On August 7, 2014, the Washington State Supreme Court ruled that “psychiatric boarding” under Washington’s Involuntary Treatment Act (“ITA”) is unlawful.
“Psychiatric boarding” is a term used to describe the practice of leaving mentally ill patients in hospital emergency rooms because there is no space at certified evaluation and treatment facilities. Certified evaluation and treatment facilities are the facilities authorized under the ITA to detain involuntary mental health patients.
County mental health officials began using authority granted under the ITA to issue “single-bed certifications,” which permits mental health officials to leave patients at hospitals which are not certified evaluation and treatment facilities, to address the increasing – and now common – problem of insufficient space at the certified facilities.
In its clear opinion, the court held that the ITA does not authorize single bed certifications to avoid overcrowding at certified facilities. In doing so, the court recognized that the ITA repeatedly provides that persons who are involuntarily detained under the ITA must be held in certified evaluation and treatment facilities in order to receive the proper evaluation, stabilization and treatment afforded to these patients under the ITA: “Patients may not be warehoused without treatment because of lack of funds.”
Although the court’s opinion may be a catalyst towards forcing the state to address failures and flaws in its mental health system, the immediate impact of the ruling has left hospitals and county mental health professionals scrambling to figure out what to do. If mental health professionals are unable to detain psychiatric patients who present at hospital emergency departments and who otherwise meet the criteria for detention but no evaluation and treatment bed is available, hospitals will find themselves in the difficult position of choosing between either allowing a mentally ill patient to leave the hospital or detaining the patient without clear legal authority under the ITA to do so. The issue is further complicated for hospitals as they must also consider their EMTALA obligations in this situations.