Judge orders hospitals to stop ‘boarding’ mentally ill patients

A judge in Tacoma wants to stop the practice of “parking” mentally ill patients in hospital emergency rooms, sometimes for days at a time, without psychiatric treatment.

It’s also known as “boarding” and it happens during the process of involuntary commitment. That’s when people are in need of psychiatric treatment “and there are no beds available for that person and so they’re boarded, or kept where they are, until a bed opens up,” explained Amnon Shoenfeld, director of King County’s Mental Health Chemical Abuse and Dependency Services Division.

Pierce County Superior Court Judge Kathryn Nelson this week upheld a county court commissioner who offered a similar ruling in March, that the practice of temporarily placing the mentally ill in hospital emergency rooms without treatment violates state and federal law.

Shoenfeld said the law calls for patients to get mental health evaluation and treatment within 72 hours but patients are often “boarded” for days longer, awaiting help.

“Defense attorneys would argue that if they’re not receiving the evaluation and treatment services that are required under the law, then they cannot be kept in that boarding situation,” said Shoenfeld.

The judge in Tacoma agreed. Prosecutors argued that boarding is better than no treatment and the judge gave them some time to appeal. And “at least, they’re in a safe place,” added Shoenfeld.

The scope of the problem is revealed in a nationwide survey.

“About 70 percent of all emergency room physicians across the country reported that their hospitals were regularly boarding people because there were no treatment beds available for people with mental illness,” said Shoenfeld. Hospitals don’t favor boarding because it’s expensive to hire people to provide one-on-one attention, according to Shoenfeld. And hospitals might not get paid if they can’t provide the needed in-patient care.

Depending on the data you find, Washington is either 47th or dead last among states for the number of psychiatric hospital beds per 100,000 population, according to Shoenfeld.

“That’s a pretty dismal rating and we definitely need to have more psychiatric hospital beds in this state and we have to be willing to pay for it.” Shoenfeld said he’s been working for the last several years trying to get hospitals to open up more involuntary psychiatric beds and lobbying the Legislature for more mental health services.

A recent survey concluded the state needs another 42-168 psychiatric treatment beds. The proposed state operating budget includes money for 48 more psychiatric beds, statewide.

“The 48 beds that are in the budget are at the bottom range of the projected need and meanwhile, we already have a huge shortage,” Shoenfeld stated. He’d like to see hospitals open up more psychiatric beds.

Last year in King County, two-thirds of all involuntary commitments were boarded, that’s more than 2,000 people. Shoenfeld said the county has lost more than 100 psychiatric beds in the last 10 or 12 years.

While he conceded a legal challenge could help generate solutions, Shoenfeld worried that the judge’s ruling could result in the the release of mentally ill patients without treatment, putting them, and the community, at risk. Something, he said, “we cannot accept.”