OPINION: State Lawmakers Seek the Wrong Answer by Demanding More Mental Health Beds

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)

20 thoughts on “OPINION: State Lawmakers Seek the Wrong Answer by Demanding More Mental Health Beds”

  1. Great article. Another “angle” on this issue is the real budget. Not for mental health *treatment* but for construction dollars and tax credit schemes funneling tax dollars to wealthy, union paid, mostly males. How much goes to pay the salaries of the social workers? We pay the wealthy up front, but force nonprofits to do a yearly dance for dollars. How long are our tax dollars going to go into the banks and big building industry? Follow the money. Dig in. It is quite a ride. Available to help. signed, former CFO of Hopelink, federal auditor +.

    1. Hi Sally, Thanks for your offer! You make some good points especially regarding the non-profits and their struggles. Come 2020 the state’s Medicaid program will be fully integrated – behavioral healthcare together with primary care. It’s already happening in some parts of WA, with King County integrated as of Jan 1 2019. The goal is to save money and maintain quality. That could be good if we are sure to watch where the “savings” go. I vote for reinvestment into the community rather than all profit to the companies. First we have to see what the gov’t has promised the companies. Denial of treatment as a way to cost-save needs to be watched like a hawk or we, patients, could be in big trouble. Let’s see what comes out of the legislature on those issues!

    2. What I’m hearing for Behavioral Health Care is central forensic beds for CMI and beds for community behavioral SMI.

      Good Evening. Putting People First, Keeping People First.
      4:00 P.M. Friday, March 22, 2019. In process, Senate Republican Caucus News conference In Washington, our home, at Olympia TVW.
      Spirit of bi-partisanship raising its voice. Cautiously optimistic, (Gene’s note). Homelessness/Affordable Housing/Behavioral Health values being addressed. Stop pollution initiative in Pend Oreille County, (Gene’s note). Lack of effectiveness stops, Yes. The buck stops here, Yes. Better ideas, Yes. What are the outcomes, Yes. Safe addiction-eradication medication sites for patients, Yes. Drug dealers placed in protective custody, (Gene’s note). Preventive Public Policy, Yes. Republican mindset seemingly changing for the better, (Gene’s note). Pay attention to the rank and file, the troops, the frontline, Yes. Values. Values. Values (Gene’s note). 10-15 year process? Really? Values, not issues, (Gene’s note).

  2. Much of the mental health crisis in the US today is due to the escalatinng inequality over the last 40 years. Just read Wilkinson and Pickett (“The Inner Level”). To reverse this we need to take on Wall Street and the billionaires. In this state we could start with a strong capital gains tax and use some of the funds for more and better community mental health facilities.

    1. Agree that real budget is one issue to examine before action is taken.
      Another issue is the legislature is moving in the wrong direction supporting involuntary treatment with no legal representation and forced drugging and electro shock. The hospitals, the treatment is all moving forward without liking at evidence practices that are shown to work. We keep hearing that Washington is 48 out of 50 states in psych beds. There is no evidence for that, no studies.

    2. Agree that real budget is one issue to examine before action is taken.
      Another issue is the legislature is moving in the wrong direction supporting involuntary treatment with no legal representation and forced drugging and electro shock. The hospitals, the treatment is all moving forward without looking at evidence practices that are shown to work. We keep hearing that Washington is 48 out of 50 states in psych beds. There is no evidence for that, no studies. Also in this post Americans with Disabilities Act (ADA) era, it is a huge mistake that peers with lived experience were not involved, not welcomed to the stakeholder planning table. Nothing About Us Without Us is an important saying in the disability movement. Any affected marginalized group should be a significant part of planning laws and policies that affect them.

  3. There is just so much that is wrong with this article. #1 is it is just speaking for the needs of the moderately mentally ill. #2 is that you equate “beds” with great big mental health “institutions.” Local hospitals, like Harborview, Navos, Swedish, Fairfax, etc.,serve a lot of the ill in our area. You are glorifying the Kennedy-era push for releasing people from large institutions, in favor of local sites that would serve them……it never happened! No money was allocated for this, so the Seriously Mentally Ill (SMI) became homeless. It was a romantic theory, supposedly kind to the ill, but really a disservice. Another sad event that happened in WA state in 2008 was that money was taken from all kinds of Social Services to balance the state budget, including Mental Health services. It’s only now being replaced. Just ask parents of the SMI (bipolar, schizoaffective, schizophrenia, and severe depression), who attend local NAMI meetings, if hospital beds are needed! It’s the shortage of beds that makes it hard to find a spot to begin treatment and keep them long enough for the meds to start to work. 50% or so of the SMI have Anosognosia, inability to understand they are ill & refuse treatment. The evidence-based needs of the SMI, who are difficult to treat, are these: more hospital beds for treatment, more supportive housing, more outpatient treatment with accoutability, more psychiatrists who will take Medicaid patients. Please read DJ Jaffe’s “Insane Consequences: How the Mental Health Industry is Failing the Seriously Mentally Ill.” His book is full of data.

    1. I appreciate the free press and the dialogue. I remember the old days when you had an OpEd printed and maybe one or two letters to the editor would get published. Now we have ‘automatic’ letters for the writers to tackle. Let me give this a try…

      Thank you for sharing the comment. I’ll give it a try.

      My article with J. Bertram presents part of the history of the behavioral health field as it pertains to the current “transformation” underway with legislation in Olympia. We believe giant steps will be taken backwards (think back wards, even). Olmstead stemming directly from the ADA mandates us to look at providing the least restrictive environments. More resources are being proposed for institutions than what is needed in the community. We know this because there are now at least 200 patients at Western State Hospital (also an institution) who have been deemed ready for discharge but cannot get out. Housing and services are not able to be found for them. (I believe they can be found but that’s a whole other story.)

      We note there are various perspectives on the Kennedy era and mental health. Yes, you have one.

      In the 1980’s people with mental health issues who became homeless did as a result of failed housing policy. The Robert Johnson Foundation Program on Chronic Mental Illness was funded in part to pair up housing (desperately needed at the time and still is) with model services. https://www.rwjf.org/en/library/research/2000/01/to-improve-health-and-health-care-2000/the-program-on-chronic-mental-illness.html

      Yes, there was a recession in 2008. We still talk about it, however, we have emerged from it and ought to bring our behavioral healthcare system up to par and based on factual data and reputable studies. We have yet to see how legislation in this area was crafted and what information was utilized (or not) to make those decisions. As a Washington resident who cares about services and practices that help rather than hinder – I want to know.

      As a fair-minded person, I remain at a loss as to why the Governor, legislators, and others declined to involve people with mental health and substance use issues in the development of the ‘transformation plan’ for behavioral healthcare in Washington. Did you know that 2019 marks the 20th Anniversary of the U.S. Surgeon’s Mental Health Report? It was the first and so far only report from that prestigious office. In that report are sections prepared by peers and family members and many reviewed sections for the scientific editor – that was a first for a report of this nature. More importantly, no one ignored or argued their inclusion. So tell me, how come Washington state left out the voices peers? I appreciate that you may not be curious, but I certainly am.

  4. You haven’t posted my comment yet, disagreeing with your premises here….hm-m-m. One addendum: the new “institution” for the severely mentally ill is now JAIL. We do need more beds to keep people out of jail, since they have an illness. check this out: http://www.peteearley.com/2019/03/04/another-step-toward-making-jails-into-treatment-centers-why-thats-wrong/?fbclid=IwAR3GfuZvAVJ3Q8d2cKWbteiraXBxugPDGEEpigNvoNV4LEdmUxq48F7JEmo

    1. South Seattle Emerald does the posting. I hope you can google Trueblood Settlement. It addresses your point about jail.

      We can all agree jail is a terrible place to get well.

      I am very familiar with Mr. Earley’s work.

    2. Of course jails are not the place for people with significant behavioral health disabilities. Housing in the community with services and supports IS the place and that should center around peer services. Psychiatric hospitalization must only be by consumer choice. Forced treatment is unlikely to work and may cause more serious trauma and behavioral health disabilities.

      I get that family members want control over adult relatives with behavioral health disabilities. They are desperate enough to lobby for forced incarceration and treatment of adults. And they may well convince the legislature which will have huge human costs for patients undergoing forced treatment and huge financial costs for taxpayers and voters.

      It was so sad that the son of the Director of MOMI chose suicide. I am sorry for her grief. But perhaps it is sadder that this individual tragedy is moving many legislators to say they will vote for these expensive policies based on emotion and no evidence. They will cause so much suffering for many with behavioral health disabilities and all taxpayers.

      The forced treatment and building of 8 hospitals are companion bills because they must fill all the extra and unnecessary beds with people forced into treatment in order for reimbursement and financial feasibility.

      1. As far as I know Jerri Clark’s son has not committed suicide. Perhaps you should fact check that assertion. Do you have a loved one with serious mental illness? You don’t bother to explain in your Op-Ed that one of the criteria for involuntary treatment is being a danger to yourself and others. Psychosis is dangerous to the person experiencing it and to the community in which the person lives. Housing is not enough to help people with psychosis and while people are experiencing it they are not able to make decisions about their care that will keep them and others from harm. Many people with serious mental illness do end up in jail and they can be moved from jail to the hospital if there are beds available. They get sent to the first available bed so they end up in different facilities in many different cities and counties. They do not get doctors who have treated them before or know their history. They do not get enough time in the hospital to get stable. This is a lack of parity, or more bluntly, discrimination in health care which a lack of psychiatric hospital beds is a major contributor. Based on my lived experience with a loved one with serious mental illness I sincerely believe you and your co-author have somehow been misled about our mental health care system and you are now misleading others. Please don’t judge our pain as less than your own.

      2. You were correct. I just learned that Jerri Clark’s son has died. I hope everyone will read her accounts of the struggle to get treatment for her son, watch the videos of her media appearances, and try to understand how much discrimination and lack of services the seriously mentally ill and their loved ones suffer. More psychiatric hospital beds are definitely a major part of reducing the suffering and keeping people alive.

  5. Janine, you said, “Forced treatment is unlikely to work and may cause more serious trauma and behavioral health disabilities.
    I get that family members want control over adult relatives with behavioral health disabilities. They are desperate enough to lobby for forced incarceration and treatment of adults.” If you were a regular attendee of NAMI meetings, you would hear many sad stories of loved ones who had Anosognosia (lack of insight) and how dangerous they have been to their parents trying to shelter them, and many other relieved stories about how much better the Seriously Ill are doing after Involuntary detention and treatment has worked via a Psych hospital. Hospital social workers help the ill apply for SSI, and can help look for supportive housing. It’s a disease that requires a long time to “recover,” so Assisted Outpatient Treatment is needed. You are not advocating at all for the 3% Seriously Mentally Ill who need SO much help, since they did not CHOOSE this illness that’s chronic, often can’t recognize it or CHOOSE to treat it in themselves.

    1. When I attended NAMI much of the discussion was to help family members deal with co-dependence. I imagine there are some situations like you describe. Violent acts must be controlled. I agree. But danger to self gets into a blurry area that becomes locking up adults and taking away their rights There are also a plethora of examples of individuals locked up and forcibly drugged who live with lifelong horrors, trauma and PTSD and even kill themselves because of it.
      Washington legislators are planning to pass bills that are a huge cost to taxpayers and rather than transform mental health they are setting us back to the early 1900s.

  6. Ms. Karenselander:

    There does not seem to be a way to comment directly under your two comments, so I hope you see this from me. I’m the primary author of the article and while Janine and I come from different “peer” experiences, we both share a common belief that if we accept what we’ve got we will get nowhere. And, that idea is not wholly related to the behavioral health care system, but to life as well.

    Yes, Ms. Clark’s suffered a loss many of us cannot fathom and we owe a debt of gratitude to her for her advocacy and persistence to not accept what we’ve got. I have sent condolences to her along with many others in public hearings and online. Many applaud her efforts in a relatively short period of time for a budding organization. She and I have corresponded and I believe we agree to disagree with a great deal of respect.

    I have spent the better part of 35 years working in the field and now I volunteer. I have had personal challenges with mental illness and mental health. When I was just 17 I was told I would never work or have a “normal” life. That is what happened to young people when they suffered a major break. I’ve been institutionalized several times and while I can count those times they were horrible experiences where I didn’t think I would get out alive. My most recent hospitalization was only 30 days (some say 1 day is long enough) in a psychiatric ward of a general hospital. I slept on and off for 30 days. That is what I needed and the hospital allowed it. I had been homeless and sleep was what I needed. I ate and took medication but it was sleep that I felt healed me. I still use mental health services and have a doctor and amazing therapist. But what helps me now is community support and all that goes with it: family, friends, Clubhouse, meaningful volunteer work, and you know – all the rest most people enjoy.

    It is extraordinarily disheartening that Janine and I put out there for the universe our opinion and you say we are misled by some amorphous being. Well, these were our ideas based on our experience in the field, literature and research to back up our assertions, and well, a bit of common sense. Most people with behavioral health care challenges want their lives back when they recover or even reach a modicum of recovery. That is healthy and an expectation of most helping professions.

    I appreciate your insistence that I/we understand the plight of families. I have a family and while I cannot speak for them, I know in my heart they have grappled with the very issues you describe. These matters are not easy – no one said they were – but we must be vigilant to ensure people with mental health issues are not relegated to lives of despair either.


  7. Thank you for your comments and the dialogue. Janine and I encourage an ongoing dialogue on these and other issues but we will not be responding to future comments about this OpEd in this online forum. We greatly appreciate the opportunity to have been published in this excellent community information source. Thank you! ~ Laura Van Tosh