UPDATE: Psych Boarding Ruled Unlawful in Washington State

Stephen Anderson, MD, fully felt the impact of emergency department psychiatric boarding when it knocked him unconscious.

The former Washington Chapter ACEP president had a schizophrenic patient who decided to try to leave the hospital. When staff blocked him, he reacted by attacking Dr. Anderson.

“It triggered retraining for the entire hospital on safety measures … [and] I love to be a bellwether for change, but I really didn’t want for it to happen at the end of a schizophrenic fit,” he said.

Both patient and staffer were victims of psychiatric boarding, the process by which psychiatric patients are admitted to the emergency department under a crisis and remain for days or even weeks before being admitted to an inpatient psychiatric department.

As part of its efforts to address the issue of psychiatric boarding, the Washington Chapter ACEP filed an amicus curiae, or “friend of the court,” brief with the Washington Supreme Court, asking it to uphold an appeals court ruling declaring the practice unconstitutional. They, along with the Washington State Hospital Association, the Association of Washington Public Hospital Districts, the Washington State Medical Association, the Washington State Nurses Association, SEIU Healthcare 1199NW, the Washington State Council of the Emergency Nurses Association, and the Northwest Organization of Nurse Executives, hope a favorable ruling will lead to more funding for mental health services, according to Nathan Schlicher, MD, JD, who serves as secretary, treasurer, and legislative chair of Washington Chapter ACEP.

The court began hearing oral arguments for the case on June 26, 2014, and it’s hoped there will be a ruling within two to three months.

“While no one likes to believe that the courts are the solution to the problem, sometimes we do need a hammer to follow up with the needs of our patients to make change happen at the legislature,” Dr. Schlicher said.

Currently, Washington ranks between 47th and 50th in the nation in its provision of services and availability of inpatient psychiatric beds, he said.

Meanwhile, Washington Chapter ACEP is forming a new best-practices guide for hospitals to use telemedicine and resource distribution to better serve mental health patients. It hopes to expand it to a national initiative.

“We’re hoping that by waking up our state and coming up with a better plan that nationally others will not just learn from it but be able to adapt to their environments,” Dr. Anderson said.