Experts hope the recent ruling by Washington state's Supreme Court prohibiting the holding of psychiatric patients in hospital emergency departments while they wait for admission to a certified mental-health facility will prompt policymakers nationwide to address this pervasive problem.
In its Aug. 7 decision, the court said the state's involuntary treatment act does not allow for the boarding of psychiatric patients in EDs and other hospital units that are not certified to evaluate or treat them. The state initially had until Aug. 27 to move patients out of unauthorized areas, but that action was delayed while the court considered a motion to delay its decision for 120 days to allow the state to implement its plan.
Many hospitals around the country have been forced to keep psychiatric patients in what they widely recognize are unsuitable settings because of the lack of available beds at authorized-care facilities. Psychiatric boarding has increased as state and local mental-health budgets have shrunk. In addition to quality-of-care issues, boarding creates problems for hospitals because holding psychiatric patients delays treating other patients, reduces revenue, and creates security and safety issues for patients and staff.
Under the Washington law that the court found invalid, a patient can be committed initially for up to 72 hours at an evaluation and treatment facility, but could remain in custody for as long as 180 days, based on the severity of their illness and the threat they may pose to themselves or others. Patients needing longer involuntary commitment often wait in EDs from a few days to as long as a few months until they are placed.