Category: Mental Health

Addiction, King County, Mental Health

County Plans Emergency Walk-In Centers for Behavioral Health Crises
King County Executive Dow Constantine, flanked by Sheriff Patti Cole-Tindall and state Rep. Nicole Macri
King County Executive Dow Constantine, flanked by Sheriff Patti Cole-Tindall and state Rep. Nicole Macri

By Erica C. Barnett

On Thursday morning, King County Executive Dow Constantine announced his plan to introduce a plan to expand services for people experiencing behavioral health crisis as part of his 2023 budget proposal in September. The plan will attempt to address the worsening shortage of short- and long-term treatment for people with behavioral health conditions and substance use disorder. As of this year, Constantine said, the county has lost a third of its residential behavioral health care beds, “and it would have been more but for our intervention. And more facilities are potentially closing their doors in the months ahead.”

Currently, there is only one 16-bed crisis stabilization unit—the Downtown Emergency Service Center’s Crisis Solutions Center—in the entire county. A person in crisis who needs help right away can call 911 or the new 988 mental health crisis line, but people who need immediate, intensive intervention generally have nowhere to go but emergency rooms, which are ill-equipped to deal with behavioral health crises, or jail.

:I’m glad we’re here to be talking about potentially expanding [the crisis] system, but we can’t just expand it. We need to fix what is broken. And if I’m being honest with you, I am part of what’s broken, and every other behavioral health worker, because the system has put us in an impossible situation.” —DESC registered nurse Naomi Morris

Gesturing toward the King County Correctional Facility across the street from the county building where the press conference was taking place, Constantine noted that of about 1,530 people in the county jail, more than 600, or two in five, are in some kind of treatment for behavioral health conditions. Many of those have been jailed for crimes that are often related to mental health conditions and poverty, such as theft, trespassing, and assault.

“We cannot accept having the county jail as the main place for people to get behavioral health care. And right now, the fact is that the jail across the street is the second largest behavioral health facility in the state of Washington. We can’t accept relying on law enforcement to solve what is ultimately the health care challenge,” Constantine said.

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Constantine did not provide any details about the scope or cost of his plan, which the county is working on as part of a coalition with other elected officals—including state Rep. Nicole Macri (D-43), Seattle Mayor Bruce Harrell, and King County Councilmember Girmay Zahilay—and health care providers. However, he did indicate that in addition to new walk-in crisis centers, it will include better pay for behavioral health-care workers, such as Naomi Morris, a registered nurse who works for DESC.

“I’m glad we’re here to be talking about potentially expanding [the crisis] system,” Morris said, “but we can’t just expand it. We need to fix what is broken. And if I’m being honest with you, I am part of what’s broken, and every other behavioral health workerm because the system has put us in an impossible situation.” Morris said a coworker recently had to take unpaid leave to deal with the trauma caused by their job as a case manager and found themselves unable to meet their basic needs because “the amount of money they make [is] barely above what the clients we serve get.”

Earlier this year, the King County Regional Homelessness Authority asked the city to pay for salary increases for people who work for agencies like DESC; the KCRHA also funds its own in-house outreach team and pays them significantly more than nonprofit employees doing similar work.

Mayor Harrell, Mental Health, Morning Fizz, Police

Council IDs Funds for 911 Alternative Pilot, Prosecutor Won’t Pursue Charges Against Police Who Killed Lyles

1. City council members Lisa Herbold and Andrew Lewis, who have advocated for creating an alternative response system for 911 calls that do not require police, sponsored a change to the city’s 2022 budget that sets aside $1.2 million originally budgeted for former mayor Jenny Durkan’s “Triage One” program to pay for a future “alternative response model” for these calls.

Although the money is currently frozen—Mayor Bruce Harrell’s office wants to reserve it to help backfill an anticipated budget shortfall next year—the amendment moves the money out of the Seattle Fire Department in case the council and mayor’s office can agree on a pilot proposal this year.

As we’ve reported, the city has backed away from its initial commitment to quickly fund alternatives to traditional police-based 911 response, made in the immediate aftermath of citywide protests against police violence sparked by the murder of George Floyd in 2020, and recently outlined a process for standing up a new public safety department in 2024. Council members have expressed frustration about the slow timeline, arguing that the city could create a pilot program now and see how it goes, rather than waiting years to start.

Using the cost estimates for Triage One, Lewis had council staff create a spreadsheet with a very rough estimate of what a pilot civilian response program, along the lines of CAHOOTS in Eugene, OR or the STAR program in Denver, would cost. The total for a three-person pilot—”basically one van,” Lewis said—came out to about $940,000, or about one-quarter of one percent of the $355 million the city budgeted for the police department last year.

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Lewis noted that the cost could be lower if, for example, the new team used existing city cars instead of buying a $100,000 new custom Ford F150 (Durkan’s Triage One budget called for three) or if they found space that cost less than the previous estimate of $20,000 a month.

Ultimately, it will be up to Harrell’s office to decide whether they want to spend the money on a pilot program for new responders, or to help fill the city’s budget gap, which could total well over $100 million. The city budget office will release its latest revenue forecast next month.

2. King County Prosecutor Dan Satterberg announced Thursday that he would not prosecute the two police officers who shot and killed Charleena Lyles in her apartment in 2017, citing the fact that the law in place at the time effectively exonerated officers who acted “without malice and with a good faith belief that [a shooting] is justifiable.”

In a memo explaining his decision not to prosecute, Satterberg cited testimony during the inquest from experts who agreed “that the use of deadly force was necessary given the circumstances.” Hearing similar testimony, Satterberg wrote, “a criminal jury would likely conclude that the use of deadly force was necessary.”

An inquest earlier this month found that the officers did not violate the law or SPD policies on use of force when they killed Lyles, a 31-year-old Black woman whose history of mental illness was known to both officers, in 2017.

After voters passed Initiative 940 in 2018, the state legislature removed the “malice” standard and required officers to go through additional training in de-escalation and mental health.

In a memo explaining his decision not to prosecute, Satterberg cited testimony during the inquest from experts who agreed “that the use of deadly force was necessary given the circumstances.” Hearing similar testimony, Satterberg wrote, “a criminal jury would likely conclude that the use of deadly force was necessary.”

The inquest process itself is designed to make very narrow determinations about responsibility; in Lyles’ case, the six-person jury was only instructed to answer “yes,” “no,” or “unknown” to a list of 170 factual questions. King County reformed its inquest process in 2018 to give families access to an attorney and to give inquest juries more latitude in deciding whether officers followed department policy. The inquest into Lyles’ shooting was only the second inquest, and the second to find a police shooting justified, since the state supreme court allowed inquests to restart under the new rules last year.

Courts, criminal justice, homelessness, Mental Health

Seattle Court Agrees to Exclude City Attorney’s List of “High Utilizers” from Community Court

By Erica C. Barnett

The Seattle Municipal Court voted Friday to exclude so-called “high utilizers” of the criminal justice system—those who have been accused of misdemeanors more than 12 times in the past five years, and at least once in the past eight months—from community court, a therapeutic court established in 2020 for people accused of certain low-level crimes.

PubliCola reported the news exclusively on Twitter Monday morning.

Davison asked the court to intervene on her behalf in late April, after community court judge Damon Shadid (one of seven municipal court judges, and the only one who handles community court cases) declined her request to immediately bar “high utilizers” from community court.

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Currently, people whose charges consist entirely of low-level misdemeanors (a category that excludes more serious crimes like assaults, domestic violence, and DUI) are automatically eligible for community court, which gives defendants access to services without requiring them to plead guilty to a crime. People can only go through community court four times; after that, they have to go through mainstream court, which frequently convicts defendants but does not jail them beyond the time they have already served.

The King County Department of Public Defese analyzed the “high utilizers” list and found that most were homeless or had undergone competency evaluations, an indication of behavioral health disorders.


In meetings between the court and Davison’s office, Shadid had proposed putting off a decision about “high utilizers” until July to allow parties to court deliberations, including the King County Department of Public Defense (DPD), to come up with a plan for this group that went beyond jail and traditional prosecution. 

In a statement, Davison said she was pleased that the court agreed to her request. “Individuals causing the most impact on our community need meaningful accountability for their criminal activity paired with increased behavioral health services,” she said. “The best venue to ensure appropriate accountability and community safety is in Seattle Municipal Court and my team will continue to engage service providers to address underlying behavioral health needs. Addressing the impacts of individuals engaged in frequent, repeat criminal activity is one of the best ways to improve public safety.”

Davison has not proposed any additional spending on behavioral health care, which is mostly funded by the county, not the city. An analysis of Davison’s “high utilizer” list by DPD showed that the list consists primarily of people who are unsheltered or have been through a court-order evaluation to determine their competency to stand trial, a sign of extreme behavioral health issues that are most effectively addressed with health care and treatment, not jail.

DPD director Anita Khandelwal said community court came out of a collaboration between the municipal court, the previous city attorney, and her department, with the goal of charting “a new path for people accused of misdemeanors in Seattle that would reduce the harm of the criminal legal system and quickly address the needs of vulnerable members of our community. While the court continues, we’re sorry to see this collaboration unravel so quickly at the behest of the City Attorney.”

Traditional prosecution and jail, Khandelwal continued, “takes far more time, is very expensive, and fails to produce meaningful results. The City Attorney has produced no data—and I have seen none—that shows that the traditional criminal legal system is effective in changing behavior. Instead, it means people who have significant unmet needs will continue to cycle through a system that we know to be expensive, ineffective, and racially disproportionate.”

In a statement, the municipal court judges said they agreed to the changes Davison requested “in an effort to work collaboratively” with her office and “in the interest of preserving Community Court as an option to address many non-violent misdemeanor cases.” Later, the court amended the judges’ statement (which we quoted on Twitter) to read, “The Community Court agreement already provided the judges with discretion to screen defendants out of Community Court. The changes approved last week will allow the City Attorney to decline to refer a case to Community Court even if it is technically eligible.”

As a partner in community court, Davison has the ability to withdraw the city from the court, effectively shutting it down. This gives her office considerable leverage in negotiations over court rules, including which defendants are eligible.

Community court, the judges noted in their statement, was established as a corrective to a system in which people are already being released onto the street (instead of jailed) and are often hard to track down for court appearances specifically because of “housing insecurity, mental health issues, and substance abuse issues; all issues that Community Court was meant to address.”

human services, legislature, Mental Health

Mental Health Advocates Raise Concerns About Psychiatric Commitment Bill
Eastern State Hospital
Eastern State Hospital. Photo by T85cr1ft19m1n, via Wikimedia Commons

By Paul Kiefer

As Washington lawmakers grapple with the shortcomings of the state’s behavioral health system, Sen. Manka Dhingra (D-45, Redmond) is sponsoring a bill that aims to open beds in the two state-run psychiatric hospitals, Eastern and Western State, to provide short-term mental health treatment beds for people with serious behavioral health disorders to stabilize so that a court can decide whether they need to be hospitalized long-term, a process called civil commitment. Neither hospital currently provides any short-term beds; instead, they provide long-term treatment, mostly to people accused of crimes who have been deemed incompetent to stand trial.

The bill would require the state hospitals to admit patients who need to undergo the two weeks of mental health evaluations and treatment needed for a civil court to decide whether they belong in long-term care. It does not set aside a specific number of beds for this purpose.

Across Washington, short-term psychiatric beds are hard to come by, especially for people with a record of violent crime. To fill the gap, Washington courts send hundreds of people each year to regular hospitals, which usually aren’t equipped to provide the level of mental health care that a psychiatric hospital can; some patients with severe behavioral health disorders even end up in emergency room beds, and others are turned away, often into homelessness. In September 2021 alone, King County courts committed 361 people to non-psychiatric hospitals.

Dhingra’s bill would prioritize opening beds at state hospitals for people whose criminal records would make it difficult to place them elsewhere.

“The hospitals are already seeing this group of people. We should take them in when they first come into contact with the civil system instead of waiting for them to commit a felony.”—State Sen. Manka Dhingra

The proposal sparked pushback from mental health advocates, who argue that the bill would only make it more difficult for the state’s Department of Social and Health Services (DSHS)—the agency that runs the two state hospitals—to manage its backlog of patients who either need to get into the hospitals for long-term, court-ordered treatment or who are sitting in the hospitals waiting for housing after their treatment ends. Advocates also say that hospitalizing people who need short-term treatment in large institutions far away from where they live works against the state’s larger goal of treating people with behavioral health disorders in their own communities.

In Dhingra’s view, Eastern and Western State Hospitals should help meet the demand for short-term treatment—especially for people that other hospitals refused to treat because of their criminal record. “The hospitals are already seeing this group of people,” she said. “They don’t get the treatment they need in the civil system; they then commit felonies and wind up at Western State. We should take them in when they first come into contact with the civil system instead of waiting for them to commit a felony.” Using the state hospitals may be a temporary solution, Dhingra added, until more local psychiatric beds open; since 2016, DSHS has been investing in small, community-based treatment facilities across the state, but that effort hasn’t met the demand for beds.

Some mental health advocates and DSHS itself, however, say Eastern and Western State Hospitals stopped handling short-term treatment for a reason. During a hearing on the bill last week, DSHS Assistant Secretary Kevin Bovenkamp told lawmakers that opening the hospitals to short-term patients again “moves us in the wrong direction.”

“We worked for years to shift the focus towards getting people places to recover in their own communities,” said Laura Van Tosh, an advocate who previously spent time as a patient at Western State Hospital. “If this plan goes through, it will upturn all those efforts. The last thing we want to do is put more people in the state hospitals.”

From Van Tosh’s perspective, while the bill might get people into psychiatric beds faster, a short stay in a large state hospital is far less useful in a patient’s recovery than treatment in their own community. “From where I stand, this doesn’t seem patient-centered, and it doesn’t seem focused on recovery,” she said. “It just seems like a mechanism to get homeless people off the streets and keep them in hospital beds for who knows how long.” People experiencing homelessness are more likely to be civilly committed, and people who have been civilly committed are more likely to become homeless after they are released Continue reading “Mental Health Advocates Raise Concerns About Psychiatric Commitment Bill” →

Health, legislature, Mental Health

Hospital Overcrowding Prompts Push For Guardianship and Informed Consent Reforms
King County COVID data as of January 14, 2022

By Leo Brine

Seattle Rep. Nicole Macri (D-43) is working on a bill to reform Washington’s informed consent and guardianship laws, which have prevented hospitals from discharging some patients who need long-term care at a time when hospitals need as many beds as possible to handle the latest spike in COVID cases.

Washington’s guardianship and informed consent laws have prevented hospitals and family members from transferring some patients who cannot make decisions for themselves into long-term care facilities even when a family member has given consent. Macri has a bill cued up which will address the problem, she said.

While the state’s informed consent laws empower family members to make many decisions for incapacitated people, they don’t allow incapacitated patients to leave hospitals for long-term care without the consent of a court-appointed guardian. The reason? Money: Guardians are responsible for paying for long-term care.

It can take months for courts to establish someone as a patient’s guardian, so Macri wants to amend the state’s informed consent laws to make it easier for patients to move to long-term care facilities while allowing courts to establish guardianship for the patient’s long-term financial management later.

Right now, hospitals have patients occupying hospital beds that could be used to treat people with acute needs because they don’t have a paper saying who’s going to front the bill.

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As of January 12, Washington state has 2,062 COVID patients in hospitals with 172 on ventilators, according to state data. In King County, hospitalizations more than doubled between January 2 and January 9, county data shows.

Hospitals in Washington have said they are in “a state of crisis” after operating for months at high capacity and now with omicron sending more people to the hospital than ever before.

The Washington State Medical Association sent Governor Jay Inslee a letter last week saying that hospitals are in “a state of crisis” and asking the governor to change guardianship laws so that family members can agree to transfers. The letter included the draft of a proclamation that, if Inslee signed, would have that efect.

However, Inslee said last week that he does not have the executive authority to make the proclamation because, “you have to comply with federal law to admit someone to a long-term care facility. I cannot waive federal law.”

Instead, the governor—inadvertently highlighting the need for Macri’s fix—announced Thursday that he hopes to increase the number of social service workers who work on patient transfers. He also proposed create a program to expedite the process of establishing guardianships and increase the number of guardians, which could help reduce the backlog of patients stuck in hospitals. “[This] may involve more resources for the superior court,” he said. Additionally, to help long-term care facilities take on more discharged hospital patients, he’d add new health care workers to long term care facilities.

Macri says her bill is still necessary because establishing guardianship “can still take months even with the steps that [Inslee is] putting in place.” Her bill will change informed consent laws to allow family members, those with power of attorney, and other surrogate decision makers to consent to a patient’s transfer to a long-term facility.

Macri plans to meet with the governor’s team about her bill to hammer out how it fits in with Inslee’s plans and to address some concerns the governor’s office has around informed consent. One potential sticking point is that, according to Macri, Inslee’s team is sticking with their position that only guardians should be able to make these transfers happen.

Meanwhile, patients without guardians are not the only ones who are having a hard time getting out of hospitals. Often, there are no shelter beds available for homeless patients. And some patients came to the hospital from long-term care facilities but are unable to go back into their care because of understaffing.

criminal justice, Mental Health

Appeals Court Rules State Must Pay When People With Disabilities Wait in Jail for Services
A “rubber room” at the Snohomish County Jail in 2013, used to hold people with serious mental illnesses in isolation.

By Paul Kiefer

The Washington State Department of Social and Health Services (DSHS) won’t appeal a ruling by state Court of Appeals that could enable people held in jails for weeks while awaiting mental health evaluations to receive financial compensation for their lengthy, and possibly unconstitutional, confinement.

The ruling signals a possible turning point in a push by public defenders and disability rights advocates to overhaul how Washington’s criminal legal system treats jailed people with serious mental illnesses.

When someone’s mental health during and after an alleged crime comes into question, the state gives them a “competency evaluation” to determine whether they are competent to stand trial. If they’re not competent, their case can be paused while they are treated at a state facility, where staff can “restore” them to competency by using medication and therapy to treat their mental illness. The goal of restoration is to return people to a point where they can understand the charges against them, return to jail or the community, and eventually go to trial.

The ruling, which the Court of Appeals issued at the end of November, centered on Shymila Luvert, who spent four months languishing in a jail cell last year while awaiting a mental health evaluation that never came. Luvert, charged with a second-degree assault and booked into King County’s Maleng Regional Justice Center in Kent last spring, didn’t appear to understand what was happening to her.

The push to force DSHS to compensate individuals with disabilities for long wait times is new, but the underlying problem is not. The number of people with mental disabilities and illnesses left waiting for mental health services in jails across Washington has risen steadily for years.

A King County judge ordered that Luvert receive a competency evaluation in her jail cell. When she refused to engage with the evaluators from DSHS, the court changed strategies, directing the department to move her to Western State Hospital in Lakewood for an inpatient evaluation within a week.

As Luvert waited for a bed to open, she sank deeper into her mental health crisis. “It was clear that she was not understanding what I was doing there, or what I was talking about,” said Ramona Brandes, the King County public defender who represented Luvert. “She was just sitting in jail, and she didn’t understand why. It was doubly sad because I couldn’t move her case forward in any way and I couldn’t get her the services she needed.”

As weeks turned to months, the court gave the department an ultimatum at the end of July: Find a bed for Luvert in less than a week or temporarily release her. When DSHS didn’t comply, the court ordered the department to pay Luvert $250 for each day she spent in jail beyond the first two weeks of her stay.

The push to force DSHS to compensate individuals with disabilities for long wait times is new, but the underlying problem is not. The number of people with mental disabilities and illnesses left waiting for mental health services in jails across Washington has risen steadily for years. Many spend their time in isolation cells with only occasional visits from mental health care providers, and their mental and physical health often deteriorates as time drags on. Some people spend more time in jail waiting for evaluation than they would have if they were simply convicted of the crime and sentenced to jail time.

In 2014, a group of public defenders and mental health advocates sued DSHS and its two major hospitals in federal court on behalf of more than 100 defendants statewide who had languished in jail while waiting weeks or months for evaluation or to have their competency “restored.” That case, known as Trueblood—named for one of the public defenders who filed the lawsuit—appeared to mark a turning point.

“Jails are not hospitals, they are not designed as therapeutic environments, and they are not equipped to manage mental illness or keep those with mental illness from being victimized by the general population of inmates,” US District Judge Marsha Pechman wrote in her ruling in April 2015. The court ordered the state to complete initial in-jail mental health evaluations within two weeks, and to transfer anyone who does not appear mentally competent to a state psychiatric hospital within seven days.

But in the years since the case, DSHS hasn’t been able to consistently reduce wait times for people in need of competency evaluations or restoration. “[Trueblood] gave us all this hope that there is going to be a change, that things were going to get better,” Brandes said, “and that DSHS was going to start transporting people in a timely fashion. And then they didn’t.”

Instead, the department has paid more than $85 million in contempt fines to the federal court, along with millions to county courts. Those dollars were set aside to pay for new mental health services, staff and facilities, both in county jails and in DSHS hospitals. In 2018, DSHS reached an agreement with disability rights advocates in federal court to take a new approach. Rather than paying contempt fines, the state agreed to devote more resources not only to meeting the court’s intake timelines, but to scaling up diversion and crisis intervention programs. The court didn’t fully waive contempt fines; instead, DSHS has accrued another $100 million in fines that it will need to pay if it can’t meet its promises to improve wait times and diversion programs.

“[Trueblood] gave us all this hope that there is going to be a change, that things were going to get better, and that DSHS was going to start transporting people in a timely fashion. And then they didn’t.” —King County public defender Ramona Brandes

Kim Mosolf, the director of the treatment facilities program at Disability Rights Washington—the nonprofit that negotiated the settlement with DSHS in 2018—said the new emphasis on diversion, which keeps people out of both jails and hospitals, is a way to stem the flow of people with disabilities into jail and psychiatric hospitals. DSHS, she said, “had been trying to build their way out of the Trueblood contempt fines for several years without luck,” opening hospital beds slower than the demand for them rose.

The number of people who need in-patient evaluation or restoration outpaced the department’s ability to open new hospital beds and hire staff, keeping wait times long for people awaiting transfers from jails. The COVID-19 pandemic, which forced Western State Hospital to temporarily pause intake to contain an outbreak, only exacerbated delays.

Mosolf added that adding beds to speed up the process of competency restoration isn’t a long-term fix. “Restoration is not treatment in the way that most people consider treatment,” she said—the purpose of restoration is to make a patient competent enough to stand trial, even if their improvement is temporary. “The state’s own data shows that experiencing restoration does not lead to longer-term stability and health for people—so investing in more inpatient restoration beds is actually a very bad investment in terms of the returns.” Continue reading “Appeals Court Rules State Must Pay When People With Disabilities Wait in Jail for Services” →