Progress in Washington State in Obtaining Emergency Access to Psychiatric Care

Big Strides for mental health reform, but work remains,” published originally May 16, 2015 as an editorial in the Seattle Times, provides some encouraging news in the national efforts, state by state, to improve incrementally mental health services delivery approaches.

This editorial provides a concise summary and history of the development of the current crisis in that state’s public mental health services that have long been coming. Like so many other states, the economic hits suffered especially since the great housing bubble and “Great Recession” hit the funding of public services ranging from state’s higher education university and public education funding to public mental health care resources, mandated huge budgetary cuts nationwide.

Washington state’s Governor Jay Inslee signed “Joel’s Law,” nearly two weeks ago a bill named for Joel Reuter, a bright, young software engineer whose illness made him believe he was shooting zombies when he was killed in 2013 by Seattle police.

Joel’s Law for the first time gives parents or guardians in Washington state finally, the right to directly appeal to judges for involuntary commitment of a loved one, a power previously reserved for mental-health evaluators. As I had commented in another post concerning Wisconsin’s surprising and highly tragic, misguided laws which permits only police to initiate involuntary commitment petitions for emergently needed psychiatric care, Washington had a very restrictive process to allow commencement of emergency psychiatric care.

The Washington Legislature has moved in exemplary fashion to adapt helpful legislation from other states such as New York and California in creating  new programs to allow judges to mandate outpatient treatment in House Bill 1450 for people with serious mental illness. This sort of program has been utilized to great benefit in many states in the last 10 years or so, including my home state of practice, North Carolina involving “ACT” teams which operate on a public health model of providing follow up and on site, meaning in the patient’s place of residence to supervise compliance with reliable of taking of psychiatric medications to prevent relapse into psychosis, and many kinds of social supports, entree’ into day programs, educational pursuits and keeping up even with their routine medical health maintenance.

This kind of proactive assisted outpatient treatment program can overcome the endemic lack of recognition that many of the chronically mentally ill that they indeed have their condition, which causes them to not take their medications, relapse into psychosis over and over, ending up needing otherwise needless expensive re-hospitalizations. These kinds of programs are from the public health model utilized over decades ago in ensuring tuberculosis patients took their daily curative anti-TB medications. Similarly syphilis was reduced from an all too common scourge to a relatively uncommon sexually transmitted infection by use of public health workers who not only tracked down carriers but also were able to utilize legally supported powers of enforced treatment. Somehow these massively protective and effective treatment approaches were lost in the anti-institutionalization fervor that held sway decades ago with the unintended consequences of not providing for effective outpatient public health like treatment models that would have prevented much of the national mental health crisis we confront daily.

But these kinds of programs are expensive as it takes serious money to pay for these outreach workers, frequent health care worker contact etc. Unfortunately the editorial cited above, are not yet budgeted to their needed levels. The Seattle Times pointed out sadly that perhaps only less than half of the projected $9M cost has been budgeted to date.

Joel Reuter’s father, himself notably, a former Republican Minnesota state lawmaker, was quoted concerning the ongoing reform efforts as stating: “It’s a monumental accomplishment to get both parties and both (legislative) bodies on board for this large of a change,” and that “the system here was so broken.”

My sad comment is that in the past year or so, we have had two legislator or former legislator families suffer the deaths of their sons, one due to his psychotic behaviors forcing lethal intervention, and the other to suicide. It took the grief driven but enormously selfless dedicated efforts of these two men, fathers who lost their sons to psychosis, to prod, shame and lead their states toward enlightened action on the behalf of the severely mentally ill and their families to facilitate securing even emergency psychiatric intervention. This goes against the political ethos and ideology that this country has suffered under for the last 30 years; that of cutting taxes no matter the human costs. Hopefully the public is finally catching on to these nationwide mistakes that this cruel approach has cost us in many areas, slashing teachers’ salaries, cutting our investments and support of our stellar state educational systems. All this has been under the banner of the self proclaimed boasting of resisting “raising taxes.” I submit that the time for this cruel shortsighted approach is approaching the end of the time when this was true and needed. But even now in this slow recovery, novel revenue streams are waiting to be enacted and tapped that would not be as onerous as our dogmatic politicians would have use believe. This ideology itself is becoming too costly to maintain for the health of our country in multiple arenas of essential functioning.

It is time for more enlightened leadership that politicians love to espouse but few are able to demonstrate in times of our need.

 

Advertisements

Author: Frank

I am a older child, adult, geriatric teaching psychiatrist with over 30 years' practice experience in North Carolina, first at Duke as clnical teaching faculty, then in Western NC as a primary child psychiatry specialist. I have taught and supervised child psychiatrists and psychiatrists in training and many other mental health professionals and taught at two medical schools. I have served in many public and private practice settings. My primary interest is in observing and documenting the ongoing mental health reform efforts in the State of North Carolina and documenting its sucessess and failures at all levels. My favorite pastime among many others is spoofing my friends and kids with my deadpan sense of humor.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s