Cost shouldn’t prevent humane mental health care

Washington state’s reluctance to order the mentally ill into psychiatric care isn’t about compassion, except the false kind.

It’s really about trying to treat grave illnesses on the cheap – and pretending that we protect people’s freedom by letting them live on sidewalks in rainstorms while suffering crippling psychoses.

At last – spurred by the state Supreme Court – the Legislature is poised to ratchet up its commitment to citizens who can’t fend for themselves because of severe mental disorders.

One corrective – “Joel’s Law” – was approved unanimously last week by the House of Representatives. It would let family members appeal to courts if they believe therapists were wrongly refusing to order psychiatric treatment.

“Joel” was a young suicidal man who was shot and killed in 2013 by Seattle police during a standoff. His father and mother had repeatedly and unsuccessfully tried to have him ordered into treatment.

The bill obviously enjoys bipartisan support, but the Senate last year defeated the same measure after unanimous House approval. This year, the Senate should send it to the governor’s desk.

The other side of the equation is the scarcity of psychiatric hospital capacity that has resulted from decades of underfunding the system. Depending on the metric, Washington ranks last or nearly last in the nation in hospital beds. A cynic might suggest that the best way to save money on treatment is to ensure there’s no place to put the patients who need it.

One consequence has been the often inhumane practice of psychiatric boarding. For lack of space at Western State Hospital and other mental facilities, severely distressed patients have been confined involuntarily in the emergency departments of ordinary hospitals for weeks on end without personal treatment.

The Washington Supreme Court in August unanimously ordered an end to psychiatric boarding. Gov. Jay Inslee and state mental health authorities have since been scrambling to open beds. Lawmakers appear to be on board. After years of squeezing patients out of psychiatric hospitals, both House and Senate appear ready to invest serious money to create capacity.

Three Pierce County senators who’ve shown genuine concern for the mentally ill have introduced a bill that could allow psychiatric boarding on a small scale until the state has opened enough beds to handle all patients in need of involuntary commitment.

This looks odd, given the court’s emphatic rejection of boarding. But Sens. Bruce Dammeier, Jeannie Darnielle and Steve O’Ban are asking an important question: If a severely disturbed patient poses an imminent threat to himself or others, and the state is still short on psychiatric beds, should he be simply be put back on the streets?

Ethically, the answer is no. When a patient is suicidal or homicidal, confinement in a medical hospital is the lesser of evils.

The real solution, though, is to fast-track those beds. It’s time to get creative. Darnielle, for example, has suggested converting empty nursing homes for psychiatric patients. She’s also talking about converting jail space to treat patients facing criminal charges.

One promising bill would provide for involuntary outpatient treatment, which could include intensive follow-up professional and supervised medications. That approach appears to have worked in New York, where some people have been effectively treated at half the cost of hospitalization.

Lawmakers shouldn’t be mesmerized by the lower price tag, though. Any savings should stay right in the mental health system. The state wouldn’t be in panic mode today if its leaders had simply accepted the fact that humanely caring for psychiatric patients costs real money.