No Exit

There are 100 of them in there. They cannot get out. They've done their time. They are not free to go. They are Western State Hospital patients, well enough to be discharged from the psychiatric wards but, as a practical matter, unable to leave the grounds. You probably don't know them; you don't hear about them. They are nameless and faceless, held hostage by a mental health system that doesn't work and a society that doesn't care.

If you were a prison inmate who had served your sentence and yet you couldn't get out of jail, society wouldn't just care—it would be outraged. There's a similar situation at Western State, in Steilacoom in Pierce County—the most notorious of Washington institutions—but the public outcry is missing. Two years ago, a new state program enabled stabilized patients to leave the hospital and, with help, make their way in the real world. But then this freedom train stopped, and 100 people were left in limbo. State and local health officials know there is an effective way to release them, one that's fast and cheaper than keeping them institutionalized. But they are afraid to act.

Twelve of these 100 patients are former prisoners; the rest have never been accused of any crime. They have rights. But, being mentally ill, they are screwed. Freedom is the creed of this country, but it mostly applies to these patients in the abstract.

One man for whom freedom has worked is a 53-year-old schizophrenic named Wei Li. He was in Western for six years. He's now in a progressive program run by Highline Mental Health in West Seattle, and he's proving to be a very determined patient. He knows the difference between in there and out here, despite the many challenges to piecing his life back together.

"More better," says Wei Li, whose mother tongue is Cantonese, of life out here.

The reason more patients—including the 100 in Western limbo—aren't winning the freedom Wei Li enjoys is that the Legislature and state and local mental health officials have created a system with knots that Hercules couldn't cut.

For society, the convenience of keeping people like Wei Li locked up is easy to justify. They're nuts. They're a menace. They can't live amongst us. We've long regarded the institutionalization of mental patients as a joke: "You're going to Western State," goes the giggling putdown of children and adults. So no one much cares about what goes on behind the low stone wall around Western's grassy hospital grounds or inside the graceful, early 1900s brick buildings. Plenty has. Rape. Torture. Murder. Seclusion for weeks and months strapped to a bed in leather restraints. Forced prefrontal lobotomies. Walking zombies. Frances Farmer.

The main entrance at Western State. (Kevin P. Casey)

You went in and you didn't come out, and few gave a damn. Until the 1950s, Western patients' remains, unclaimed by families, were buried in a nearby graveyard. Names did not appear on markers. Instead, they got a number. Three thousand numbered graves lie near the Western campus today. No lie.

On occasion, journalists and citizen groups reported on deplorable conditions at Western. Lawsuits and spotty reforms followed. It took many decades, but Western made the shift from warehouse to hospital. Today, its wards—units, in Western's parlance— resemble hospital wings at a low-budget medical center. The cinderblock walls are painted gray. Patients get bedrooms with a dresser, desk, and mattress.

But our attitudes on the outside have not changed. Even in 2004, families forget about relatives in there. Why should the rest of us give a damn? They are crazed, unable to live in society, right?

But in the 21st century, something's different: Medications and behavioral treatment for schizophrenics—the hospital's core population—are far, far better than in decades past when doctors used cold baths as a treatment. People can improve. They can "recover," as many in the mental health field now call a patient's progress from the depths of illness to reintegration into society. They can live in society, and they should not be held without prospect of release.

A few years ago, the Legislature and state mental health officials hammered out a plan to downsize Western. It costs $425 a day to hold a patient at the hospital, but it would cost one-third that to house them in a group home or halfway house and offer a reorien­tation program like the one at Highline. Indeed, over the past two years, patients who previously would have had little chance of being freed were released through a state program called Expanding Community Services (ECS). Seventy adults and about 100 geriatrics tasted freedom for the first time in years via ECS. Among the adults, only five have returned to Western—a far cry from the regular recycling of patients.