NYAPRS Note: An important precedent set in Washington this week may incentivize appropriations to crisis respite and alternatives to psychiatric hospitalization. In NY and in many states, the practice of psychiatric boarding still confounds some urban hospitals who don’t have funds to open more psychiatric hospitals but also have no community connections to assist with the need for treatment. With NY’s efforts to reform hospital payment systems to incentivize community care, programs that keep individuals in mental health crises out of the ER and engaged in services are moving to the forefront.
Washington’s High Court says Psychiatric Boarding is Unlawful
Puget Sound Business Journal; Valerie Bauman, 8/7/2014
Psychiatric boarding – the practice of detaining patients with mental health problems without treatment because of limited psychiatric beds – is unlawful, according to a unanimous opinion the Washington state Supreme Court issued Wednesday.
In a state with too few psychiatric beds, the decision is both a victory for mental health advocates and a problem without a clear solution. The issue has drawn public outcry across the state in the past 18 months, particularly after news broke that some patients were being tied to beds because the emergency rooms and hospitals where they were confined had no way to treat them.
The boarding was taking place under the state’s Involuntary Treatment Act, which allows counties to briefly detain people who, “as the result of a mental disorder,” are at risk of harming themselves or others. These detainments are authorized under “single bed certifications” when a qualified mental health professional deems it medically justified.
But the act provides that each person involuntarily detained has the right to adequate care and individualized treatment.
Despite that provision, many patients were being detained for days without any mental health treatment because the state didn’t have enough psychiatric beds to house them and the emergency rooms or hospitals didn’t have the expertise necessary to treat them.
“This rule does not authorize a single bed certification merely because there is no room at certified facilities with which the county already has a contractual relationship,” the justices wrote in the opinion.
If the rule did authorize such a detainment, it “may violate both the (Involuntary Treatment Act) and constitutional rights of the patients.”
The opinion reveals that Western State Hospital would approve requests for these involuntary detainments without knowing whether there was a medical justification for the individual patients.
The way forward is unclear. If these detainments continue, health facilities must find a way to actually provide the mental health treatment that patients need.
How the state will pay for providing that care will be the next problem.
“Patients may not be warehoused without treatment because of lack of funds,” according to the opinion. This is a de facto unfunded mandate that Washington will have to find a solution (and money) for.
The state has already taken steps on this issue, including spending nearly $5 million in December to create 56 more short-term psych beds.