Eight hospital, physician, and nursing advocacy groups argue in an amicus brief to the state Supreme Court that the lack of mental health services deprives patients of essential care, due process and personal liberty. This release was distributed by WSHA on behalf of all the co-signing organizations.
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 Health Care Leaders Unite To Petition Court to Require Increased Access to State Mental Health Services

Eight hospital, physician, and nursing advocacy groups argue that lack of mental health services deprives patients of essential care, due process and personal liberty

June 2, 2014:  Eight organizations representing health care professionals who care for patients in emergency situations co-signed an amicus brief asking the state Supreme Court to uphold a Pierce County Superior Court ruling that psychiatric boarding is unconstitutional and the state must do more to provide adequate access to inpatient mental health services.

The Supreme Court is reviewing In re the Detention of: D.W., G.K., S.P., E.S., M.H., S.P., L.W., J.P., D.C. and M.P. on June 26. The amicus brief was filed in the state Supreme Court on May 23.

The brief documents can be read here and here.

Psychiatric boarding occurs when a patient in a mental health crisis comes into, or is brought into, a hospital emergency department and is evaluated and detained by a designated mental health professional and is unable to get the needed inpatient care because none is available. The detained patient remains at the hospital until there is room at an appropriate facility.

Psychiatric care and crisis interventions are designed to be delivered through certified inpatient evaluation and treatment (E&Ts) facilities– not hospital emergency departments. If beds are unavailable in a certified facility, the patient is “boarded” in the hospital to the detriment of the patient, physicians, nurses, and other patients.

Hospitals are often the entry point for many patients in crisis, yet emergency departments are not equipped to provide ongoing psychiatric services. Federal law requires hospitals with emergency services to provide treatment and stabilizing care to patients, and to transfer patients to appropriate facilities if the services is not provided. The primary goal in emergency departments is to keep psychiatric patients safe until there is space in an appropriate facility where they can receive the mental health treatment they need.

Severe underfunding has resulted in a significant drop in services available at E&T facilities. The number of available beds for mental health patients dropped by 36 percent, while the population of the state grew by 14 percent. At the same time, funding for the community mental health system, which is designed to help keep people out of crisis and out of the inpatient system, was cut by more than $90 million in just three years.

Several of the organizations offer their perspectives on the lawsuit and the brief:

Washington State Hospital Association:  “It is grossly unfair to patients and families to board mental health patients in crisis when they need specialized care in a secure, comfortable environment,” said Scott Bond, WSHA president and CEO, the lead/initial organization on the brief. “Emergency departments cannot offer the kind of care provided by an evaluation and treatment facility, and it’s critical that the state begin to adequately provide access to mental health services.”

Association of Washington Public Hospital Districts: "Forty-two of Washington’s hospitals operate as public hospital districts, a form of local government.  The intensive staff requirements for taking care of a boarded psychiatric patient amounts to a drain on the resources of a local government," said Ben Lindekugel, Executive Director for AWPHD. "About half of Washington’s hospitals are small, rural hospitals with very limited staffing.  While it is possible in a larger hospital to have someone on staff who has some expertise in psychiatric care, simply given the size of the staff, this is highly unlikely in a small, rural hospital where the staff are more generalists.  These hospitals are also less likely to have a safe space to put a patient who needs psychiatric care and for whom a normal hospital room can be hazardous.  A single bed certification is particularly unworkable in a small, rural hospital – yet they happen every day."

Washington State Medical Association: “Boarding patients not only deprives patients of needed treatment, but it also contributes to overcrowding in the emergency
department, and may negatively impact other patients as well as providers,” said Dale Reisner, president of WSMA.  â€œPatient safety and quality care are paramount and neither is achieved unless there is adequate funding for mental health services.”

Washington Chapter of the American College of Emergency Physicians: "The severe lack of resources and inpatient capacity for mental health patients plays out in emergency department across the state every day," said Enrique Enguidanos, MD, president of the Washington Chapter, American College of Emergency Physicians. "Our most vulnerable and at-risk patients are stranded in emergency departments for days, sometimes weeks, at a time waiting for in-patient hospital beds. While our country has always been challenged with proper funding for mental health, the current combination of cutbacks in beds and facilities has resulted in unprecedented limitations in our ability to care for patients."

Washington State Nurses Association: “As registered nurses, we see the detrimental effects when psychiatric patients are boarded in emergency departments and other units of the hospital where nurses and other health care providers often may not have the resources, training or preparation to deliver appropriate care. This is not the ideal care environment for these patients and the practice raises serious safety concerns for the patient, health care providers, and the other patients on the unit,” said WSNA Executive Director Judy Huntington, MN, RN. “This increased burden to care for psychiatric patients will not go away until we invest in a stronger mental health safety net and increase access to mental health services.

SEIU Healthcare 1199NW: “As a psychiatric nurse, I know that patients in crisis need care, not confinement in a holding pattern in the ER,” said Diane Sosne, RN, MN, President of SEIU Healthcare 1199NW.  “This case is a wakeup call to our state lawmakers that it’s time to restore access to our behavioral health safety net so people living with mental illnesses get the treatment they need in their communities before they escalate to crisis.”

Washington State Council of the Emergency Nurses Association: ""The current lack of mental health resources and services is a public health crisis that is felt daily in emergency departments across the state. Vulnerable patients are left waiting for hospital beds for days to weeks resulting in a delay in therapeutic treatment. During these tough financial times we must closely consider the needs of the most vulnerable and advocate for improved services for these patients."

Northwest Organization of Nurse Executives also signed onto the brief.

Washington State Hospital Association
Mary Kay Clunies-Ross, VP Communication & Public Affairs,, 206/817-4845

Association of Washington Public Hospital Districts
Ben Lindekugel, Executive Director, AWPHD,, 206/216-2528
Washington State Medical Association

Susan Callahan, Director of Communications & Membership,, 206-441-9762

Washington Chapter of the American College of Emergency Physicians
Pauline Proulx, 206-956-3648 or
Washington State Nurses Association
Lillie Cridland,, (206) 854-7911.

SEIU Healthcare 1199NW
Julie Popper, Strategic Communications Director, 425-919-8577

Washington State Council of the Emergency Nurses Association

Northwest Organization of Nurse Executives

Copyright © 2014 Washington State Hospital Association, All rights reserved.

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