(Oct. 8, 2014) For more than 20 years, I have watched a family member ride the roller coaster of Washington’s mental-health system. This has included countless stints at most of the state’s psychiatric hospitals, arrests, incarcerations, suicide attempts and victimization of others.
For short periods, especially while under court order, there were times of wellness. My family member is part of a subset of the mental-health population that is severely ill and hard to treat due to frequently disregarding the need for treatment.
The Washington public mental-health system has never been able to provide proper treatment for my relative. Partly, this is because Washington’s legal criteria for mandated inpatient and outpatient psychiatric treatment are, quite illogically, the same. The other reason is that Washington lacks enough inpatient psychiatric treatment beds and a budget to fund them.
Budget permitting, the current laws mandate a crisis-oriented system. If a person is severely mentally ill and unable to realize and manage it due to the illness, the roller coaster is a way of life.
The only way a person can be court-ordered into less-restrictive outpatient treatment in Washington is after reaching the point of inpatient hospitalization or after incarceration.
No system in Washington exists to ensure that the small subset of mentally ill people prone to dangerousness receive mental-health care if the need exists on a continuous basis. No legal avenue exists for concerned others to petition for those in need to receive such services.
From a taxpayer perspective, incarceration and hospitalization are financially costly. From a citizen perspective, there are other costs.
In 1999, New York state effectively addressed the issues that Washington has yet to. Kendra’s Law, legislation backed by National Alliance of Mental Illness, is named after a woman pushed to her death by a man who was severely mentally ill.
Kendra’s Law differentiates the legal criteria for mandated outpatient treatment with a petition process. Concerned loved ones and professionals can petition. Stringent criteria must be met. The criteria include, but are not limited to, a person having severe, untreated mental illness and a history of risk to self or others. The people who qualify for treatment under Kendra’s Law account for about 10 percent of very ill psychiatric patients. Left untreated, this 10 percent makes up about one-third of the homeless and nearly a fifth of incarcerated populations.
In Washington, the question that seems to come up most often regarding Kendra’s Law is: What about civil rights? There is not much further a person can be limited regarding civil rights than incarcerating them or placing them in an inpatient setting involuntarily.
Also, Kendra’s Law does not mandate medication. And Washington state is already doing what New York is, but only after use of more restrictive means. Regarding my observation of wellness cycles of my relative, studies of Kendra’s Law indicate that the very presence of a court order may be a critical ingredient of its effectiveness.
Multiple independent studies of Kendra’s Law show reduction in inpatient hospitalization, homelessness, arrests and incarceration among participants. Costs to New York’s mental-health system decreased by 50 percent in the first year after legislation of Kendra’s Law and continued to fall in following years.
Washington needs to take a cue from a cost-saving legislation like Kendra’s Law. Washington also needs to work on funding psychiatric beds and jails, reducing recidivism, increasing public safety and saving people from self-harm.
Kendra’s Law has proved to do all of this. Washington needs solutions to the mental-health system’s inability to meet the needs of those who are most ill and unsafe while not increasing costs to taxpayers. The solutions exist. Part of the solution is working in New York. It is time for Washington to pay attention.
Jaffee's column originally appeared in the Seattle Times.
Rachel Jaffee has worked in social services for around 15 years, including mental health. She is studying for a master’s degree in social work at the University of Southern California.
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