The high price of saving money on mental health

The fate of people with severe psychiatric disorders in this state has traditionally been driven by two factors:

Washington hates to spend money treating the mentally ill.

Washington also hates to commit them to involuntary treatment unless they’re on the verge of killing themselves or others.

The two are closely connected. Those who don’t want to spend much on the sick may find it especially easy to give them the "freedom" to live on the streets.

As The News Tribune’s Sean Robinson and Jordan Schrader reported Sunday, this state’s economy-minded approach to mental illness carries an appalling human cost.

Washington ranks at or close to the bottom of all states in hospital capacity for the mentally ill. There aren’t near enough beds for patients who need intensive care in a secure setting.

The scarcity backfires in nasty ways.

Some people with severe but untreated illnesses act out in fear, anger or delusion and wind up in jail. They may commit crimes they wouldn’t have committed had they gotten enough care.

A jail is a miserable – and extremely expensive – substitute for a psychiatric hospital.

Other sick people wind up languishing in emergency rooms awaiting an opening at Western State Hospital or other appropriate setting.

On one day two weeks ago, for example, 11 patients with mental illnesses were rolled into Pierce County’s involuntary commitment court on gurneys. They’d been more or less warehoused in conventional hospitals- – receiving minimal mental health treatment – under a system misleadingly named psychiatric boarding.

Most of the 11 got sent right back to places they didn’t belong. There weren’t enough beds to accommodate them at Western State or at smaller treatment centers designed to stabilize patients in crisis.

The ranks of the mentally ill haven’t been shrinking in recent years, but the state’s willingness to care for them has been. At Western State Hospital, for example, the Legislature has cut the number of beds from 777 to 517 over the past five years.

Robinson detailed the appalling case of a 26-year-old woman with multiple diagnoses and a record of assaults and sex offenses. She wants to be getting the treatment she so clearly needs – but Western State won’t keep her. She was rolled into the commitment court on a gurney that day – and she wound up being rolled back to St. Clare Hospital in Lakewood.

More beds in high-overhead Western State aren’t always the answer, but the loss of beds there must be made good with expanded community-based care – including more small, high-level treatment centers and fewer obstacles to court-ordered outpatient treatment.

This will take both money and compassion. The mentally ill have seen too little of both in our state.