by Laura Van Tosh and Janine Bertram
State lawmakers in Olympia are debating House Bill 1394 (and its companion bill, Senate Bill 5431), an expensive proposal to build more hospitals with inpatient beds for people suffering from mental health or substance use challenges. This bill has gained wide appeal, and yet it takes a very awkward and giant step backward in terms of reforming what has been called, “a broken system.” We don’t believe our system is “broken” but we do believe Washington State policy makers are on the wrong path, thinking that more inpatient beds are the answer.
The resurgence to fund more inpatient beds takes us back to the years when deinstitutionalization took place. It was the 1960s when President John F. Kennedy embarked on a journey to confront the wrongs of institutionalizing people with mental illness with a new perspective and by suggesting that community-based programs in the form of community mental health centers should be established so people with mental illness could leave the overcrowded and unsafe state institutions to restart their lives in the community with services close to home. Back then, there was hope for recovery and wellness not seen before. Former patients could learn skills, perhaps get a job, go to school, have relationships, and even operate their own mental health and substance use programs. And it happened. There are various historical opinions about why Kennedy’s plan was not a complete success, but most people by today’s standards acknowledge his efforts were squarely headed in the right direction.
This period of reform occurred nearly 40 years before the U.S. Supreme Court decision called Olmstead. In Olmstead v. LC, the most important civil rights decision for people with disabilities in our country’s history, continues to challenge us to think creatively about “community” or “home,” rather than hospitals, beds, and forced treatment. This 1999 United States Supreme Court decision was based on the Americans with Disabilities Act and the court held that people with disabilities have a qualified right to receive state funded supports and services in the community rather than institutions under reasonable circumstances. See olmsteadrights.org for more information.
So, we have President Kennedy, Olmstead, and now we exclaim, “Broken System!” and demand more beds.
How did we end up here? House Bill 1394 is an “act relating to community facilities needed to ensure a continuum of care for behavioral health patients.” The community facilities proposed in this bill are in fact hospital beds for civilly (involuntarily) committed patients for various lengths of stay, depending on the term of commitment.
State government and legislative policymakers believe we need more beds to fulfill the “continuum.” This has been established by policy makers without a clear definition of “continuum” and without involvement from people with lived experience. It offers no exit for people with mental illness. Meanwhile, there are no known validated studies indicating the need for more beds in Washington. What specific data are policymakers using to make this determination? We need to look under the hood, rather than diagnose the problem from what appears to be a high-flying drone.
We are not only concerned with the inherent necessity of the beds but the lack of accountability in the bill. If passed, this bill does not include an evidence-based quality assurance mechanism that would absolutely be required to rigorously monitor patient treatment, safety, and patients’ rights. These issues clearly dovetail with accountability of the use of public funds to pay for the beds.
Last week the federal government decertified a portion of Rainer School, a state-run facility for persons with developmental disabilities, due to several issues mentioned above; and Western State Hospital (WSH) was completely decertified for health and safety issues, including treatment and discharge practices. The decertification at Rainier School could cost the State (taxpayers) $12M in annual federal funding. The state has already lost $53M annually in federal funding when the federal government decertified WSH last year.
Funds lost due to these basic issues could have gone to the development of community-based housing and services people with mental health and substance use issues desperately need. People with behavioral healthcare challenges should not suffer and go without these services, that many say they prefer. The recent decertification of Washington’s state institutions cannot bode well for a state that is banking on the creation of more hospitals and beds to unbreak a broken system.
What never happened over the course of preparing for the legislative session was an opportunity for the Governor to sit and listen to current and former patients about what our ideas are to heal the broken system. Until that happens, we are set back to the 19th and 20th Centuries, when institutionalization was what was “best.” We think Washington State can do a whole lot better.
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Laura Van Tosh is a behavioral health care advocate and founder of the Mental Health Policy Roundtable, and lives in the Central District in Seattle.
Janine Bertram is an organizer for disability rights and justice and is a member of the National Advisory Board for REVUP (Register, Educate, Vote -Use Your Power), and lives in Burien.
Featured Image: Western State Hospital in 1892. (Pacific Coast Architecture Database)