Psychiatric Boarding Illegal in Washington State: Now What?

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Laura Umetsu, Editor in Chief

Earlier this month, the Washington State Supreme Court ruled that psychiatric boarding (the practice of keeping patients strapped to beds for up to a week in hospital emergency rooms without adequate treatment) is not only unethical, it is clearly illegal under Washington law. Civil liberty advocates who brought the suit cheered as hospital staff members across the state began their scramble to find a humane way to comply with the ruling while simultaneously complying with their personal and professional medical ethics codes, in addition to federal law. In the case of conflicting state and federal law, federal law governs.

According to federal law, under the Emergency Medicine Treatment and Labor Act, it is illegal for doctors to release patients into the general public if they are a clear danger to themselves or to the public. Yet being a clear danger to themselves or to the public is the case with the overwhelming majority of hospital emergency room psychiatric patients. Beds at both of our underfunded state psychiatric hospitals (Eastern and Western State) are extremely limited, and harried medical providers often feel pressured to release very ill patients in order to make room for incoming new patients who are even more severely ill: a tragic game of mental healthcare musical chairs. Taxpayer funded budgets are still limping along in the aftermath of the worst recession in living memory for most. Though the death of Robin Williams sparked an unprecedented national dialogue on the need to eradicate the stigma of seeking help for mental illness, the stigma remains painfully salient for those suffering from their invisible wounds.

This pervasive stigma, coupled with limited budgets, bedspace, and healthcare providers, currently make reformation of our current mental healthcare system to allow for compliance under the new ruling very tricky, if not impossible.

Though on its face, psychiatric boarding seems inhumane, the alternative (allowing severely mentally ill citizens who are a danger to themselves or others to fend for themselves in the streets) is even worse. Without an increase in state budgets or reallocation of resources for more innovative and cheaper methods of treatment (such as telepsychiatry), the fate of the state’s mentally ill will only get worse (as will the state’s expenditures for caring for them when they destabilize).

One in four American families suffers from a severe mental illness. The derivative negative toll on family members, caretakers, and healthcare systems of untreated or inadequately treated mental illnesses due to stigma and lack of resources makes access to adequate mental health care one of the most pressing and underfunded needs in our overall healthcare system. These Americans are your friends, your coworkers, and your family members. To love them would be to advocate for the expansion of the state budget to allow for exploration of alternative treatment plans and an increased overall mental healthcare budget as the deadline for compliance with the State Supreme Court’s ruling draws near.

Laura Umetsu is a disability rights advocacy attorney residing in Seattle, Washington. Ms. Umetsu is a 2008 graduate of the Michael G. Foster School of Business who focused on project management.

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