Washington’s treatment of the mentally ill is to our shame

You’ve seen the many headlines arising from our state’s mental health crisis: of a concentrated downtown crime problem; of shootings during delusional episodes; of police overwhelmed by their role on the frontlines.

You’ve also seen the headlines when those matters are dealt with by the system: of competency hearings, insanity defenses, and lawsuits over the warehousing of the mentally ill in our jails and hospitals.

Unfortunately, here in Washington it is shocking how badly we treat the mentally ill. The fact is, our state’s treatment of the mentally ill over the decades is shameful. One need only look at the concentrations of misery in Seattle’s urban core and elsewhere to see the scope of the problem.

How is this humane? We’re leaving mentally ill people in the streets to slowly die.

Roots of the problem
Part of today’s problems in mental health care stem from an overreaction to past issues. For many decades Washington and other states ran large mental health hospitals that offered very little in the way of treatment.

The mentally ill were essentially warehoused in these institutions. Some of the treatments approved for patients, including lobotomies and sterilization, are considered shocking today. Something had to change.

A national reform movement sprung up. Advocates for the mentally ill pushed to close institutions and move care to community-based facilities. They also liberalized commitment laws, making it more difficult for the government to commit a patient for mental health care.

Some of those changes were needed, but the pendulum swung too far. The standards to commit someone were so high that people too ill to realize they needed help couldn’t get it. Mental health beds were cut but weren’t replaced with the same level of community-based care. Politicians were happy to spend the money on other priorities. We still warehoused mental patients, just in hospitals and jails instead of institutions.

Criminal justice system overburdened
We expect so much of our police officers, including the handling of people on our streets with chronic mental health issues. They know and we know that police forces cannot solve these problems. When treatment isn’t available to those that need it, the police and our courts deal with the consequences.

That’s an expensive, round-about way of dealing with the issue.

Meanwhile the problem festers. The vast majority of mentally ill, whether on the streets or not, never commit a violent crime. They’re their only victims, entrapped in a troubled mind.

But we do see violent consequences to untreated mental health issues: the Gabby Giffords shooting, Newtown, the Aurora movie theater…on and on. We’ve had unfortunate local examples as well: the Café Racer shooting, and last year’s attack at Seattle Pacific University.

Columnist Charles Krauthammer, who was a practicing psychiatrist before his career as a pundit, wrote eloquently after the Navy Yard shooting in 2013 about what civil commitment really means for those who need it:

For many people living on park benches, commitment means a warm bed, shelter and three hot meals a day. For [the shooter], it would have meant the beginning of a treatment regimen designed to bring him back to himself before discharging him to a world heretofore madly radioactive.

That’s what a compassionate society does. It would no more abandon this man to fend for himself than it would a man suffering a stroke. And as a side effect, that compassion might even extend to potential victims of his psychosis — in the event, remote but real, that he might someday burst into some place of work and kill 12 innocent people.

Positive changes happening
The news on mental health in Washington isn’t all negative. Good things are happening, even if it took lawsuits to spur some of them. For one, our state is finally starting to deal with the problem of warehousing people with mental health issues in jails and regular hospitals.

On another positive note, the legislature recently passed Joel’s Law, named after a young man who was killed by police while in a delusional state in which he thought he was shooting at zombies. In their grief, his parents pushed for changes to our commitment laws. In doing so, they represented many people who have repeatedly sought help for loved ones but were thwarted by the system and our overly-restrictive “imminent threat to self or others” standard for commitment.

Now with Joel’s Law on the books, parents and guardians can petition the courts to commit their children, even if they’re adults. That’s an important change.

Our state still has a long ways to go in offering quality mental health care, helping families, and taking the burden off of police and criminal courts. Making further improvements is the right thing to do, financially and morally.
-Rob McKenna

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Rob McKenna
Rob served two terms as Washington’s Attorney General, from 2005 to 2013. He successfully argued three cases before the U.S. Supreme Court and negotiated three of the largest consumer financial protection settlements in national history, all involving mortgage lending and servicing. He is a recognized leader in the development of consumer protections on the internet, in data protection and privacy regulation.