Editorial: Fix county’s mental-health revolving door, standards
Blown deadlines for psychiatric commitment are in excusable, but they are also no excuse for patients to be dumped on to the streets, without treatment.
Seattle Times Editorial
AT the moment you read this, a seriously ill person somewhere in King County is probably lying in an emergency room, maybe strapped to a gurney, waiting to be evaluated for involuntary psychiatric commitment.
It happens too often, and the frequency is increasing. Since 2009, filings for involuntary psychiatric commitment in King County jumped by nearly a third, from 2,451 to 3,477 cases last year.
There are too few beds for these patients, and too few treatment resources to maintain their mental health. As difficult as this task is, it will get harder after July, when state law changes to expand criteria for involuntary commitment.
On Sunday, The Seattle Times documented the crushing consequences of an overburdened system. State law requires evaluations for commitment to occur within 12 hours, but that deadline is routinely blown, according to a snapshot of previously undisclosed data gathered at the request of The Times.
When that happened, seriously ill people were allowed to walk out of a hospital without treatment, even if they presented a potential threat to themselves and to the public.
Fixing this problem must be a priority for King County’s mental-health system. King County evaluators have caseloads one-third larger than Snohomish or Pierce counties. Jim Volendroff, the new head of King County’s mental-health division, agrees, and said he is hiring two assessors and has authorized overtime to ensure no more deadlines are missed.
But most important, King County Superior Court judges who hear involuntary commitment cases must act sensibly. Long-standing case law dictates that dismissals should occur only if mental-health staff have “totally disregarded” the process.
It is difficult to believe that high standard is routinely met. More likely, judges are relying on a technicality to dismiss commitment petitions, without fully considering the consequences.
The 12-hour rule first became law in 1973, two years before “One Flew Over the Cuckoo’s Nest” cemented the public’s dim perception of psychiatric hospitals. In that era of deinstitutionalization, a 12-hour rule was intended to avoid psychiatric patients from being dumped into hospitals.
Four decades later, the U.S. has allowed the number of psychiatric hospital beds to shrink too much, and failed to fund a robust outpatient mental-health system. An overly legalistic reading of the 12-hour rule has resulted in a sad perversion of deinstitutionalization: Instead of being dumped into hospitals, patients are dumped to the streets, without treatment.
Editorial board members are editorial page editor Kate Riley, Frank A. Blethen, Ryan Blethen, Sharon Pian Chan, Lance Dickie, Jonathan Martin, Erik Smith, Thanh Tan, William K. Blethen (emeritus) and Robert C. Blethen (emeritus).