Some see danger in state mental-health cuts

State budget cutbacks have forced the closure of a little-known but pivotal program at Western State Hospital that allowed difficult psychiatric patients, including those with violent criminal histories, to continue living on its grounds after discharge.

The shuttering of that facility at the end of February followed the closure in January of a 30-bed ward. The cutbacks are a further sign of how state budget cuts are ripping through the mental-health safety net here and nationwide, said mental-health professionals.

"We're in serious trouble," said Amnon Shoenfeld, director of King County's Mental Health, Chemical Abuse and Dependency Services Division, which sends many of its clients to Western when they need long-term psychiatric care.

The lack of beds has meant more people are being held in hospital emergency rooms while waiting for psychiatric beds to open up.

During one week last month, the county "boarded" more than 25 in ERs throughout King County because they'd been declared a danger to themselves or others, Shoenfeld said. "We had no place to put them."

The most recently cut program, called PALS, or Program for Adapted Living Skills, housed more than two dozen former patients no one else would take because of behavioral problems, medical needs or histories such as arson.

Of those, one is now in a shelter and two are living in motels, awaiting benefits to kick in, said Western State Hospital spokeswoman Kris Flowers. Another five were readmitted to Western. The rest were absorbed into their home-county community-health systems, already overloaded.

Meanwhile, a patient who had been civilly committed and previously had threatened his community corrections officer, walked off the grounds at Western State on March 4, fueling concerns among some mental-health and public-safety advocates. They warn that closures and staffing cuts could result in the deterioration of care, potentially endangering patients and the public.

Convicted arsonist Jonathan D. Wilson, 26, walked out of an unlocked door in the gym but was captured in Tacoma the following day, state officials said.

The incident is under review, but Flowers said it was unrelated to staffing issues. Cutbacks, however, have forced the hospital to reduce overtime and juggle staff between units.

Jonathan Rosenblum, with Service Employees International Union 1199, which represents about 4,000 mental-health-care workers in the state, said staffs at Western and throughout the mental-health community have been affected. "Our members who work in state institutions are more stressed," he said. "Members who work in the community are reporting higher caseloads."

The cutbacks at Western are the latest fallout for the mental-health community from 6.3 percent across-the-board state cuts ordered by Gov. Chris Gregoire last October to close the state budget gap.

26,000 people affected

Budget cuts here follow a national trend. According to a report by the National Alliance on Mental Illness released last week, states have cut $1.8 billion total from spending on children and adults living with mental illness since 2009, when the recession began.

An October study by the National Association of State Mental Health Program Directors Research Institute, which tracks spending cuts, also found evidence of increased homelessness, unemployment, suicide rates, use of emergency rooms and longer waits for services among the people served in state mental-health programs.

As a result of Washington's emergency 6.3 percent cutback, and expected cuts in the proposed 2011-2013 budget, state spending on mental illness is expected to fall by $42 million over the biennium.

Of that, $7 million will come out of Western's budget. Another $17.4 million will come out of community-based mental-health programs, which means services will be cut to 26,000 people, according to David Dickinson, director of the state Department of Behavioral Health and Recovery, which oversees state mental-health care.

Last year, the state served 144,000 clients through its community mental-health system.

The cutbacks also have had a ripple effect. In November, North Sound Evaluation and Treatment Center, a 16-bed inpatient psychiatric facility in Skagit County, was forced to close.

The bed shortage is acute and growing. Western currently has 23 patients on a wait list, and 205 who have been declared ready for discharge but who have yet to be placed in community treatment, Flowers said.

In King County, the cutbacks have virtually eliminated all outpatient community-based psych services for non-Medicaid patients, Shoenfeld said.

The cutback in outpatient services has strained the capacity of the system to provide support for patients leaving the state hospital or coming out of jail, or to help less-acute patients to remain functional in their communities, said Trish Blanchard, director of Sound Mental Health, which has slashed its crisis-services budget by 60 percent.

The number of crisis-counseling appointments at Sound Mental Health dropped from 18 per week to eight, she said. "These are [for] people who are suicidal or seriously depressed."

Demand is rising

Service providers say demand for such services is escalating. Sound Mental Health treated about 18,000 clients last year, up 2,000 from the year before.

When support systems get cut off, clients risk losing the gains they've made in treatment, which in turn can put their employment, housing or sobriety at stake, Blanchard said. "When that happens, our emergency rooms and our jails get busier."

Arden James, manager of the Co-Occurring Disorders Clinic, which treats patients with both substance-abuse and psychiatric diagnoses, said she's seeing that start to happen. "It's really frustrating to see them take steps backward," she said.

Eric Barbee, 41, is worried as well. Sound Mental Health helped him find a medication regimen to control his bipolar disorder. "That was huge for me," he said. "Huge." But his appointments have been cut back even as his doctors try to determine the right dosages.

Such cutbacks put more people at risk of failing to get help in a crisis, said Shoenfeld.

Hypothetically, he said, if a student like the one now accused of the Arizona shooting rampage lived in King County and had been referred for outpatient psychiatric treatment, the patient would not be able to get those services. "Someone with serious symptoms, but not on Medicaid, is not able to get mental-health treatment in our system," he said.

Mental-health advocates emphasize that the vast majority of patients with mental illness are not violent. They also emphasize that treatment is effective when it's available and can restore a patient's ability to function well in the community.

Commitments may rise

Ironically, the state budget cutbacks come on the heels of passage of new state rules likely to increase the number of involuntary commitments.

In 2010, the Washington Legislature passed a law allowing county mental-health workers to take into account previous violent behavior and the testimony of family and friends when making decisions on involuntary treatment. That law was passed in the wake of a number of highly publicized slayings in Washington by individuals with histories of untreated or inadequately treated mental illness.

A study by the state-funded Washington Institute for Public Policy found that the new law is likely to result in a 10 to 20 percent increase in involuntary commitments, which would require up to 49 more beds in short-term facilities, as well as more hospital beds.

Instead, the governor's 2011-2013 budget proposes more cuts. Many in the field worry things are going backward for those in need of mental-health care, Dickinson said.

InvestigateWest is nonprofit investigative journalism center based in Seattle. For more information, go to invw.org. Information from Seattle Times archives is included in this report.