[Hpn] Western State Hospital said to free psychotics

William Charles Tinker wtinker@metrocast.net
Fri, 4 Feb 2005 10:35:43 -0500

Western State Hospital said to free psychotics
Full story:

 By Jonathan Martin and Nick Perry
Seattle Times staff reporters

 Western State Hospital is being accused of dumping unstable, mentally ill
patients onto the streets of Tacoma, homeless shelters, even to soup

 As part of a 2-year-old lawsuit, attorneys for Pierce County filed evidence
yesterday alleging that nearly half the hospital's patient discharges were
inadequate and some patients were even hallucinating when they left. Nearly
one-third of discharged patients returned to the Lakewood mental facility
within three months.

 Dozens of individual stories contained in court papers portray the
hospital's release process as chaotic and mismanaged, accelerating the
spiral of chronic mental illness instead of helping recovering patients find
stable homes.

 Pierce County and mental-health watchdog groups also requested an
injunction that would ban substandard discharges and appoint an outside
expert to monitor patient releases.

 "The definition of insanity is doing the same thing over and over and
expecting different results," said Dave Stewart, Pierce County mental-health
administrator. "That's a component of what's happening with Western State
Hospital discharge planning right now."

 Dr. Ira Klein, Western State Hospital's medical director, said he hadn't
see the court filings, but disputed them.

 "I would doubt that to be true," he said. "We wouldn't discharge anyone who
wouldn't meet professional standards. We don't pressure anyone to be

 But according to an analysis of 82 randomly selected discharges, nine
patients were released to the streets or shelters, and three more were sent
to motels, according to court papers. Case descriptions include:

 A 54-year-old man with a three-decade history of schizophrenia was
discharged to a homeless shelter despite being psychotic at the time.

 A patient was discharged to the streets, but soon was readmitted after
trying to kill himself by jumping from a second-floor window.

 A woman who was frequently suicidal was discharged against her wishes the
same day she cut her wrists.

 A man who had previously threatened his wife and a judge was released with
no warning to either of them.

 Ira Burnim, a lawyer at the Washington, D.C.-based Bazelon Center for
Mental Health Law, said the frequency of such questionable discharges makes
Western State Hospital unique nationally, and he has persuaded his
organization to join Pierce County's lawsuit.

 "When we looked at Pierce County, we were kind of shocked," he said. "This
is throwing people off a cliff and expecting them to fly. That's what it has
the feel [of] to us."

 Pressure to discharge Since 2001, 150 beds have been eliminated at Western
State Hospital as part of the decades-old movement to help the mentally ill
live free of institutions. The hospital now has 642 beds. But advocates say
just 60 percent of the savings went to community mental-health care,
intensifying the chronic problem of underfunding outpatient care.

Patients now stack up at Tacoma-area hospitals waiting to get into Western
State Hospital, according to an analysis prepared for Pierce County. The
pressure on the hospital's front door causes a high-pressure effort to
release patients, said Stewart.

 "There is this real drive to get people out that happens because they're
overcrowded and have people waiting to get in," he said.

 Last year, a special committee of mental-health professionals and
legislators recommended no more ward closures at Western State Hospital
until more treatment is funded outside its brick walls. Nonetheless, state
mental-health officials are asking that 100 more beds be eliminated this

 King County has not seen as many questionable discharges from Western State
Hospital as Pierce County, but shares the same concern about funding, said
Amnon Shoenfeld, King County's public mental-health director.

 The budget woes would get worse, he said, if the state Legislature does not
make up $23 million a year that federal Medicaid auditors recently yanked.

 "There really is a major crisis right now," he said. In many local cases,
psychiatric evaluators have decided a person needs to be committed to a
hospital, "but we have nowhere to put them. Harborview [Medical Center] is
boarding people. People are being shipped across the state."

One-hour notice Discharge planning is supposed to begin the day a patient is
admitted to a psychiatric hospital, with help finding safe housing, ongoing
treatment and public benefits to pay for expensive medications.

 Western State Hospital also is supposed to collaborate with case workers in
community clinics. That happens only sporadically, according to yesterday's

 The Washington Protection and Advocacy Systems, a federally funded watchdog
group, reviewed 1,300 patient charts and found the hospital was often
warning community-based case managers that their client would be released in
an hour with no housing, support or benefits arranged, said Debbie Dorfman,
an attorney for the organization.

 That's in part because the hospital doesn't have a formal discharge policy,
she said. "You don't have a policy, and different people do it differently,
so you're going to have different results," she said.

 In a separate analysis of 82 hospital discharges, seven released patients
had no discharge plan at all. In 41 more cases, a community case manager
disagreed with the discharge, but the patient was released anyway.

 Klein, Western's medical director, said all the discharges that he's aware
of are negotiated with the case managers. There may be an isolated case
where that doesn't happen, he said.

 As the hospital director, Klein is the final arbiter of discharges that
community case managers protest. If the community is so upset by some of the
hospital's discharges, Klein asked, why does he see only five to 10 appeals
a year?

The street Homeless shelters appear to be bearing the brunt of questionable
discharges by Western, according to the court filings.

Last week, a hospital social worker brought eight soon-to-be-discharged
patients on a tour of the Nativity House, a day shelter for the homeless
which has no mental-health counseling, according to Diane Savage, the
shelter's director. One was showing obvious signs of mental illness, she

"He looked at me with a vacant stare and when I attempted to talk with him,
he could not convey his thought to me in any obvious way," Savage said in
sworn declaration. "The social worker told me that this patient would be
discharged in less than 30 days."

 The jails also feel the brunt of the discharges: At least 20 percent of
Pierce County inmates are part of the county mental-health system caseload.

 And out on the streets,  there are four times as many people with serious
mental illness who are homeless as there are in state institutions,
according to a state-funded study in 2003.

 "People with mental illness on the streets create a public-order problem
and don't save us money," said Pierce County Sheriff Paul Pastor. "We have
law-enforcement officers and corrections officers doing the work instead of
social workers."

"You're a free man now" The way Brian Floyd Price tells it, Western State
Hospital simply released him to the streets. "They just said 'Well, you're a
free man now,' " said Price, 42, who suffers from paranoid schizophrenia.

 He occasionally sleeps at Nativity House and has begun wearing a thick tow
chain as a necklace and a hard hat to protect his soul and spirit, he says.
Some complain about his odor, while others have became protective of him.

 This week, Price was standing in front of a gas station on Pacific Avenue
South, wearing an orange road-worker jacket and holding a flattened
Budweiser box out to passing traffic. "I'm not a troll under the bridge,"
said Price. "I'm nice to the neighbors. I'm nice to the people. We all have
our ups and downs in life."

 Jonathan Martin: 206-464-2605 or jmartin@seattletimes.com


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