DAN VAN HO'S KNIFE hung over a recent state Senate hearing like Damocles' sword. The topic was cutbacks at state mental hospitals—a 40 percent budget savings based on sending institutionalized mental patients back to their communities for treatment.
Well, cautioned Senator Jim Honeyford, a Sunnyside Republican, "I don't want to see them back on the streets, like the guy who stabbed the fireman."
Ho, a former Western State Hospital mental patient, was homeless and fresh from jail when he impulsively stabbed retired fireman Stanley Stevenson to death on a Seattle street in 1997, leaving members of Stevenson's family asking why public officials allowed a clearly violent mentally ill offender to wander loose.
A year earlier, developmentally disabled Betty Antus set a fire that killed two others at the North Seattle group home into which she'd been wrongly placed, prompting the judge who gave her 21 years in prison to wonder if "the system needs to bear responsibility" too.
Other than to cite chronic understaffing and overcrowding at mental hospitals, the state had few answers. (Stevenson's family only recently won a court decision to compel officials to provide details of Ho's release.) But the public outcry that followed the two crimes led to tightened release policies at state mental hospitals, helping create another round of overcrowding—which brings the state full circle today, back to the same jammed system and back to a familiar downsizing plan that could put new Bettys and Dans on the street. Spare us, says Dr. Dean Brooks.
"What will happen; where will they go?" if the state slashes its mental hospitals' budgets by 40 percent, asks Brooks, the advisory board director at Western State Hospital since 1989. "Community care providers are already at capacity. Long-term treatment beds are full, and waiting lists are growing longer. Where would these people go?"
At 85, the retired psychiatrist is a rabble-rouser not unlike the Jack Nicholson character in the movie One Flew Over the Cuckoo's Nest. Brooks, in fact, played Nicholson's ward doctor in the film, shot at Oregon State Hospital where Brooks was superintendent for 27 years. He concedes downsizing is needed but groans at the state's plan for Western. At the bidding of Gary Locke, the Department of Social and Health Services proposes to reduce patient load by 400 beds now occupied mainly by adult psychiatric patients with substance abuse problems and geriatric patients with mental or medically related illnesses. Another 30 beds will be cut at smaller Eastern State Hospital.
ON AVERAGE IT TAKES two years to create just one additional local mental-health treatment bed, once you overcome funding, zoning, NIMBYs, and construction roadblocks, Brooks claims. "And the state plans to send hundreds back to the communities within 15 months?"
Tim Brown, a DSHS assistant secretary, says the cuts would begin this fall and continue into 2003. Though short on details of where new beds would be found and how much they'd cost, he said, "We won't place [remove from the hospital] someone if there isn't an alternative."
Some Western workers say that's already happening at their red brick hospital. Patients have recently been moved out "at an alarming rate," according to members of Local 793 of the Washington Federation of State Employees. They also complain that unjustified cuts have been made in staffing and training, and note that the hospital has eliminated its emergency medical response team, leaving staff to handle life-and-death emergencies on their own while waiting for a response from 911. (At a recent demonstration outside a Western board meeting, one picket sign read, "When your heart stops, does your hospital call 911? WSH does!")
Brooks acknowledges the recent patient transfers and other changes but says they're related more to existing overcrowding and long-standing budget problems. Nonetheless, he says, if DSHS' new "draconian" plan is realized, Western will be hazardously crowding its remaining patients into seven wards, with the likely result of more assaults on patients and staff, overuse of restraints, and early releases—followed by loss of the hospital's accreditation and ultimately $50 million in federal funding.
DSHS thinks that doomsday scenario is unlikely and that its proposal will improve the system—saving $41 million at the hospitals and shifting about $26 million to community programs for a relatively modest net savings of $15 million. "It's not only a matter of savings," adds Tim Brown, "but of more appropriate care elsewhere." In some cases, Western's patients do not need institutionalized care at $365 a day when nursing facilities at $125 a day would suffice.
Again, where are those facilities? asks a frustrated Brooks. "I'm on the board of Compass House, the biggest [community treatment] provider in the North Sound area," he says. "Last year alone we saw 154 new homeless mentally ill, and more are coming. But there are no beds—none. If the state is to release even more from its institutions, those people will wind up homeless or in jail." Unfortunately, he has history on his side.