Washington State Supreme Court Rules Against Psychiatric Boarding

On August 7, 2014, the Washington State Supreme Court ruled that the practice known as “psychiatric boarding” violates the law. Psychiatric boarding refers to housing psychiatric patients temporarily in hospital emergency rooms until space becomes available at specialized treatment facilities.

Supreme Court Psychiatric Boarding Violates Law - PhysicianHealthProgramIn 2013, The Seattle Times reported that psychiatric boarding had become an epidemic in Washington, with more than double the number of patients involuntarily detained in emergency rooms in 2013 than in 2011. The Washington Supreme Court decision noted that the state’s psychiatric facilities have been under stress ever since involuntary commitments began in 1979. The recent recession resulted in cuts to mental health services funding, further straining a system with too many patients and too few beds.

Washington State Supreme Court States Psychiatric Boarding Violates Involuntary Treatment Act

The court reached a unanimous decision that involuntary boarding of psychiatric patients violated the Involuntary Treatment Act. This Act states: “each person involuntarily detained or committed pursuant to (the Act) shall have the right to adequate care and individualized treatment.”

One of the principle objections from those who oppose psychiatric boarding is that patients who are kept in emergency room beds typically receive the bare minimum of psychiatric care, or none at all. This frequently results in a worsening of symptoms, and many patients have a much harder time stabilizing after the stress of involuntary detention without proper care.

Ruling Will Cost In Short Term, May Save In Long Term

Following the ruling, patients who are involuntarily committed to psychiatric care must be admitted to a location that has been certified for evaluation and treatment of psychiatric disorders. Ross Hunter, Chair of the State House Appropriations Committee, says early estimates put the additional cost to the state in the tens of millions.

However, advocates for the mentally ill believe that the ruling will result in better treatment for people in desperate need of it. Some, like Cassandra Ando, Chair of the Public Policy Committee of the National Alliance on Mental Health, believe that the changes brought about by the ruling could actually save the state of Washington money in the long term.

Providing adequate care right away could reduce the amount of time that patients have to spend in care, as well as lessening the odds that their condition will deteriorate further in the future and require expensive hospitalization.

Both Hunter and Ando also suggest expanding community treatment services as a way to keep costs manageable in the short term while making treatment more readily available to many people. Hunter notes that beds at community clinics can cost half of what it costs to commit someone to a state psychiatric hospital, and can have the benefit of keeping patients closer to home and to their support networks.

Some Patients May Be Released Without Care

One major concern following the ruling—which became effective on August 27, 2014—is that the state will not be able to act quickly enough to provide proper care to all the patients who are currently being boarded. As a result, any patient who does not have a bed in a psychiatric facility will need to be released without care, since it will be illegal to continue detaining them in their current location.

While some advocates for the mentally ill are opposed to involuntary commitment altogether, others simply want to ensure that those who are committed are given individualized and effective care. They do not want people with severe mental illness to simply be released without treatment, since any delay in care can make recovery a longer and more difficult process.

Based on the number of beds that have been found so far, Washington Governor Jay Inslee’s health and human services policy advisor, Andi Smith, estimates that approximately 100 severally ill patients will be released without treatment.

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