The Mental Health Minute

Articles and news about mental health issues

Bills would make it easier to force mentally ill into care

Seattle, it seems, is going to try something different from Kendra’s Law.  The gist of this article is that changing the law about involuntary commitment will get more people into psychiatric hospitals and thus into care and protect innocent people out in the communities.  Sounds really good, except that mental health budgets everywhere are being cut to the bone.  Psychiatric beds are disappearing rapidly due to lack of funding.

So my question would be, if more people meet the criteria for involuntary commitment, where are these people going to go to get care when psychiatric hospitals currently turn people away for lack of space, or lack of ability to provide care?  In case you haven’t been to an ER lately, the wait time has grown.  This could be because of several things, but I’d bet money that some of the holdup is due to psychiatric patients that are simply taking up a bed while staff try to find a psychiatric bed to transfer the patient to.  It’s a frustrating and thankless position to be in; I’m sure this change in the law will improve things immensely.

By Carol M. Ostrom

Seattle Times health reporter

Isaac Zamora spiraled into darkness for more than a decade, attempting suicide, enduring hallucinations, damaging property and threatening violence, causing neighbors and relatives to fear for their safety.

Family members tried repeatedly to get him help, but under state law, hospitals couldn’t hold on to him long enough to get him the mental-health treatment he needed.

In the fall of 2008, Zamora, 28, slipped into the abyss. During a rampage that began near his family’s rural Skagit County home, he shot and killed six people, including a sheriff’s deputy, and wounded two others.

Later, he told a judge: “I kill for God.”

The state House of Representatives has passed two bills — both by unanimous votes — aimed at helping people like Zamora before it’s too late.

The legislation would make it easier to detain dangerous mentally ill people under the state’s controversial Involuntary Treatment Act by broadening the criteria for holding them against their will. One key revision: The current threshold, which requires that they pose an “imminent likelihood” of harm to self or others, would be lowered to a “substantial” likelihood of harm.

The measures would modify other definitions and also specify that those making the commitment decision may consider information offered by family members, co-workers and others.

While some worry the changes could make a current shortage of psychiatric beds even worse and might prove very costly, others celebrated the proposals.

The modifications may seem insubstantial, but they represent a “sea change” in attitudes by lawmakers, said Eleanor Owen, executive director of the Seattle chapter of the National Alliance on Mental Illness (NAMI).

“Trust me, if we in fact implement those ‘minor’ changes, we will see a reversal of the number of people who end up with criminal records,” Owen said.

Over the years, family members have complained that the high bar for commitment under the 1970s-era law has made it nearly impossible to get early help for a mentally ill and potentially violent relative.

“You have to have a gun to your head or your mother’s head” to be held, Owen said.

The Involuntary Treatment Act was passed in the early ’70s after civil libertarians complained that mentally ill people were being locked up and treated against their will — even when they weren’t considered dangerous — sometimes because family members or others found their behavior upsetting.

The law’s creators argued that taking away a person’s liberty was extremely serious and should be done only under the strictest standards, and courts have agreed.

Over the years, though, family members of mentally ill people and some mental-health experts have complained that the law erred on the side of civil liberties while shortchanging public safety and clinical knowledge about mental illness.

While the law effectively protects a person’s civil liberties, said Dr. Peter Roy-Byrne, chief of psychiatry at Harborview Medical Center, “I don’t think it protects your right to be treated.”

Dr. Cristos Dagadakis, medical director of the crisis-intervention service at Harborview Community Mental Health Services, praised the proposed revisions.

“I’ve been advocating it for two decades,” he said. “I think this is an opportunity to get people into care quicker.”

The two bills containing the proposals are now in the Senate Human Services & Corrections Committee, where a hearing on one is scheduled for Thursday.

Lawmakers, prosecutors and others have long struggled with the best way to balance civil liberties while getting dangerous mentally ill offenders off the streets.

Slaying led to task force

After 31-year-old environmental worker Shannon Harps was stabbed on Capitol Hill in late 2007 by a mentally ill man with a history of violence, King County Prosecuting Attorney Dan Satterberg convened a task force to examine the system.

Its report is dedicated to the memory of Harps and examines the history of her assailant, James A. Williams.

Williams had a history of violence — including shooting a stranger in 1995 — and severe mental illness. He was resistant to treatment, arrested, jailed and committed for four months for threats against others. But 10 days before he killed Harps, those evaluating him ruled he could not be detained under the law.

Although most people with mental illness are not violent, those who are have tested the system. Among them:

• Paranoid, delusional and agitated, Thomas Gergen was brought to an emergency room in January 2003 by his wife and mother, who hoped his mental illness would get him committed. Over the previous several months, his paranoia had reached the point that his pregnant wife, Kari Osterhaug, was terrified.

Even so, evaluators said he did not qualify for involuntary commitment, and sent him off in the middle of the night with a prescription for an anti-anxiety pill. By daylight, his wife was dead. Gergen shot himself but survived. He was found not guilty by reason of insanity, and spent five years in Western State Hospital before being released.

• Teenager Samson Berhe was twice taken to Harborview in June 2005, first because he was suicidal and again after exhibiting violent and threatening behavior, ranting that “all confused people should be killed.”

Both times he was turned away, deemed not imminently dangerous. Later that month he fatally shot Newport High School tennis coach Mike Robb. Police found the 17-year-old on a barge in the Duwamish River, making faces, spitting and drooling. He was found not guilty by reason of insanity and committed indefinitely to Western State Hospital.

Experts disagree on whether the changes now proposed would have altered the course of cases like these and Zamora’s. In general, though, the goal is to intervene “upstream,” Owen from NAMI said, rather than so late it’s expensive and possibly futile.

Rep. Mary Lou Dickerson, D-Seattle, a sponsor of the bills, said Harps’ murder shows that “mental-health professionals do not have adequate tools” to use in deciding when to commit someone for treatment.

“It is my hope that by intervening early we can actually save these individuals from having to go into the criminal-justice system, where so many of them end up.”

The issue of involuntary treatment and commitment is perhaps “the most divisive and controversial topic” within the mental-health community, a consultant reported to the state in early 2007.

So it comes as no surprise that there’s not universal support for the proposed changes — particularly in light of a long-standing shortage of local psychiatric beds in King and other counties.

Early intervention is good, said Amnon Shoenfeld, director of mental health, chemical abuse and dependency services for King County, but “changing the law with the specific intent of detaining more people will make a bad situation worse.”

“We don’t have enough capacity to detain the people we’re already detaining,” Shoenfeld said.

Who decides

Those who evaluate people with mental illness for possible commitment are called “designated mental-health professionals.”

Most have a master’s degree in social work, while others are psychiatric nurses or psychologists. King County has 28.

In deciding how much risk a person poses to himself or the community, they investigate circumstances, often talking with police, relatives and neighbors. In emergency situations, they alone can decide to hold someone for 72 hours.

Deliberately independent of both the legal and medical systems, they must understand the complexities of mental illness as well as the provisions of the law, said Shoenfeld, because ultimately, committing a person against his will is a legal process.

In King County, 2,365 mentally ill people were committed under the law in 2009, Shoenfeld said. The majority went to Navos in West Seattle, a psychiatric hospital, or to Harborview.

About one-quarter had to be “boarded” in an emergency room or other place, waiting an average of two days for a psychiatric bed.

Washington ranks at or near the bottom of states in number of local psychiatric beds per 100,000 population, experts say. But because earlier treatment might help stabilize people more quickly, beds may open up sooner, Dagadakis said. “Nobody really knows how things will play out.”

In any case, not having enough beds should not preclude changing the law, said Roy-Byrne at Harborview.

“That’s like saying, ‘We don’t have enough room in the emergency room, so we won’t see anybody with heart attacks.’ ”

Gov. Chris Gregoire had asked for a more comprehensive revision of the commitment law, but supports the measures passed by the House. She has designated $2.3 million in her budget for more beds at state hospitals, but with an expected $2.8 billion budget shortfall, there are no guarantees the Legislature will go along.

Carol M. Ostrom: 206-464-2249 or

Information from Seattle Times archives and staff reporter Maureen O’Hagan was included in this report.

Here’s the link to the original article posting.

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February 22, 2010 - Posted by | Mental Health | , , , , , ,

1 Comment »

  1. I would only suggest readers go to the original article at the “Seattle Times” and gaze through the comment section. I personally believe there are some interesting arguments and insights to be considered that go beyond the article itself.

    Comment by MsPiggy | March 1, 2010 | Reply

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