IN a very recent story of less than a week ago, entitled: “Washington accrues almost $7.5 million in contempt fines,” written by Martha Bellislea of the Associated Press published in many major newspapers across the country, the sad story of the travails of Washington’s Western State Hospital continues to showcase the plight of a number state public psychiatric hospitals.
The state of Washington has now been officially fined almost $7.5 million for failing or being unable to marshall sufficient restoration to competency to stand services to mentally ill people charged with crimes. This large nationwide now, group or legal “class” of people are found in every state and with few exceptions their clogged state systems dictate that they wait in jails for weeks or months beds are open for them in state hospitals to receive evaluations or treatment for restoration of declaration that they are incompetent to proceed to trial.
An unusual crusader if I can use the term has arisen over the past year and a half in the legion region of Washington: U.S. District Judge Marsha Pechman. She has taken the lead in holding the state with a progressive governor all too aware of this slow-motion crisis that has been developing, as in many states for 10-15 years. At its simplest this many state crisis has been caused by money saving, ill-advised mental health reform efforts operating through the misguided but economically forced downturns in states’ budgetary revenues, and subsequent cutting of beds wholesale of public psychiatric hospital beds under the new over used mantras of “least restrictive environments,” and “de-institutionalization. As a practitioner I see few instances of patients who become “institutionalized,” and instead hold that this population is not what was pointed to in the 1950’s on, as the compelling social reason to discharge long-term seriously mentally ill from state “institutions.” This patient cohort today exists in every state hospital and are so disturbed, “treatment resistant,” to nearly all medications which only afford the very partial moderation of their psychoses, are who we are talking about today. And the “least restrictive environment is a concept I dearly believe in but does not still largely exist in the community for such patients. In truth only comprehensive full service, secure state psychiatric hospitals can come close to containing and managing these patients. In fact, to go even further, it would serve this entire national debate to debunk and see through the lack of applicability or even truth of the driving ideology of “institutionalization,” as it is conceived of as something that we do intentionally harmfully or tacitly/unintentionally to the chronically psychotic, to make them unsuitable for living in the community.
So as has happened in some many other arenas such as product liability, e.g., the tobacco lawsuits and settlements of past years where governments would not take action, the legal profession has had to rise to the occasion of addressing a growing national crisis that state governments find themselves powerless to take on and correct.
Reading Judge Peckman’s history in her efforts to take on the deficiencies of Washinton’s state mental health system mess, shows how one individual has started to force a seemingly paralyzed governmental body into addressing and ongoing week by week disaster that in the words of a former medical colleague of mine, “just keeps on giving.”
Western State Hospital over the past two years has a distressing record of escapes of several dangerous prisoners/patients causing national headlines. A few years ago working conditions were so bad at the hospital with overloaded cases loads and such, that professional staff. psychiatrists, nurses, psychologists fled the hospital in droves and went to other psychiatric position such as the state’s VA hospitals and elsewhere. Staffing shortages increased dramatically as Western is in a not so big town/city, Lakeland, and the labor pool was small to begin with. Line ward staff had to start working mandatory overtime and staff injuries increased. Hospital and CEO’s came and went over the last few years like paper airplanes in the wind, taking these thankless jobs, trying to turn things around and being fired for the latest crisis that made the headlines in the news media with each new crisis. The CEOs I felt very sorry for and in my mind they were the mental health equivalent of major league baseball managers of pro teams that performed poorly, and their managers, of course, were fired as supposedly the cause for failure.
The latest and current CEO of Western is in my mind a very brave and dedicated public servant who has long worked in that system and accepted the “dangerous to one’s career,” position as CEO. Months earlier this year she was threatening with contempt of court when she could not guarantee the prompt admission of a patient/prisoner needing admission and restoration to competency treatment. The hospital was beyond full and there were no beds. Fortunately, all parties pulled back and did not jail her. But that incident showed the desperation and untenable state of the system there.
But still not much was done nor was changed and the deficiencies remained. Beds were in short supply since the hospital had had to close approximately a hundred beds back when there was the partial exodus of professional staff. So Judge Peckham finally I guess, had enough and lowered the judicial-economic gavel down on the state of Washington. Of course she no accolades for doing so, and I expect in certain beleaguered circles was roundly vilified for being too activist and exceeding her authority and so on. Her economic penalties were not small, starting at $2.3M.
The legal groundwork for such penalties had started with citizens’ rights organizations such as the ACLU and Disability Rights Washington suing the state way back in 2014 to correct the excessive wait times for servicing this special patient population. So this was not initiated by Judge Peckham but in a sense forced upon her too as time dragged on, and so to speak, very little corrective action appeared anywhere in the state bodies responsible for, well, running the state.
The basis of the legal actions and rulings go back to a concept in my mind of a “right to a speedy trial.” The lawsuits brought cited excessive waiting times in local jails, community hospital statewide not equipped to perform such specialized services or more commonly, such patients’prisoners being held up in country jails for months on end. This logjam strained the budgets and manpower staffing abilities of jails who were in effect truly turned into mental hospitals and completely ill-equipped to manage psychiatric illnesses as are most jails with the exceptions of the largest jails in the country such as Harris County Jail in Houston who have their own psychiatric sections and now I think, at last count, FIFTEEN psychiatrists, and over 60 psychiatric extenders to cope with the more than 2,000 mentally ill prisoners they have relegated to them from the metropolitan Houston area alone.
Judge Pechman gave the state of Washington’s Department of Social and Health Services last year, until January 2016 to fix the issue, so there is a long time frame that has been in place to institute corrective action but it has come to naught. The Washington Governor has made a valiant effort to try to start commendable reforms and remediations but the perpetual stumbling block of the Legislature and many financial legislative issues have forestalled more than a modest start, but as they say, “at least it is a start.” So in July, 2016 Judge Peckman acted and imposed the fines officially and by this past month they now total as of Dec 14, 2016, some $7,486,550 by media reports.
The starts that have been made, are such measures as hiring 19 additional “evaluators,” and adding 96 beds in four different facilities finally. Some progress is measurable to note the positive news in all this. Waiting periods for entry into the restoration programs have shrunk to a few weeks instead of months.
But much more will have to be done. And this is a telling example, that many observers nationwide will be watching carefully, as judicial action forcing what should have already been done in the past decade or so at least. It would not be surprising to see more judicial interventions taking place if the growing national problem in just this one sector mental health care service delivery continues to be such a serious problem.
The Mental Health Reform Blog 