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Originally published Thursday, December 25, 2014 at 4:05 PM

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Editorial: As psychiatric boarding ends, work remains

The end of psychiatric boarding should show policymakers that our mess of a mental health system is not some unsolvable riddle. It takes money, and will.


Seattle Times Editorial

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PSYCHIATRIC boarding officially ends Friday. Good riddance.

A state Supreme Court ruling in August found the state’s practice of boarding unconstitutional. That is the temporary warehousing of involuntarily committed mentally ill patients in hospital emergency rooms until a too-scarce psychiatric bed can be found.

That practice often involved strapping patients to gurneys without treating their acute psychiatric crisis. It allowed the state to strip away a person’s liberty and dignity without offering real help.

The Supreme Court agreed to delay the ruling’s implementation until Dec. 26 because the practice had become so routine — so embedded in the failing mental-health system — that to remove it would create chaos.

Incidents of boarding skyrocketed by more than 400 percent since 2009 in King County, the epicenter of the practice. Two out of every three peopleinvoluntarily committed in the county were boarded.

Since the Supreme Court’s bold ruling, at least 134 beds statewide have opened, reversing a decadelong downward trend. At least 64 more beds are scheduled to open next year, if enough trained staff can be found.

Is that enough? Mental-health experts are unsure.

All that progress and about $15 million in emergency spending by the Department of Social and Health Services at least mitigate the immediate crisis in mental-health care.

But these efforts do not address fractures in the mental-health system that result in a rising number of people needing emergency inpatient care.

The state system is inefficient enough that, on average, it takes 23 days for a Medicaid patient discharged from a community hospital to get reconnected to therapists and case managers. Nearly one in five gets no services at all after discharge.

That means government spends thousands of dollars getting a patient healthy and then allows them to drop off the map, sometimes directly into homelessness. It is the definition of inefficiency.

The end of boarding as a routine practice should also make policymakers reconsider why it was allowed to fester in the first place. Allowing Washington to drop to near the nation’s bottom in psychiatric beds was an obvious wrong, but state resources were spent elsewhere.

The work to end boarding should show lawmakers and elected officials that our mess of a mental-health system is not some unsolvable riddle. It takes money, and it takes resolve.

Editorial board members are editorial page editor Kate Riley, Frank A. Blethen, Ryan Blethen, Mark Higgins, Jonathan Martin, Thanh Tan, Blanca Torres, Robert J. Vickers, William K. Blethen (emeritus) and Robert C. Blethen (emeritus).



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