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Western State: a broken place in a broken system

Western State Hospital, a psychiatric hospital founded in 1871, is located in Lakewood, Washington. (Photo by Matt M. McKnight/Crosscut)

The last time I visited Western State Hospital was nearly two decades ago. I went there to see someone who’d run out of all other options and for whose involuntary commitment I’d advocated. I knew it would be her last stop and the place where she’d live out the rest of her days. We’ll call her Carrie.

I had encountered Carrie off and on at a Friday night community meal I started with fellow University of Washington grad students in a U District church. When we first met her, we mistook her frequent falls for intoxication. Later we found out that they were a symptom of a fatal neurological disorder for which there was no cure.

She disappeared for a while, but I soon learned she had been staying in an adult family home. One rainy October night, her case worker and a representative from Adult Protective Services finally gave in to her pleas to return to the street. “I miss my friends,” she had said. They dropped her off in a gas station parking lot and watched her leave using her wheelchair, stumbling off into the dark and wet night.

She somehow found her way to us, and, after some tearful discussion, agreed to accept emergency shelter for the night. I raced to get her to the Women’s Referral Center before the 10 p.m. deadline and then to a mat on the floor of a nearby shelter. Later I went back and retrieved her wheelchair from the rainy parking lot.

Over the course of the next year, Carrie navigated the bewildering social services system, hovering between programs that couldn’t meet her unique set of needs and the impending possibility of involuntary commitment that she so feared. Finally, a Downtown Emergency Service Center (DESC) case worker moved mountains to get Carrie into housing and tried to make that work, until things fell apart and all that was left was to help facilitate her placement into Western State.

The last stop for poor lost souls.

Her condition had been deteriorating for a while, but Carrie seemed to turn a corner during her early months there. She hated the foam helmet she had to wear for protection during her frequent falls, but she began to get steadier. Her scrapes and bruises healed. She was in better spirits than I’d seen in almost a year.

The place was a godsend compared to the other options we had been considering. She “looks great” I wrote to one of her former case workers a couple of months into her stay there. “The improvement over the two months that she’s been in Western is amazing.” 

But over time, her disease advanced and her condition deteriorated. She seemed to stop recognizing me, and I eventually stopped going.

I don’t have a memory of how she looked that last day, but I will carry with me the rest of my life the depressed faces of the staff I spoke with. I remember talking to the psychiatrist assigned to the ward, his shockingly vacant eyes and the disjointedness of our conversation. He seemed more like one of the overmedicated patients than the doctor in charge.

Since then, nothing in the endless series of reports on the problems at Western State has come as a surprise to me. But the news that it lost certification and $53 million in federal funding still stings, and I wonder if it will only make things worse in a state that ranked next to last in 2016 for care provided for mentally ill adults.

To have those beds further reduced “would be tragic and only exacerbate a problem already so seriously out of control,” says Joe Martin, a longtime social worker. “It’s a tragic situation that I don’t see any alleviation of anytime soon.”

The problems at Western State are profound, and we’ve been reading about them for years: From the truly outrageous cases of sexual harassment among staff, to the firing of whistleblowers, to security lapses and rampant understaffing in the wards.

I don’t dispute that the place is broken.

Of course Carrie wanted out. She’d even occasionally try to make a break for it. But there was no place for her, no place for someone who’d been worn down by a life of constant crisis, terminal disease and little or no money. Her mother was already institutionalized with the same disease and her dad seemed worn out, too, and not interested in helping when I called him.

This was the best we could do in a broken system.

Yes, Western State is broken. This whole insane mess is broken. It wears on you. It wears on everyone involved — from the patients to the staff to the families and loved ones. I often wonder about Carrie and feel a tinge of guilt that I stopped visiting years ago, but the flow of people who need help is endless and there’s never enough time to do it all.

Deinstitutionalization and the closing of mental health facilities, which began in the early 1960s, was predicated upon there being community alternatives that were better and more life affirming than the mental hospitals — but that’s not what happened.

The early years of the homelessness crisis, now entering its fifth decade, came on the heels of the closure of Northern State Hospital in the mid-70s. At one time it provided more than 2,000 beds for those struggling with mental disorders. Many residential care facilities and halfway houses were also closed around the same time. During the final wave of deinstitutionalization in the early 1980s, more seriously mentally ill individuals were being released to the streets.

Many of them die on the street. Carrie floated from group homes to couch surfing to short-term commitments to shelters to the street. A couple of times she had her own place, but she could never make that work for very long. She couldn’t make any of it work.

But through some of the worst of it, her spirit stayed alive. Every time she fell down, she picked herself back up and kept going. She knew how to have fun, possessed as she was with a wicked sense of humor and an artist’s sensibility that shined when she was at her best — even if she no longer had the physical dexterity or cognitive acumen to express all that she imagined.

It is a profound failure of our society that there is simply no room for someone like Carrie, who has reached the end stage of a terminal disease. And it is a tragedy for all those ill-served by this system.

“We do a disservice when we don’t have space in which to honorably and respectfully hold someone until they’re ready to heal and recover,” says Ann McGettigan, Executive Director of Seattle Counseling Service.

The State’s answer is to move most civilly committed patients to smaller facilities in local communities. In a statement released this week, the Washington chapter of the National Alliance on Mental Illness (NAMI) acknowledged that “this would be better for people living with mental illness and (for) their families.” At the same time, they recognized the reality that this requires “significant and sustainable fiscal investments on the part of the state,” a political lift of no small proportion.

So, until that happens, Western State Hospital (formerly Western Washington Hospital for the Insane, formerly Fort Steilacoom Asylum) is all there is. We can't afford to lose it when there is no other option. 

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Western State: a broken place in a broken system