Federal regulators are mulling over millions of dollars of cuts to Washington’s largest psychiatric hospital, even as staff warn they’re stretched too thin and episodes of inter-patient violence make the headlines.
This week, doctors at Western State Hospital, an 800-patient facility in the city of Lakewood, are reeling from an attack in which a patient suffered a broken jaw. Shortly after authorities sent the victim to the hospital for injuries he sustained “for no reason,” another patient attacked someone with his fists and shoe. These instances follow an investigation into complaints of ill-timed mental health services to people charged with crimes.
The state’s Department of Social and Health Services told the federal government it would implement a series of changes by next month. Those improvements include requirements that nurses assess patients after violent outburst, and the documentation of attacks that will allow workers coming later in the day to protect sedated patients. The federal government will review the plan. If Western State Hospital doesn’t change course, the facility could lose nearly $16 million of annual funding.
“The medical staff had recommended a freezing of admissions until they get it under control, but we were told we should think about finding another job,” Dr. Joseph Wainer, a psychiatrist at the hospital for 10 years, told The Associated Press on Thursday.
This situation is plaguing mental health clinics and hospitals across the country, becoming part of what experts are calling “the silent shortage.”
A host of factors come into play, including an aging psychiatrist population, a small percentage of medical school graduates entering the field, and mental health care facilities eager to admit a large number of patients, regardless of the current availability of professionals. Unlike many physical ailments, mental illness can’t be treated in one visit. Indeed, the ideal regimen includes long-term treatment, and a combination of drugs and therapy.
Partly because of the deinstitutionalization of mental health care during the 1980s, many Americans struggle to get connected with the health services they need and may end up behind bars instead of in a treatment facility. Most mentally ill people who enter the criminal justice system — often as a result of their condition — have committed nonviolent offenses, a process that costs the nation an average of $9 million annually. Even worse, inmates with a mental disorder often don’t receive the help they need during their stints under state supervision. One reason officials haven’t given it much attention perhaps stems from stigma around mental illness. People who have mental illnesses — including depression, bipolar disorder, and schizophrenia — have historically been stereotyped as dangerous, making discussion of these ailments more taboo.
In recent years, jurisdictions have tried to better address mental illness in the prison system. For instance, mental health courts and other diversion programs provide mentally ill offenders with alternatives to incarceration that tackle the root of their criminality. In Cook County, Illinois, these deliberations often follow stints in a months-long therapy program during which participants receive comprehensive treatment for their mental illness.
The success of these programs, however, depends on the presence of mental health professionals. Even with the steps it has taken to address mental illness, Cook Country has struggled to attract psychiatrists for its inmate population — 8,400 of whom may be struggling with a mental disorder. Strategies include increasing pay and pushing loan forgiveness legislation. “It’s been very difficult to attract and retain talent,” Lanetta Haynes Turner, who heads County Board President Toni Preckwinkle’s justice advisory council, told the Chicago Tribune earlier this year.
Type of insurance notwithstanding, the gap in psychiatric services also affects a significant number of Americans.
Although the Affordable Care Act expanded mental health benefits to 32 million people, fewer than 40 percent of Americans receive the services they seek, according to a survey conducted by the Substance Abuse and Mental Health Services Administration. More than 91 million Americans will most likely be unable to schedule an appointment with one of nearly 93,000 licensed psychiatrists in the country. Rural areas accounts for more than 85 percent of locations the federal government as designated as “mental health professional shortage areas.”
Earlier this year, 2,600 psychologists, therapists, and social workers picketed along nearly three dozen Kaiser Permanente locations across California to shed light on what they described as negligence toward mental health workers and patients. Picketers alleged Kaiser didn’t alleviate the workload of the mental health professionals, even as the patient rolls increased by 387,000 clients.
Employees of Western State Hospital currently face a similar situation. They say inadequate staffing levels endanger patients and workers, and the impending cuts will strain a mental health system already in need of additional funds at a time when the state government wants to add more beds. “Our number one priority is to ensure the health and safety of our Medicare beneficiaries,” Western spokeswoman Magill Stephanie McGill told the Chicago Tribune.