Renata Alder, a New York Times film critic and award-winning novelist, made a concise observation of society’s need to respond to the needs of the mentally ill. She said, “Nothing defines the quality of life in a community more clearly than people who regard themselves, or whom the consensus chooses to regard, as mentally unwell.”
The tragic shootings in Skagit County that claimed six lives once again reminds us of the fragility of our state’s Mental Health system. It’s not the first time we’ve received this kind of reminder. Eleven years ago, the stabbing death of a retired Seattle firefighter by a mentally ill man who had been released from jail prompted changes in the law. But all too often it takes a tragic crime before we discuss the needs of the mentally ill.
The Heritage Foundation reports, “An estimated 5.6 million Americans suffer from severe mental illness. It strikes without regard to age, gender, race, education, socioeconomic status, culture, or ideology. In many cases it brings suffering not only to the individual but also to family and friends. Depression, which causes many of the 30,000 suicides in America each year, especially targets the elderly…” They also conclude that the “economic costs of mental illness are staggering. America spends over $69 billion yearly on direct treatment costs.”
So what are the major challenges facing the State of Washington’s Mental Health system? A state-commissioned study of residential and hospital bed capacity and need that was completed several years ago found an additional 680 residential and inpatient beds are needed statewide. But no action was taken on that study. Instead, state and local hospital beds have continued to be closed, and even more closures are planned next year.
The 1999 Legislature initiated the “Community Integration Assistance Program” to improve the process of identifying mentally ill offenders released from the Department of Corrections. These individuals, who pose a threat to public safety, were to be provided with treatment and services for up to five years. The funding provided by the state for each person served is $700 per month for Medicaid-eligible participants and $900 per month for those not on Medicaid. The reimbursement rate has not increased since the program began in 2000 despite an enormous increase in housing and other costs. In many cases, especially in King County, the cost of housing alone exceeds the reimbursement received from the state that is meant to cover all costs
Housing is absolutely critical for people with mental illness if the mentally ill are to benefit from treatment and move toward independence, employment, and recovery. It is integral for them to have the best opportunity, yet housing is hard to find for anyone with low income, and even harder for those who have a serious mental illness. The homeless, mentally ill, are much more likely to commit crimes and end up in jail. It is imperative that the housing dollars authorized by the recently adopted sales tax for mentally ill services should not be diverted for other uses.
We need training for our police about how to work with people with mental illness, and more resources for police to refer people to programs that help avert crises and violent acts; to divert people from jail and into treatment.
Legislation on gun ownership for people who have been involuntarily committed needs to better align between the state and county – currently there are different standards – with state legislation allowing ownership if you have been committed for 14 days or less and federal legislation not allowing ownership if you have been committed for any length of time.
There is insufficient state funding to provide services for people who are mentally ill, but not covered by Medicaid, either because they are too disorganized to get through the process, or because their illness is new (such as the first break psychosis of young people), or because of their immigration status. When people can’t get the treatment they so desperately need, they are much more of a risk to themselves and others.
Involuntary commitment is an extremely controversial issue. Most people with mental illness are not dangerous and their civil rights must be protected. Yet many people believe that it should be easier to commit people who have mental illness. As a result, commitment laws have been amended numerous times since 1998, all with the intent of making it easier to commit people who might be a danger.
Last year, the state Mental Health Division brought in national consultants to lead a task force of mental health professionals, law enforcement, consumers, advocates, prosecuting and defense attorneys, and state officials to review the involuntary commitment law. The conclusion of the task force is that changing laws is not the answer; what is needed are more accessible, consumer-focused, comprehensive services.
Even if the state were to respond to all of the issues listed above, there is no way to ensure that nothing like what happened 11 years ago in King County, or last week in Skagit County, will ever happen again. What we can and should do is provide services and safe housing for persons with mental illness that will minimize the risks for them and for society, while also giving them the resources needed to help them in the recovery process.
The Heritage Foundation report concludes, “Current mental health policy tends to support the status quo system regardless of the effectiveness of services.” This must not continue. America has the compassion, resources, and available treatments to care effectively for its citizens who suffer from severe mental illness.”
- King County’s Mental Illness and Drug Dependency (MIDD) Action Plan
- More about Renata Alder
- Sick minds of shooters a bigger problem than guns, Seattle Post Intelligencer
- State pays in blood for flawed mental health system, Seattle Post Intelligencer
- Suspect’s mom describes him as being ‘desperately mentally ill’, MSNBC
- Campaign for Mental Health Reform
- President’s new Freedom Commission on Mental Health, Mantal Health
- Families and the Crisis in U.S. Health Care, Child Parenting
- Principled Mental Health System Reform, Heritage
- Mental health reform: What it would really take, CNN
- Reform how we treat mental illness, Seattle Post Intelligencer