State Supreme Court rules against “psychiatric boarding”

Hospital Sign in Front of Hospital
“Psychiatric boarding” illegal

The Washington State Supreme Court ruled unanimously August 7 that the state must halt its practice of holding people in need of psychiatric treatment in hospital emergency rooms as a means of avoiding overcrowding in psychiatric facilities.

“The government would have you believe there are only two options – leave people with mental illness on the street with no treatment or lock them in a local emergency room with no treatment,” said Emily Cooper, staff attorney with Disability Rights Washington, in a news release. “That simply isn’t true. Consistent with public safety concerns, the law requires that when someone is detained in order to deliver treatment, adequate treatment must be delivered.”

Under the state Involuntary Treatment Act, enacted in 1979, counties have the authority to briefly detain a person with a mental disability in a certified “evaluation and treatment center,” if that person “presents an imminent likelihood of serious harm, or is in imminent danger because of being gravely disabled.”

Due to overcrowding in these centers, the state has developed a practice where it grants counties “single bed certifications,” allowing them to temporarily detain patients in other facilities, such as “hospitals and acute care centers,” where they receive emergency treatment, but not the individualized, psychiatric treatment required by the ITA. Critics have dubbed this practice “psychiatric boarding.”

From 2007 to 2013, the number of “single bed certifications” spiked from 1,221 to 3,412, according to a Seattle Times editorial.

The lawsuit was brought by 10 patients, each of whom was detained in non-certified facilities in 2013 by Pierce County, south of Seattle. Pursuant to the ITA, the County petitioned to the state for “single-bed certifications” to hold these patients for an additional 14 days.

The 10 patients were challenging their detentions. The trial judge ruled in their favor, prompting an appeal to the state Supreme Court.

Disability Rights Washington, the American Civil Liberties Union of Washington, and the National Alliance on Mental Illness of Washington filed an amicus brief on behalf of the plaintiffs.

In a 12-page ruling, the state Supreme Court disagreed with the state’s interpretation of when it can authorize single-bed certifications.

As described by the Court, single-bed certifications can only operate as an exception to the rule that patients be treated in certificated “evaluation and treatment centers” when “a properly qualified agent of the mental  health division determines that there is either a medical justification for involuntarily detaining a patient outside a certified facility or that the single bed certification would facilitate continuity of care.”

In other words, the ITA does not allow the state to use single-board certifications as a way to compensate for its failure to provide an appropriate number of psychiatric beds.

“By its plain terms, this rule does not authorize a single bed certification merely because there is no room at certified facilities with which the county already has a contractual relationship,” the Court wrote in the opinion.

Disability advocates hope that the state decision will push the state to provide the necessary services to avoid overcrowding in psychiatric facilities.

“The Court rightly recognized that when the government deprives someone of their liberty, the government’s failure to provide adequate funding does not allow it to violate the law and constitutional rights,” said Jennifer Shaw, deputy director of the ACLU-WA, in the news release.

Disability Rights Washington, the publisher of this DisAbility Galaxy website, is part of the federally funded protection and advocacy system and a member of the National Disability Rights Network.