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Originally published Tuesday, January 21, 2014 at 5:40 PM

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Guest: Psychiatric boarding of mentally ill needs to end

The epidemic of boarding of people with severe mental illnesses in hospital emergency rooms needs to end, writes guest columnist Eleanor Owen.

Special to The Times

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THERE are striking similarities between patients who have severe mental illnesses and Washington state’s mental-health system. Both struggle to survive; both reject reality.

The similarities are apparent to me as the mother of a son with schizophrenia and as someone who has advocated for changes to mental health care for almost 50 years.

These parallels have become clear after learning about the shameful epidemic of boarding people with severe mental illnesses in hospital emergency rooms, many often strapped in restraints and injuring themselves trying to get free.

For people with mental illnesses, it appears that the internal force of a delusion seems too powerful, the threat too terrifying, the will too frail to grasp reality. Thus actions are often taken that result in irreversible harm to the self or others.

Likewise, the prevailing delusion that all people with mental illnesses can be appropriately treated in the community is too powerful to openly question or challenge, and the specter of institutionalization is too threatening.

Too many of the most severely ill end up in jail and prison; all too often it’s after doing irreversible harm to self or others.

Most disturbing, while inexcusable and permanent harm persists, there are no villains. No one is to blame. Not the victim of the illness, not his or her family and not those who provide needed services.

Almost without exception, my personal observation after nearly half a century is that everyone involved is knowledgeable, hardworking, intelligent and compassionate. Everyone wants to do good.

When jails and prisons are overcrowded by people with mental illness, the Department of Corrections pleads for “public safety.” And the Legislature responds; limited funds are shifted from some state hospital budgets to fund prisons and jails.

Currently, needed wards are being closed at Western State Hospital while funding is being sought to add more beds at Monroe and Walla Walla state prisons and boarding continues in community hospitals. Does this make sense?

Future historians will say, “For shame, America, for shame. Is this a nation that spends more money on mental illness than any other industrialized country, yet straps patients down in emergency rooms for days, and routinely sends them to prison rather than care for them in hospitals?” Why? Because reality is denied.

Similar to other illnesses, mental illness spans a wide range of symptoms. Many individuals with mental illnesses can and should be provided support and treatment in local communities and local hospitals. However, it is time for everyone involved to re-examine their biases. More patients need treatment at a state mental hospital.

Why do most community providers perpetuate the myth that state psychiatric hospitals are like those of 75 to 100 years ago? They aren’t. And, statistically, patients receive no more one-on-one care and no more visitors at local community hospitals than they do at Western State Hospital.

A weekend, a two-week stay or even a month is not enough time for a person with major paranoia or other possibly harmful delusions to get stabilized on the right medication or to gain sufficient insight to live peaceably outside of a structured treatment program.

And there is yet another incentive seldom mentioned, but equally harmful. The incentive to keep “good customers” forever. The current system fails not only those who are most ill, it also fails those most able to move on and become productive members of our community.

It is time to stop bad-mouthing state hospitals. It is time for the Legislature to fund skill building and job incentives so fewer individuals need to remain dependent upon perpetual support.

It is time for regional support networks and community providers to give up their fantasies and acknowledge the need for state hospitals. Most important, it is time for citizens to demand the reversal not only of boarding persons in emergency rooms, but of the criminalization of persons with major mental illnesses.

It is time for everyone to face reality.

Eleanor Owen co-founded the Greater Seattle, Washington state and National alliances on Mental Illness.

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