Nurses on the Front Line of Behavioral Health


If the continuing COVID-19 pandemic has taught us anything, it’s the importance of improving access to behavioral health resources across the country. Nurses are an overlooked part of this access to care. From workplace violence prevention, to safe nurse staffing laws, to pay equity for psychiatric nurse practitioners, we must learn from the past to ensure a better present and future.

Long before Washington became a state, the first official caregivers of people with mental health issues were immigrant nurses from Montreal. Often overlooked and forgotten, the Catholic Sisters of Charity of Providence opened St. John’s Lunatic Asylum near Fort Vancouver in 1861. Caring for the mentally ill was part of their charitable and religious mission.

Today, nurses remain the largest providers of behavioral health care. In providing compassionate, quality care to people struggling with mental illness and substance use disorders, mental health nurses assume that families, friends and others can no longer provide. Yet nurses are consistently underpaid.

In 1862, when the Washington Territorial Legislature granted the sisters a three-year contract to provide hospital care for the mentally ill, it pledged to pay $8 per person per week. The Sisters took on privately paid patients because government funding was so low.

Despite the low payment, the Sisters provided high quality care. A notable component of treatment was careful observation, helping to prevent suicide or other harmful behavior. In accordance with prevailing treatment recommendations that a good environment would restore the spirit, the sisters offered accommodation in a beautiful and healthy place.

Visiting St. John’s in 1863, Territorial Governor William Pickering was pleased with the sisters’ care; however, the territory did not make any payments. The following year, the Territory made partial payments, offering devalued paper greenbacks worth only 50–80% of face value instead of the monetary change that Mother Joseph, the Superior, wanted. The sisters’ bill remained unpaid by the territorial legislature until 1872.

Despite the lack of payment, the Sisters worked under the contract until 1866, when the Territory awarded the contract to the lowest bidders, a father and son partnership at Monticello. They transferred the patients to the hastily built asylum, devoid of nurses or doctors. Conditions at the Monticello asylum have raised cries of alarm. An inspection revealed a “shameful neglect of duty” towards a patient who had become pregnant. Patients lived in filth and stagnant water.

In 1869, the famous nurse and advocate for the mentally ill, Dorothea L. Dix, visited our area. Dix spearheaded the opening of state-supported mental hospitals across the United States and Europe, using advocacy and his detailed first-hand documentation of asylum conditions. Learning of the conditions at Monticello, she urged the governor to remove the patients from Monticello. Fearing that bad publicity would undermine the status of the new territory, the legislator decided to open a permanent public establishment with a resident doctor. Later known as Western State Hospital, the new facility opened in 1871.

Our historical experiences highlight critical questions about who will pay for the necessary treatment that our brothers and sisters with mental illness need. Initiatives funded by the private sector, religious organizations and charities can provide assistance, but their goodwill and financial resources are limited. In 2019 and 2020, Washington lawmakers approved legislation to improve our mental health system.

With the combination of the prolonged COVID-19 pandemic, a worsening mental health crisis, especially for our young people, and half of the nursing workforce nationwide exhausted and contemplating to resign, we must pay and support our nurses and our future nurses.

Note: I wrote this message with the help of Mary K. Fleck, a former litigator. She researches and writes about the history of the Sisters of Providence in the Pacific Northwest.

Also note: Due to a lack of adequate state support, safe personnel, infrastructure maintenance, and quality patient care, Western State has lost federal certification and support. financial in 2018.


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