Lawmakers support emergency lockup during a psychotic break, but will they fund it?

Mar 12, 2013

Gun control proposals are having trouble getting majority support in the state legislature. But when it comes to people in a mental health emergency – who may pose a threat to themselves or others -- lawmakers appear more united.

They unanimously approved several measures late Monday aimed at making it easier to hold someone involuntarily.

They have the support of family members who’ve had to deal with a loved one who’s out of control.

One major hurdle remains: the price-tag.

It would cost the state a minimum of about $16 million per year, to add extra psychiatric detention beds. Even that could leave the system woefully underfunded, according to people who manage regional mental health systems.  

A parent's nightmare

High-profile murder cases have put the spotlight on people overcome by psychotic delusions, but a more common and equally sad nightmare faces thousands of Washington parents every year.

Lorena Taylor-McPhail shared her story with the Senate Human Services and Corrections Committee.

Her son, Jordan Anderson, was about 21 when started had his first psychotic episode, she said. He was hospitalized, treated and eventually released. He seemed stabilized at home.

But, a few months later, he went off his medications and started hearing voices. She called 911 and hoped to get him held in the psychiatric wing at Seattle's Harborview hospital, where he had recovered the last time.

“The EMT called Harborview, and they had seven waiting in the ER, and the beds were full,” she said. “So they asked where I wanted him to go, and I felt he had no choice but to go to the closest hospital.”

A mental health professional there determined there was no imminent danger, she said. They released him, and a day later he “committed suicide, by throwing himself out of the Fairmont hotel, on June 13, 2011.”

She told senators her son might be alive today if they could have implemented a law that was approved back in 2010. It prescribes an easier standard to hold someone on an emergency basis. However, that law (SB-3076) was suspended and implementation delayed because of money.

If more people in crisis can be detained, then the state would need up between 975 and 3,104 more psychiatric beds statewide. Each one of those beds requires close supervision by nurses and others, and the process of evaluating and committing someone can run $1,000 in court costs.

So, even though lawmakers voted unanimously to support the policy, and to move the implementation date to July 1, 2014, they haven’t yet found the money.

More crisis beds, less outreach?

That’s not even acknowledging an existing backlog, clogging up hospital emergency rooms around the state, says Amnon Shoenfeld, King County’s mental health director.

“I'm very worried,” says Shoenfeld.

If more people meet the criteria for involuntary commitment, he says, that could simply mean “many more people being strapped down in emergency rooms, waiting for days to get into a treatment bed.”

He’s against making the changes because he fears the state will underfund the treatment beds. People will still end up on those gurneys in emergency rooms, he says, and to cover the costs, local mental health systems will have to cancel outreach programs.

The backdrop is three years of budget cuts to the mental health system.

Advocates for the mentally ill and their families remain hopeful more involuntary commitments might actually prevent problems, which would eventually clear the backlog.

“I know of many folks who, if they get help earlier, are able to come out of their break sooner and more effectively,” says Sandi Ando, who serves on the National Alliance on Mental Illness Washington policy committee.

Video from TVW of Lorena Taylor-McPhail telling her son's story in the state legislature: