for hospitals, researchers found.

The study comes from the nonpartisan and state-funded Washington State Institute for Public Policy. To analyze the prevalence of mental illness, the institute used federal data from the National Survey on Drug Use and Health.

The most recent of the in-person surveys with data available, in 2010-2011, found about 24 percent of Washington adults met criteria indicating a mental health disorder, according to the institute. It’s the third-highest rate of all states.

Roughly 7 percent met further criteria for a serious mental illness that interfered with daily life — ranking Washington No. 2 in the nation.

It wasn’t clear whether the high rates were the result of more mental illness, more awareness of it or more tendency to acknowledge it.

Researchers were at a loss to explain it. So was a lobbyist for the state chapter of the National Alliance on Mental Illness, Seth Dawson, who nonetheless called it consistent with other reports.

Dawson said reports have also shown Washington is lagging in access to care.

“The dearth of mental health services in our state is a public emergency that has brought us to setting public policy through the courts because we have not stepped up to provide the funding essential for a viable system,” he said in an email.

The institute’s report may add further evidence. Just 1.5 percent of survey respondents in Washington reported having received inpatient psychiatric care in the past year, compared with 2.9 percent among all of the 30 states with reliable sample sizes, the institute said.

Those responses came before the Legislature made it easier to commit people to detention, a change that took effect last summer and could make hospitalizations more likely.

And they came before Inslee secured beds last year in response to a state Supreme Court order invalidating the routine practice of parking patients without treatment in emergency rooms and hallways.

Through a rosier lens, the low rate of hospitalization might even be seen as evidence mental illness is being treated early before it hits crisis levels. “We do provide a lot more outpatient treatment and try to intervene earlier,” Whiteaker said.

But some health care workers complain of high patient loads and a lack of funding for programs that head off problems early before someone spirals into mental crisis.

And Whiteaker said the space crunch persists. What’s more, families have been telling the Legislature it’s still too difficult to have their loved ones committed.

Lawmakers on Thursday sent Inslee a bill shoring up state government spending through June including $21 million for mental health. It funds the beds Inslee secured, while patching Western State Hospital’s budget and opening two extra wards at Western.

One of the wards could help inmates who have been waiting months in jails for state doctors to try to restore them to competency to be tried, a practice that has drawn more court rebukes.

Now attention turns to the two-year budget, where lawmakers will need to sustain those gains and address other demands. Health care workers want better staffing. They and advocates for the mentally ill want money for outpatient treatment to match the money for beds.

With the state’s recent additions, the institute’s study shows the number of beds in Washington for short-term civil commitments has reached its highest point since 2000.

But that doesn’t count state hospital beds for longer-term commitments. The state’s per-person use of those beds has plunged 39 percent since 2001, as state hospitals have fallen victim to budget cuts.