Since 1974 the Involuntary Treatment Act has been law in Washington state. It allows holding someone against their will if they are a danger to themselves or others. Its purpose is to provide evaluation and short-term treatment for the mentally ill.
However, the definition and criteria for mental illness is being debated in the state. Currently, Washington state is one 27 states where involuntary treatment is based only on the person’s likelihood of being dangerous to themselves or others and not on the individual’s “need for treatment.” House Bill 1451 and Senate Bill 5269, introduced in January aim to change that. The legislation would change the Involuntary Treatment Act so civil commitment could include people with persistent and acute disabilities. The bills have now been approved by each house and the differences in the bills are being reconciled before being sent to the governor.
Don’t believe Washington state needs to do anything about it? Washington was recently ranked 48th by Mental Health America based on whether mentally ill people had access to care.
The bills were inspired by Joel Reuter, who while a resident of Arizona, was civilly committed and received treatment for his psychotic episodes. Reuter moved to Washington state were they denied his detainment even after some erratic behavior. Following that result, Reuter was shot and killed by police in Seattle when he openly shot at them from his balcony and they returned fire. To many it is clear that something needs to be done about the mental health laws in Washington state but those working in the civil commitment committee oppose the changes until there is more funding available. The committee claims they have already seen a 58 percent increase in civil commitment cases since 2008, and if the law were to pass, they would need to hire more case workers. When interviewing Kirsti Boyd, a registered nurse at Valley General Hospital in Monroe, I asked her opinion on what would be the overall impact if these revisions were made to the Involuntary Act. Boyd’s response provides insight on one of the initial problems the state currently faces: not enough psychiatric facilities.
“I don’t think things will change at all until more facilities open up in this state. Patients will still have to wait in EDs (emergency departments) and on hospital floors waiting for a space to open up, though the number of patients will increase. Costs will increase dramatically.” Boyd understands that funding will be expensive but noted “the issue has gotten out of control and we’re putting Band-Aids on a huge gaping wound and it’s not working.”
Washington has addressed this issue in the past year. The Washington state Supreme Court made it unlawful to board psychiatric patients temporarily in hospital emergency rooms just because there isn’t space at certified psychiatric treatment facilities. The ruling was made after the court found that holding patients in settings that don’t provide individualized psychiatric treatment violates the state’s Involuntary Treatment Act. However even with the attempt to decrease the number of patients held in emergency rooms, it continues to be an issue. Washington currently has a severe bed shortage, with 18.9 beds available per 100,000 population. If it is found that the patient needs to be civilly committed, and there are not enough rooms at a locked facility there is no choice but to keep the patient longer. The lack of space is a result of cuts the mental health treatment faced during the recession. If the law passes, Washington will need to see an increase in both employees and facilities, causing a dramatic increase in costs and the increased need for funding. This is a step Washington needs to make to improve its mental health laws.
So where should the funding come from? Washington is already set to see an increase in mental health program costs this year. However, the Affordable Care Act made $50 million available across the country to expand mental and behavioral services in 2014. Over the next three years the Department of Agriculture has set a goal of also financing $50 million for the construction and improvement of mental health facilities. It appears that responsibility has been shifted from local governments to the federal government, with Medicaid accounting for more than 55 percent of mental health programs provided. Although funding should come from a federal level along with at the state level, it should be the job of the state to prioritize its mental health services.
Unfortunately, it is not clear where funding will come from. But the bottom line is that Washington needs to improve its mental health laws. The bills’ passage is the first step out of many needed to fix our mental health system. A temporary solution could be to reevaluate the disbursements of other health programs. Although in result this may cause other programs to face cutbacks, Washington will make a step toward a way-overdue process that in turn may fix other underlying issues.
The passage of these bills alone will not completely change the system but it will be the much needed door-opener.
Ashlynn Notoa lives in Snohomish and is studying health care at Everett Community College.
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