There were 78 mentally ill patients waiting to be admitted to Western State Hospital last week.
If you or a loved one has a serious mental illness, you know the suffering required to reach Washington’s unusually high threshold to even qualify for hospitalization. If you don’t, imagine your mother or son needing surgery on a broken leg, only to be told there are no surgeons available, so treatment and recovery are delayed by a month or more. Imagine the anguish of unrelenting depression and the instability of untreated schizophrenia.
The despair of these humans demands collective action out of Olympia. When the Skagit River bridge over Interstate 5 fell in 2013, Gov. Jay Inslee’s administration and lawmakers sprang into action with a replacement. That same vigor is lacking in this human crisis, which could be resolved, at least in part, by a focus on supported housing for people with mental illness.
Problems at the state psychiatric hospital are not new, but they are particularly acute now. A federal judge, due to a class-action lawsuit, has taken oversight of the portion of Western State Hospital that treats patients held on criminal charges. And on the wards treating other involuntarily committed patients, federal auditors have effectively assumed control with a stringent reform plan after finding repeated incidents of “immediate jeopardy,” including patients’ deaths.
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On June 27, a very frustrated Pierce County Superior Court commissioner, Craig Adams, added to the pressure, threatening to stop signing orders to commit patients civilly because they were routinely being ignored.
This is a moral crisis and fiscal mess with shared blame. Gov. Jay Inslee bears responsibility for the hospital’s management dysfunction under his administration. Lawmakers share blame for routinely underfunding the hospital.
One of the paths out of the mess is to put a sharper focus on Western State Hospital’s exit door, which is equally clogged.
Though 78 wait to get into the hospital, more than twice as many patients are ready for discharge. Currently, about 165 patients linger with no medical reason to stay but no appropriate place for them to go, and they wait an average of 176 days.
Do the math: At a cost of about $600 per bed per day, the bloated “ready for discharge” list is a financial boondoggle — about $100,000 a day for medically unnecessary care. Add up all the days spent on the list, and the patients represent an astonishing waste of more than $17 million.
In 2013, the Legislature recognized the need to create better options for people ready for discharge. It funded a new type of nursing-home license to take patients with dementia or brain injuries whose needs were too severe to qualify them for traditional options.
Those specialized facilities are just now coming on line — two years past the original due date and at 50 percent above the estimated cost. Instead of the 42 beds funded by the Legislature, there are now just 20. Those are already full and are barely making a dent in the “ready for discharge” list. Instead of waiving regulations and finding funding — as happened with the Skagit River bridge — these facilities fell into yearslong bureaucratic sausage-making.
Inslee should be taking the lead on this crisis. But the governor vetoed key portions of a bipartisan reform bill passed by the Legislature, and his administration did not even bother to send a top executive from headquarters to Monday’s hearing called by Adams, the Pierce County commissioner.
The Legislature must also continue to prioritize solutions and heed the calls for better-supported housing for people with mental illness. A special committee created last year is digging in, but months into their work, the committee has yet to gain traction in the complex morass.
At that hearing last week, Commissioner Adams noted lawsuits in 1982 and 2008 against Western State Hospital with similar facts as today’s crisis.
Each day of this crisis, lives are lost to illness and human suffering extended. If people were freeway bridges, an emergency fix would already be on the way.
This editorial was originally published July 3 in the Seattle Times.