Institutions Will Not Solve Overcrowding

In an effort to keep federal certification and funding for Western State Hospital, Washington State added 200 new beds, hired hundreds of new staff, and other reforms to the tune of 100 million dollars. These reforms were primarily meant to solve over-crowding. It failed. Over-crowding exists at close to the same rate as before the hundred million dollar investment. How can this be?

No amount of beds will be enough to fill the demand of an unjust system. Some reasons for this include:

  1. Lack of Home and Community Based Services (HCBS) and the underfunded social safety net
  2. There are many more people identified, or who will be identified, as having a Serious Mental Illness (SMI) or several SMIs
  3. Institutions are not therapeutic and are often traumatic

First, the lack of or underfunding of HCBS such as

  • Supported-employment
  • Vocational rehabilitation
  • Housing vouchers
  • Quality, low-cost or free mental health services
  • Social safety which everyone relies on (e.g. SNAP/food stamps)
  • In-home care providers
  • Transition services for youth with disabilities

Drives people with SMI out of their homes and onto the streets with little to no opportunity where they face criminalization and may face institutionalization at either Western or Eastern State Hospital through a process known as “forensic civil commitment.” If they are deemed “rehabilitated,” people with SMI may still not be let back into their communities because the HCBS deemed necessary for release do not exist.  According to David Schumacher from the Office of Financial Management, there are “over 100 people in Western State Hospital right now that we could release tomorrow.”1 This exacerbates the serious overcrowding caused by issue two.

Realistically, accurate estimates of people with SMI who may be institutionalized at state psychiatric institutions are impossible. However, given the prevalence of serious mental illness—4.5% of the adult population in the USA2—it is likely within the tens of thousands range at any given time.

The current bed capacity at Western State is 887. Should the governor’s plan be adopted by the legislature, bed capacity will reach 932. Western and Eastern State combined cannot hold all of these people; thus, an endless cycle of more spending and overcrowding.

Lastly, the institutional model may not meaningfully rehabilitate people with SMIs. Many survivors of psychiatric institutions have come out saying institutionalization, and the culture of abuse fostered by institutions, has made their SMIs more severe3.  In addition, institutionalization has been shown to discourage people with SMIs from seeking community-based mental health care4. Western State lost federal certification/funding due to abuse scandals. In addition, pervasive abuse, including sexual abuse, of people within institutions across all disability populations and regardless of race, sex, and age shows that not only is it an inferior model of care, it is not care at all.

Instead of putting hundreds of millions into institutions, Washington State should be funding those home and community based services needed to keep people with SMI in our communities, off the streets, and out of psychiatric institutions. Not only will this benefit those in our communities, but it will allow those currently languishing in public psychiatric institutions to come back to their communities—fully supported and no longer being harmed.

Want to join the fight against re-institutionalization? Visit our campaign page Close Down Western State!

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1: David Schumacher speaking to the Ways and Means Committee on January 11th, 2017. Link: www.tvw.org/watch/?clientID=9375922947&eventID=2017011093&eventID=2017011093&startStreamAt=1604&autoStartStream=true

2: SAMHSA Behavioral Health Trends in the United States:  Results from the 2014 National  Survey on Drug Use and Health

3: While different psychiatric survivor groups/anthologies exist, we have chosen to highlight MindFreedom International’s page because they are shorter and easy to access. Link: mindfreedom.org/personal-stories/personal-stories

Pysch Ward Reviews (psychwardreviews.com), a project by disability rights self-advocate Kit Mead is also important but focuses more on private facilities.

4: Alternatives to Outpatient Commitment by Michael Rowe. Link: http://jaapl.org/content/41/3/332

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