A few days ago, a friend of mine was watching out for a relative who’d plunged into an unexplained, suicidal depression. Brought to the hospital, the relative had to wait 22 hours in ER before being admitted for psychiatric treatment.

There’s a reason for that–it’s a deeply disturbing reason, and the problem is not going to be resolved any time soon, if our legislature has anything to say about it. To be fair, everyone is doing it.

In December 2009, I wrote a post titled, “King County’s Mental Health is Deteriorating,” after speaking with the director of King County’s Mental Health, Chemical Abuse and Dependency Services Division, Amnon Shoenfeld. One program in particular Shoenfeld was worried about being defunded even then was Western State Hospital’s PALS (Program for Adaptive Living Skills).

At the time, Shoenfeld said, “the reason these people are there is we really can’t place them in the community at large. Of those eleven people, two have committed murder–one murdered a Seattle police officer–three are sex offenders, and four have committed arson. Trying to place these people in the community? Where are we going to find a place that’s going to be willing to take them?”

Today, PALS is closed. Investigate West tells you what happened to the patients: “one is now in a shelter and two are living in motels, awaiting benefits to kick in… Another five were readmitted to Western. The rest were absorbed into their home-county community-health systems, already overloaded.” UPDATE: Amnon Shoenfeld clarifies that in King County’s case: “We successfully placed everyone in housing and treatment, and no one is in a shelter or motel or has been readmitted to WSH.”

The PALS resident who’d killed a Seattle police officer did not return to King County, citing fear for personal safety, but moved to Pierce County.

As to whether our community health systems are equipped to adequately deal with mentally ill people with troublesome histories, I submit a hatchet murder and a knife murder as evidence that they are not. (Let me also stress that it’s the actions of our legislators, not those of the mentally ill, I’m asking you to watch out for.)

Are you upset? Are you angry that legislative “austerity” takes precedence over your safety? Then sit down and count to ten, because the reason PALS is closed is this: Its budget was cut until it became too expensive to run, and then it was shuttered.

Economist Tyler Cowen writes that left-wing economists are often guilty of “evaluating government spending on a program-by-program basis, rather than viewing the budget as a series of integrated accounts.” It’s not just left-wing economists, I think. Especially during budget cuts, people fight for funding on a program-by-program basis, trying to remove costs from their budget areas. If in good times you might have tragedies of the commons, in austere times, you get penny-wise, pound-foolish tragedies of the line item.

Last October, Governor Gregoire proposed sweeping cuts as part of supplemental budget reductions. It called for the end of the state’s Basic Health Plan, but it also put mental health administrators on notice that they needed to find a way to cut $17.5 million from state spending, $5.2 million in King County, in the next seven months.

PALS was funded by a separate budget proviso, which had a date with the budget chopping block. The thought at the time, Shoenfeld says, was that the state’s regional support networks would try to cut a little here and there from their PALS expenses, and lobby for the money saved to be added to the cost of providing care locally. But when all the RSNs pitched in, the need for PALS beds shrank from 32 to 15, and the cost per day doubled from around $400 to $800.

Without the “volume discount” on beds, cutting the beds by half resulted in no savings. PALS would still have to be closed.

“I understand that there’s no money,” said Shoenfeld, but he argues, persuasively, that that doesn’t change the fact that certain cuts are guaranteed to cost more if you make them than if you didn’t.

In 2002, Pierce County filed suit against the state for failing to meet its constitutional obligation to “support and foster” institutions for the mentally ill, and for breach of contract in not providing the number of beds contracted for by the county. In 2006, Pierce County won the case.

Now, besides the PALS closure, Western State Hospital has, due to budget cuts, closed a 30-bed ward.

Shoenfeld believes Western State is contractually obligated to provide 557 beds, but is concerned that, to his knowledge, Western State is admitting just 517. Thanks in part to that shortage, King County is now turfing people with 90-day, court-ordered involuntary commitments to local hospitals. (I have a call in to Western State Hospital to see how their current capacity corresponds with their contractual obligations with RSNs.)

Typically, a hospital has 14 to 17 days to try to stabilize someone undergoing mental health dysfunction (whether it’s psychosis, a deep depression, or brought on by other medical issues). If they can’t stabilize the patient so that they are no longer thought likely to harm themselves or others, then the patient is sent to Western State Hospital for treatment and observation. Failing an open bed, the patient remains at a local hospital, where beds are much more expensive, about two times the cost of Western State, says Shoenfeld.

But there’s a larger opportunity cost in health care than pure dollars. Local ERs need all the beds they have. If you’ve been in an ER lately, you know how quickly they like to turn beds over. Their ability to provide emergency services is compromised by losing beds for up to 90 days. It’s also true, added Shoenfeld in an aside, that ER patients might be alarmed to know that the person next to them is strapped into their bed because they can’t be trusted to be left on their own.

But things are tough all over, aren’t they? Washington’s chief economist Arun Raha just added an extra $698 million shortfall to the revenue projections for the 2011-13 biennium. In the same document, though, the state notes that unless a change is made it will forego $740 million in uncollected online taxes (TechFlash). While both Republicans and Democrats are sharpening their rhetorical swords corks in anticipation of plugging tax loopholes, it turns out a loophole is in the eye of the beholder.

House Republicans seem to think the biggest priority is ending tax subsidies to sovereign Native American nations.  Senate Democrats can only find a paltry $205 million. Last year the legislature gave Microsoft both a tax amnesty and a tax cut, so that loophole has already been “closed.”