Mental Health Boarding: In Re Detention of DW and the Legislative Response

Supreme Court Decision

On August 7, 2014, the Washington State Supreme Court unanimously ruled solidly on the side of patients today, finding that patients who are in psychiatric crisis cannot be boarded in hospitals just because the appropriate evaluation and treatment facilities are overcrowded. According to the court, the State does have a legitimate interest in treating the mentally ill and protecting society from their actions, but the State cannot fail to provide that treatment because of a lack of funds, staff or facilities.

The Supreme Court’s ruling in the case of In re the Detention of: D.W., G.K., S.P., E.S., M.H., S.P., L.W., J.P., D.C. and M.P. states “that the ITA authorizes single bed certifications for statutorily recognized reasons individual to the patient, but not merely because there is a generalized lack of room at certified facilities.” The opinion can be read here.

WSHA coordinated a group of eight organizations to file an amicus curiae (friend of the court) brief in In re the Detention of D.W. et. al., describing the impact of the practice of “psychiatric boarding” on the ability of hospitals and providers to provide appropriate patient care. The hospitals, nurses, physicians and others asked the state Supreme Court to uphold a Pierce County Superior Court ruling that psychiatric boarding is unconstitutional. The brief was cited by the court both during oral argument and in the opinion. More information about the brief, including links to the briefs and contact information for all the co-signing organizations, can be found here.

Resources to assist hospitals in understanding the impacts of the case can be found here:

2015 Legislative Action

2015-2017 state operating budget: WSHA successfully advocated for significant new investments for mental health, which will result in major steps forward for patients. The budget includes about $100 million in state and federal funding for people affected by the Involuntary Treatment Act, and those who are arrested for a crime and may not be competent to stand trial.

Of these funds, $64.1 million will:

  • Pay for new community psychiatric beds that have opened since the Supreme Court case;
  • Make staffing improvements for more acute patients at Western and Eastern State Hospitals;
  • Fund a new, badly needed, long-term civil commitment ward at Western State Hospital;
  • Create a process for family members to petition the court for review of designated mental health professional involuntary detention decisions; and
  • Support involuntary (court-ordered) outpatient treatment.

In addition to funds on the civil side, additional resources were provided for those in the judicial commitment process. In response to the intense need for mental health services for those in jail awaiting trial, $36.3 million (of the $100 million investment) will fund a new competency restoration ward at Western State Hospital. Funding will also be used to increase staffing to perform evaluations to determine whether a person is mentally competent to stand trial.

Mental Health Capital Funds: WSHA also advocated for capital budget funding for grants for hospitals and other community health providers who are increasing inpatient mental health treatment facilities serving people in crisis. We are very pleased that the capital budget includes $32 million in this pool, of which $25.5 million is earmarked for specific projects. The remaining amount will be dispersed through a competitive grant process. Significant new inpatient capacity will open as a result of these grants.

As they had in 2013, the legislature exempted hospitals that receive capital grants from having to go through a Certificate of Need (CN) process for the new psychiatric beds. This reflects the fact that the capital grant application includes a review of all the same elements that CN considers.


Psychiatric boarding occurs when a patient in a mental health crisis comes into, or is brought into, a hospital emergency department and is evaluated and involuntarily detained by a designated mental health professional and is unable to get the needed inpatient care because none is available. The detained patient remains at the hospital until there is room at an appropriate facility.

Psychiatric care and crisis interventions are designed to be delivered through certified inpatient evaluation and treatment (E&Ts) facilities– not hospital emergency departments. Hospitals are often the entry point for many patients in crisis, yet emergency departments are not equipped to provide ongoing psychiatric services.

Severe underfunding has resulted in a significant drop in services available at E&T facilities. The number of available beds for mental health patients dropped by 36 percent, while the population of the state grew by 14 percent. At the same time, funding for the community mental health system, which is designed to help keep people out of crisis and out of the inpatient system, was cut by more than $90 million in just three years.


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