Mental Health: Psychiatric Bed Shortages and Boarding

Even though I read the entire Internet every day, I’m always gobsmacked by the sheer volume of things about which I know NOTHING. Sometimes, you have to go out into the real world to get wind of some of these things. That’s how I found out about the escalating number of cases of boarding in Washington state. I went out. In public.

Image courtesy MicrosoftSeattle’s Town Hall was the site of last week’s King County Mental Health & Substance Abuse Legislative Forum. It was the first time I’d attended one, but I figured it would be a great place to hear what some of the county government representatives identified as pressing issues in Washington’s most populous county (and the 13th most populous in the country). The issue that stood out was how a shortage of psychiatric beds has caused a steep increase in hospital boarding over the last five years.

What am I talking about when I say “boarding?” Sort of like it sounds, boarding refers to the temporary placement of psychiatric patients, most of who are in crisis, in a regular old hospital emergency room. There is often no psychiatric staff available, and while a person may receive medications, they don’t receive proper assessment and treatment, sometimes for days. Like, six days, in the case that Seattle Times journalist Brian Rosenthal wrote about in his eye-opening piece “‘Boarding’ mentally ill becoming epidemic in state.” And quite often, restraints are involved, or isolation, or both.

You should be thoroughly horrified right now, and if you’re not, then I suspect you also don’t like puppies or kittens. Fine. Carry on. But for the rest of us, well, it’s hard to imagine having a friend or loved one who is going through a mental health crisis locked up in restraints and left in an ER hallway for days on end. It hurts our hearts. It hurts the heart of our society.

WA State Legislative BldgThe event I attended was a legislative forum, so not surprisingly, the advice given as to how an individual can effect change with regard to the bed shortage and boarding issue was to tell your elected officials (and this issue is definitely not isolated to King County or Washington state). Find out who is voting to fund mental health care and who isn’t, then put the latter on speed dial. Attempts to get face-to-face meetings with your elected representatives were encouraged, as in-person meetings are still regarded as highly effective.

In King County, the increase in boarding – up from 425 in 2009 to 2160 in 2012 – is directly related to both the decrease in available psychiatric beds and to changes to Washington state law which have made it easier to commit people involuntarily. And while Washington doesn’t usually stand out as first or last on any state rankings list, I’m embarrassed to say that it comes in at the very bottom of the body politic for psychiatric beds per capita in the U.S.

I hate ending a post on a low note, so I will leave you with this companion piece that Rosenthal wrote for the Times, which illustrates just how intensive outpatient and early-intervention programs have been successful at keeping psychiatric patients out of emergency rooms in another of Washington’s counties, despite the lack of beds there, too. More money for that, please, dear legislators. More money for that.

Have you heard of or experienced a problem like this where you live? And is it recent, chronic or in retrograde? 

**Updated in Jan. 2014: Sadly, the very same day I posted this piece, the story came out that mental health workers were unable to locate a bed for inpatient psychiatric treatment for Virginia State Senator Creigh Deed’s son. This occurred the day before he stabbed his father before fatally shooting himself.


– Image of WA State Legislative Building from Wikipedia Creative Commons, user Jason (Cacophony)



  1. says

    I don’t know why you don’t just go over to mental health reporting altogether — you do such a great job. I’m sometimes disappointed we can’t get you equally interested in “food.” But I admire you for both the quality of your writing (and researching) and the topic you’ve become devoted to. We’d like to see you go all-out for it. But it is easier to be on the sidelines isn’t it. From the laypersons point of view; I just talked to my cousin in New Mexico. I called him to wish him happy birthday — he’s 73. He’s an accomplished, licensed engineer. However, he’s been incapacitated much of his career life by by-polar disease. I caught him in a “down.” He’s such a sweet guy. He says he’s tried every medication out there and nothing has helped him. He says he’s only living for the family now but looking forward to the end of it all. It breaks my heart. And I know how difficult is is for me trying to find myself when I’m depressed. I keep running old tapes in my head; regular movies of my father’s drunkenness and violence to me. I’ve gotten help but learned I have to live with my “panic attacks,” that it is never going away. It seems at times like no one cares; too bad for me but it’s my problem. You can see why I pay attention to you and what you have to say. It seems advocacy and reporting in mental health is the right place for you. We appreciate what you’re doing very much.

    • Laura Zera says

      Thank you, Ken. It feels like the right place for me, to be honest. I really appreciate your support as I continue to build my involvement in the mental health space.

      Your cousin’s sentiments show how tiresome a chronic mental illness can be, and I’m really sorry he’s feeling that fatigue. It can be hard to have to pick yourself up over and over again. I know that has been one of the most difficult things for me when I hit a down patch, it feels like all I ever do is fight to get back up. But once through it, then things get better again, so I have to remind myself that it won’t ever stay as terrible as it feels at that time.

      I know you’ve probably heard this before, but when those old tapes start running, do something — *anything* — to distract yourself. Work in the garden or go grocery shopping, play with Lily… something physical that requires your mental focus, too. I think it’s easier/more successful to use distraction than trying to reprogram your thoughts at that particular moment.

      Take care, Ken, and thanks again for your thoughtful comment.

  2. says

    That really surprises me that Washington comes in at the bottom of the country for the availability of psychiatric beds. I think about when I visited my mom in the mental ward at Sacred Heart in Spokane a few times, and then your post makes me think about some of those people left in an the ER for days, just makes me shudder. Keep fighting the good fight Laura, even whilst reading the entire internet every day ;)
    Jeri recently posted…Book Review: The Talented Mr. RipleyMy Profile

    • Laura Zera says

      It’s frustrating to me that there can be so large-scale differences between counties, too. How can one county get it so right and another, so wrong? Thanks for the encouragement, Jeri. I really need it sometimes after I’ve learned more about the challenges facing the mental health system!

  3. says

    I’m with Ken. I love your travel blogs but you’re at your best when you tackle mental health issues close to home. My heart aches as I read your words. On my other blog, Ukiah’s Heart, I’ve been reading about/posting alot about mental health stigma/abuse and it’s really troubling to me that the people who need treatment the most aren’t getting it, or when they do, are martyred by the system trying to help.
    Tyliag recently posted…The Sock God strikes again: Trifecta ChallengeMy Profile

    • Laura Zera says

      It is troubling, Tylia. It really is. We just have to keep talking about it, keep posting, keep sharing. Thank you for your contributions, here and on your blog.

  4. Kris McCann says

    Unfortunately, most of the time, seems like our politicians are very short sighted. “Why would I spend money on mental illness treatment, homelessness, universal preschool, etc. We need to shrink the government.” Their short-sightedness ends up costing much much more. As an example, last night, I was listening to a story about universal pre-school and how it really gives a kid a jump on school, and their life. Statistics back it up. The kid has a much more productive life, less chance of ending up in jail, etc. That’s a win/win! But when universal pre-school was proposed in Oklahoma, it was turned down. People complained about too much government, too much money, “nanny state”, etc. So much objection to the year before kindergarten but after that, it’s ok?? No investing for the future and saving money down the line.

    • Laura Zera says

      Argh, the term “nanny state” is one of my most disliked! It’s usually so inappropriate in its application.

      Anyway, I totally agree with you, Kris. What I find amusing is that “we” (the developed world) have long highlighted the shortcomings of the developing world for living with a short-term mentality, not saving, investing, looking to the future. But we are just the same! We do what is politically expedient right now and damn the consequences down the road. It’s actually even worse that it’s our politicians who are doing this, because they are supposed to be acting in our best interests.

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