County faces bed shortage for mentally ill

Psychiatric hospitals in the state of Washington are facing a not-so-unique problem: too much demand, not enough supply. According to Larry Keller, the executive director of Kitsap Mental Health, there simply aren’t enough beds to meet the constant need of those who need psychiatric help.

There currently is one in-patient 15-bed facility in the county dedicated to psychiatric patients. It is located on Almira Drive in Bremerton.

Both Linda Gunning and Suzanne Moore Ullrich work with KMH and see the problem first-hand every day.

Ullrich is the supervisor of KMH’s crisis response team and Gunning is the manager of crisis and intensive services for KMH.

Gunning and Ullrich are county-designated mental health professionals who are authorized to detain and admit people to psychiatric hospitals against their will. People often are detained because they are a danger to themselves or society or because they are unable to meet the basic needs of food or shelter because of mental illness.

The way the current state system is set up, the county has its 15-bed facility. If that facility is full —— and it usually is, Keller said —— Kitsap County has beds in other state facilities reserved for its use. However, those beds, too, are usually full and not always with people from Kitsap County.

When a person is detained, they usually are taken to the Harrison Hospital Emergency Room, where they wait until a bed is found somewhere in the state.

The problems that arise are on two levels: The effect on the emergency room and the high cost associated with the emergency room stay and ambulance transportation once a bed is found.

The average cost is up to $5,000 per admission. KMH averages a couple of admissions each month. That cost, plus the cost of ambulance rides to an available bed, are picked up by public funds if the patient does not have medical insurance.

“This is not a new problem; this has been going on for a number of years,” said Linda Batway, director of social work at Harrison Hospital. “What we see is that the Emergency Department ends up being a safety net when resources are not available in the community.”

Once a space is found, inpatient stays can range from 72 hours to 90 days. After 72 hours, the patient has the right to a court hearing. At that time, the KMH can petition the court to lengthen the stay for 14 days.

The wait also delays the patient’s treatment, Keller said.

“Treatment does not begin in the ER,” Keller said. “The person being held there is being held in a special room with one of their security people there making sure they are safe and being helped. Treatment doesn’t start until they get to a treatment center.”

Usually, the first call is to Western Washington State Hospital in Steilacoom. If there is no bed available there, the phone calls continue. In one instance, Keller said, the KMH staff made about 15 phone calls before a bed was found.

Sometimes, it can take several hours to find room for a new admission. In the meantime, the patient has to stay in the ER at Harrison Hospital, which is taxing on the ER’s resources. Often, the patients have to be monitored by a security person and they take more staff attention that the usual ER patient.

“What’s happening in the ER is that the security person is not doing their regular duty, there is another room being taken and the ER staff is providing services,” Gunning said.

A public study in 2002 revealed that state psychiatric hospitals were at 100 percent capacity. Since the study was completed, the number of beds has decreased and the state’s population has increased, Keller said.

Because there are fewer beds for psychiatric patients, some patients are being released before they should be. Admissions are averaging about two weeks. After a person is released, they are released into the community for outpatient services, if they are deemed necessary.

Patients are often released into communities that do not have the infrastructure to support them, which results in a lot of homeless mentally ill and some mentally ill people ending up in the correctional system.

“Not so long ago, someone pointed out that the King County Jail has the second-largest mental hospital in the state,” Keller said.

The solution to Kitsap County’s problem would be to let the county have access to the beds it’s supposed to have, or to give it the financial equivalent of those beds to use on community resources, Keller said.

“Some say the system needs to be tweaked,” Keller said. “I say it’s broken.”

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