Washington has allowed people to be involuntarily detained if they are a risk to themselves or others or are gravely disabled under the Involuntary Treatment Act (ITA) since 1977 – first for a short period of evaluation, then for treatment. Close of observers of modern mental health trends will not be surprised to learn that Washington’s certified evaluation and treatment facilities have been overwhelmed with too many patients and too few resources since the law was enacted.
Pierce County has tried to get around this resource constraint by housing ITA patients in emergency rooms or acute care centers. The county’s mechanism for doing so would be the issuance of “single bed certifications” allowing the ER or acute care center to be treated as an ad hoc evaluation/treatment facility. Ten ITA patients moved to dismiss petitions to extend their detention on the grounds that they were not being held in a facility that could evaluate or treat them.
In In Re Det. Of D.W. all nine Justices of the Washington Supreme Court found that it is illegal to use single bed certifications to “warehouse” ITA patients in medical facilities uncertified to provide treatment. Instead the single bed certification was to be used to place a patient in a more appropriate setting outside an evaluation treatment center. The example given by the Court was allowing an ITA patient with cancer to be placed in an oncology ward. The decision was based in statute, but contained a strong hint of due process reasoning. The Court did not, however, suggest possible ways of mitigating the bed constraint that led Pierce County to issue the single bed certifications.
The answer to this, as to other questions, is that the state needs to provide more funding for mental health treatment.