Category: Mental Health

To Help Kids Like Mine, Pass the King County Crisis Care Centers Levy

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By Brittany Miles

I am the single parent of a teen with early onset schizophrenia, and we’ve been consistently failed by the system.

At 15, Jaime has intense hallucinations, agonizing delusions, and debilitating paranoia. Getting her consistent, quality care has been a challenge. The $1.25 billion, nine-year King County Crisis Care Centers levy, which would fund the creation of five urgent care clinics around King County, including one exclusively for kids and youth, is on the April special election ballot. It would be a major step forward in helping our most vulnerable kids get the care they need.

The stakes are high: Nationwide, one in six young people between 6 and 17 experience a mental health disorder each year; half of all lifetime mental illness begins by age 14, and 75 percent starts by age 24. The mental health system is difficult to navigate as an adult, but for kids it’s inscrutable. I used the resources available to parents: I collaborated with the school district for special education services, met with social workers, and conferred with specialists—all of whom underestimated Jaime’s needs.

Our family has lived with pain, confusion, and anger with the system. If we had access to urgent care, I believe we would have been better equipped to survive my daughter’s worst days.

She started spiraling at 12 and my maternal instinct told me she needed more help than I could give her. Everyday activities could make her irritable to the point of irrationality. I often found Jaime crying in our hall closet. During one particularly frightening episode, she was admitted to Children’s Hospital. After a five-day stay (with a $50,000 price tag) I was told she was depressed and encouraged to send her back to school within a few days. When she returned home, the crisis continued. I didn’t know where else we could get help.

Our family has lived with pain, confusion, and anger with the system. Jaime’s needs were outgrowing the diagnosis and medications we’d been given. I left my lucrative tech consulting career to become her full-time caretaker. If we had access to urgent care, I believe we would have been better equipped to survive her worst days. Community-based care is vital, because it provides a continuum of care, while hospital stays triage and treat acute symptoms. Intimate knowledge of the client’s physical, behavioral, and emotional health helps providers ameliorate a crisis. Caretakers, who no longer have to share a comprehensive health history at every visit, can feel heard.

While community care shows great promise, I am concerned that the system could quickly become overloaded. Cities should take steps to prepare for the potential onslaught. Neighborhood services can feed into the expansion of the crisis care network. Last week, the north and northeast King County cities of Bothell, Kenmore, Kirkland, Lake Forest Park, and Shoreline announced a new multiservice crisis response center dedicated to serving the needs of their citizens. This center will be the first in the county to address the demand, and offers a blueprint that other cities can follow. One area which requires more discussion is how the county will manage the quality of care, so there is consistency for clients and staff.

After all we’ve been through, Jaime is currently stable with the right medication and has a therapist she adores. Life is better, but her symptoms can make the best of days difficult, and a crisis can erupt at any time. Passing the Crisis Care Center levy will ensure that a vital safety net will be in place for those struggling to manage their mental health in a post-Covid world.

Brittany Miles is the single parent of a 15-year-old with early onset schizophrenia and a member of the Kirkland Regional Crisis Response Community Advisory Board. “Jaime” is a pseudonym.

In a Sign of Worsening Conditions, Understaffed King County Jail Has Lacked Water for a Week

By Erica C. Barnett

The King County Jail in downtown Seattle has lacked potable water since Thursday, September 29, and people incarcerated at the jail have been relying on bottled water for the past week, PubliCola has confirmed.

According to a spokesman for the county’s Department of Adult and Juvenile Detention (DAJD), the county “has had the tap water in the jail tested multiple times in multiple locations, and all tests have indicated that the water meets EPA standards for drinking water. However, since the water is still cloudy, we are providing bottled water for drinking and cooking purposes.” The jail has “ample supplies of bottled water,” the spokesman said.

According to the president of the King County Corrections Guild, Dennis Folk, inmates are allowed one bottle of water at a time and can trade in empties for new bottles. This restriction, Folk said, makes it less likely that people will melt the plastic bottles to turn them into weapons or fill them with urine or feces to fling at guards or other inmates.

However, it’s unclear how frequently people inside the jail are actually getting access to water.

“What we are hearing is that there is rationing of water and people are having to choose between hydration or hygiene, and there just isn’t enough water available,” the president of the public defense union (SEIU 925), Molly Gilbert, said.

A spokesman for the jail said there is no rationing and that DADJ offers water “at every meal, periodically throughout the day, during medication delivery, and per request of jail residents.”

PubliCola reported the news exclusively on Twitter Thursday morning.

According to an email from King County Department of Adult and Juvenile Detention (DAJD) director Allen Nance to the King County Department of Public Defense, the department became aware of “complaints related to water quality” last week (according to Folk, the water coming out of the taps was brown). “We immediately implemented bottled water for all persons in custody and staff out of an abundance of caution,” Nance wrote.

“We have women in the jail who are having their period and they’re unable to get a change of underwear for the week,” Gilbert said. “It’s inhumane, it’s unconstitutional, and it’s a clear liability for the county.”—Molly Gilbert, SEIU 925, King County Public Defense Chapter

Water testing found high “turbidity,” or cloudiness—basically, foreign particles in water that can indicate the presence of disease-causing microbes—and the water has remained off since then while the county has tried to figure out the source of the problem. In his email, Nance said the brown water may have resulted from faulty screens on the water heaters at the jail. According to the DAJD spokesman, the county has sent samples of the water for testing and expects to get the results back tomorrow.

The ongoing water shutoff is just the most recent example of ongoing problems at the jail that have severely limited residents’ access to medical care, attorneys, and time outside their cells. In a survey conducted by the ACLU of Washington in late September, public defenders reported that their clients often lacked access to basic medical care, such as treatment for injuries and dental care, and medication, including everything from insulin to psychiatric meds. When there aren’t enough guards on duty, Gilbert said, escorts for the jail nurses who hand out medication are often the first thing to go. Responding to Gilbert’s statements, the jail spokesman said there are “few if any instances when medication passes would be affected by corrections officer staffing” and that the jail delivers medication even during staffing shortages.

Most of the ongoing issues at the jail stem directly from a worsening staffing shortage, combined with a growing population as the county books more people on misdemeanor charges and transfers inmates from the Regional Justice Center in Kent, whose setup requires more guards per incarcerated person. In recent months, staffing shortages at the jail have led to frequent lockdowns, in which people are locked in their cells 23 hours a day, and defense attorneys report waiting hours to meet with clients, who have to be escorted to meeting areas by guards who are in short supply.

In January, the unions for the public defenders and jail guards joined forces to ask county officials to reduce the population at the downtown jail. Although that request was in response to COVID outbreaks, the staffing shortages that were at issue back then have only worsened in the intervening months.

“We have women in the jail who are having their period and they’re unable to get a change of underwear for the week,” Gilbert said. “It’s inhumane, it’s unconstitutional, and it’s a clear liability for the county.” The jail spokesman disputes this and says jail inmates regularly receive fresh clothes regularly, and can get clean underwear whenever they want.

King County offers hiring bonuses for guards at both the adult and youth detention centers, but hiring hasn’t kept up with attrition as guards burn out and leave. Booking fewer people into the jail would be one solution—about half the people in the downtown jail are booked for three days or less—but that idea is politically unpopular at a time when perceptions of crime have increased. One candidate for King County Prosecutor, Federal Way mayor Jim Ferrell, recently signed on to an “open letter”  from eight South King County mayors calling for more felony bookings and “incarceration to ensure… public safety.”

New Tax Would Fund Behavioral Crisis Centers; Things to Look for in Harrell’s Budget Proposal

King County Councilmember Girmay Zahilay speaks at a press conference on a county proposal to raise property taxes to fund walk-in crisis centers
King County Councilmember Girmay Zahilay

1. King County Executive Dow Constantine proposed a new property-tax levy to fund five behavioral health crisis centers across King County, along with higher wages for health care workers and the restoration of residential treatment beds that have been lost in recent years. The levy, assessed at 14.5 cents per $1,000 of assessed home value—about $121 for a median $694,000 house—could be on a countywide ballot in April 2023, if the King County Council approves it this year.

Currently, there are no walk-in crisis centers anywhere in King County, and the wait for a residential treatment bed averaged 44 days as of July, according to the county. Since 2018, the county has lost more than 110 residential treatment beds and is down to 244 beds countywide. “A question that doesn’t get asked enough to the person who says ‘get people into treatment,'” King County Councilmember Girmay Zahilay said Monday, is “‘get people into treatment where?'”

In a county with 2.3 million residents, Zahilay said, we have one crisis care facility with 46 beds”—the Downtown Emergency Service Center’s Crisis Solutions Center in the Central District, which only accepts referrals from police and other first responders. “If you break a bone in King County, you can walk in and get urgent care. If you’re going through a mental health crisis or a substance use disorder crisis, you have zero urgent care options.”

The nine-year levy proposal would also create apprenticeship programs and other supports for people entering the behavioral health care field, and would “invest in equitable wages for the workforce at crisis care centers,” according to the announcement, plus mobile or co-located crisis services that would operate until the first crisis clinics were open.

“If you break a bone in King County, you can walk in and get urgent care. If you’re going through a mental health crisis or a substance use disorder crisis, you have zero urgent care options.”—King County Councilmember Girmay Zahilay

It’s unclear how many people would see higher wages under Constantine’s proposal, which his office released only in summary form. Pay for behavioral health care workers is so low that many employees qualify for the same services they sign clients up for, said Kristen Badin, a crisis counselor and representative of SEIU 1199NW.

The King County Regional Homelessness Authority has asked the city and county to provide an additional $15.4 million to permanently service providers’ baseline budgets by 13 percent in order to increase provider wages—part of an overall budget request that would add about $90 million to the regional agency’s budget, which is funded by the city of Seattle and King County through their annual budget process.

That process kicks off for both the city and county tomorrow, when Harrell and Constantine announce their 2023 budget proposals. On Monday, Constantine said he considered the KCRHA’s budget request “aspirational,” and confirmed that he does not plan to provide all the money the authority’s CEO, Marc Dones, requested.

That budget request, Constantine said, “was essentially a statement of need, and that neither the county nor the city’s budget could support that full request.” Harrell added that “we weren’t able to meet all of the requests, but you’ll see [during Tuesday’s budget announcement] the support we have moving forward with RHA and the support we have the people on the ground doing this important work.”

2. In 2019, the City Council passed legislation requiring the Human Services Department to build a cost of living increase into all new or renegotiated contracts with service providers, based on the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W). At the time, inflation, as represented by the increase in CPI, was modest—between two and three percent.

“I drew a line in the sand [on the use of the JumpStart tax to backfill the city budget], and I want to make sure that we’re sticking to that, not only because it’s what we passed in statute, but because the agreement to use the higher-than anticipated revenue was to prevent austerity.”—City Council budget chair Teresa Mosqueda.

Last year, the CPI-W increased 8.7 percent, meaning that compared to 2021, it cost 8.7 percent more to pay for the same goods and services. Any wage increase that’s lower than the CPI effectively constitutes a pay cut—something social service providers whose wages are funded by the city will likely be watching for tomorrow when Harrell rolls out his budget.

Council budget chair Teresa Mosqueda said she’ll also be watching for any effort by Harrell to transfer additional funds from the JumpStart payroll tax, which is earmarked for housing, small business support, Green New Deal programs, and equitable development. Earlier this year, Mosqueda proposed using excess payroll tax revenues to help close the budget gap; those extra revenues are projected at $71 million and $84 million in 2023 and 2024, respectively.

“I drew a line in the sand,” Mosqueda said Monday, “and I want to make sure that we’re sticking to that, not only because it’s what we passed in statute, but because the agreement to use the higher-than anticipated revenue was to prevent austerity. And part of preventing austerity is keeping our promises, [including] our promises to human service providers.”

Seattle’s “High Utilizers Initiative” Targets Frequent Offenders for Prosecution. Could It Be Put to Better Use?

By Erica C. Barnett

Six months ago, City Attorney Ann Davison announced a new initiative that would target so-called high utilizers of the criminal justice system—people with more than 12 misdemeanor referrals in the last five years—by subjecting their actions to greater scrutiny, excluding them from community court, and keeping them in jail for months, much longer than current misdemeanor booking restrictions allow.

Since launching the High Utilizers Initiative in February, the city attorney’s office has filed charges against people on the list 82 percent of the time, compared to a 63 percent charging rate for all misdemeanor cases so far this year. In 2021, under former city attorney Pete Holmes, the office charged people meeting the new “high utilizer” standard just 58 percent of the time. The initiative was also supposed prioritize this group for mental health services and treatment.

So far, the initiative has resulted mostly in more charges for people on the list, although the city attorney’s office says additional policy proposals are coming.

“We are declining fewer cases for this population than for the overall population,” deputy city attorney Scott Lindsay said. “I think it tells us that this effort is doing exactly what Ann said it would do: For individuals who are repeatedly having a significant disruptive impact on their neighborhood, we are trying to make sure that they are not slipping through the cracks.”

The initiative also allows the city to keep people on the list in jail for longer, bypassing rules that have prohibiting most misdemeanor bookings. “When somebody has a record of 35, 40 criminal cases and then they have a new property destruction case in Ballard and they’re saying you can’t do anything about that, that doesn’t make sense,” Lindsay said.

Critics of the high utilizers initiative argue, citing considerable research, that repeatedly jailing people who are homeless and suffer from significant behavioral health conditions does not reduce crime and makes the people being incarcerated sicker and less likely to be able to thrive in their communities. Anita Khandelwal, director of the King County Department of Public Defense, said the people on the high utilizers list “should not be subject to jail booking or prosecution for misdemeanor offenses; instead, they should be introduced to service providers who can develop community support and housing options without the hindrance and destabilization caused by repeated jailing and prosecution.”

“It’s hard to overstate the cruelty—and futility—of incarcerating a person who is not able to understand what is happening or to assist their attorney. What’s more, incarceration is destabilizing and leads to an increased risk of a person dying by suicide—as we have repeatedly seen happen at the King County Jail over the past year.”—Anita Khandelwal, director, King County Department of Public Defense

Lisa Daugaard, co-director of the Public Defender Association, whose programs serve people involved in the criminal legal system, said creating a list of people who are frequently arrested for misdemeanors isn’t a “good thing nor a bad thing by itself. It could be helpful if it caused local authorities to come up with a plan for these people’s situation, which is highly likely in need of a plan or support or intervention.”

So far, Daugaard acknowledges, the focus has been on the enforcement side.

“If they are choosing to file against people on the list more often, to me, that means we’re not getting busy making plans proactively for people who we already know are in difficult situations,” she said. “There should be a lot of energy pushing for programming and placement options that just don’t exist for this population right now—and they would have a lot of allies.”

PubliCola obtained a copy of the most recent high utilizers roster, from July, and reviewed the recent criminal and legal histories of each of the 111 people on the list. Two things stand out right away. First, the vast majority of people on the list are either homeless or show signs of housing instability; fewer than 10 had consistent residential addresses in the Seattle area. Second, most “high utilizers” show signs of major behavioral conditions, including addiction and mental illness.

In many cases, people’s behavioral health issues were so severe that a Seattle Municipal Court judge has recently questioned their ability to understand the charges against them and participate in their own defense, a process used to determine, among other things, if a case can proceed. Nearly half, or about 54, have been ordered to undergo a competency evaluation within the last year, and 30 have been found incompetent multiple times—a high bar that requires not just a transient lack of understanding (which might be caused by drug use) but a profound underlying mental health condition.

Prosecuting such people, Khadelwal says, is pointless and counterproductive. “It’s hard to overstate the cruelty—and futility—of incarcerating a person who is not able to understand what is happening or to assist their attorney,” Khandelwal said. “What’s more, incarceration is destabilizing and leads to an increased risk of a person dying by suicide—as we have repeatedly seen happen at the King County Jail over the past year.”

Katie landed on the high utilizers list after racking up more than two dozen separate charges in the last five years—everything from tampering with a fire alarm to vehicle prowling to pedestrian interference, for walking in the middle of busy Rainier Avenue South. She spends most of her time in Ballard, despite restraining orders and arrests and people warning her, over and over, to stay out of the area. She has a connection to the neighborhood—it’s where her family once lived, she has told officers and court officials and anyone who will listen, and where her “street family” lives now.

Mostly, Katie’s charges involve stealing from, screaming at, and harassing employees and patrons of businesses and institutions in Ballard’s commercial core, including retail stores, a car dealership, and the Seattle Public Library. Typically, she will enter a business, yell and knock things down, and run off with random items, such as pile of Starbucks paper cups a barista set outside one day. For just one person, people familiar with Katie say, her impact is tremendous; she might enter a single business multiple times a day, causing havoc and running out only to return a few hours later.

Katie has also assaulted people directly—pulling an earring off a waitress who told her to go away, attacking an employee at St. Luke’s Presbyterian Church, which offers daily meals from its building across from the Ballard Commons. St. Luke’s is among at least half a dozen Ballard businesses that have a no-contact order barring Katie from coming within 1,000 feet of their property—an almost unprecedented move for a church whose institutional mission includes serving Ballard’s homeless population. Earlier this year, because of her status as a “high utilizer,” she was detained for nearly five months at the King County Jail; when she got out, she went straight back to Ballard, where she was promptly arrested—not for harming anyone, but for simply being there.

This time, the city attorney’s office didn’t seek to keep Katie in jail , and she was released two days after her arrest. But her months-long stay in jail had consequences she was still living through. During that period, her name had come up on a waiting list for housing, but no one noticed; as a result, she missed a crucial deadline and fell off the list. Now, after case conferencing that included representatives from the city attorney’s office, she’s staying in a tiny house in a neighborhood across town. But she’s still barred from most of Ballard, which will make it hard for her to avoid arrest in the future.

Despite her erratic behavior, Katie has been found competent at least once, after two previous incompetency findings. Her most recent evaluation, in February, concluded that she was competent to stand trial as long as she stayed away from drugs—a conclusion that shows one of the limits of “competency” as a measure of behavioral health.

Peter, another “high utilizer” who has been found incompetent to stand trial repeatedly, most recently in July, frequents the University District, where his name is on a private list of high-impact individuals maintained by the University District Partnership (UDP), which represents businesses in the area.

“There may be a reason to incarcerate a person to keep them away from everybody else and stop them from doing that [behavior] for some period of time. But does state punishment itself cause a positive change in people? I think the answer is clearly, no, it does not.”—Daniel Malone, Director, Downtown Emergency Service Center

Peter—also a pseudonym—has been arrested repeatedly for walking into businesses, stealing small items—a can of Campbell’s chicken and dumpling soup, an Ace bandage, a bottle of A&W root beer—and threatening employees who catch him or tell him to leave. He says things like, “If you stop me, I have a gun and I will kill you,” and “fuck you, I’ll kick your ass,” and “if you call the police, I will murder you,” according to police reports. On occasion, he’s taken a swing or tried to “head butt” a clerk. Once, he grabbed a “small pink pen knife” from a homeless woman’s cart and pointing it toward a Safeway clerk, Other than the pen knife, which he returned to the woman who owned it, police reports do not indicate that has ever been caught carrying a weapon.

Peter is also, as his many incompetency findings make clear, profoundly disabled, to the point that he’s frequently incapable of carrying on a coherent conversation. He may be “terrorizing” a neighborhood, but he’s also lost in his own delusions of money, grandeur, and persecution; it’s hard to imagine him understanding the nature of the charges against him, much less sitting still in front of a judge and testifying in his own defense.

“We have a lot of clients who are just so gravely disabled that you’re not going to get the same result if you tell them to do something” the way you would with most people, said Ailene Richard, the North Seattle LEAD supervisor for the homeless outreach organization REACH. “They’re not internalizing information in the same way. You have to ask people, what is your motivator? Why do you keep stealing things? Even to do that takes relationship building and trust building.”

The UDP participates in case conferencing—a process that involves sitting down with representatives from Mayor Bruce Harrell’s office, neighborhood organizations, LEAD, REACH, and the city attorney’s office and figuring out how to address and assist people who are having a negative impact on local residents and businesses. But for cases like Peter’s, UDP president Don Blakeney says, they’re at a loss.

“What is the solution for someone who is having a negative impact on the neighborhood but is not really a great candidate for behavioral change?” Blakeney said. “Those kind of people on the list are going to be hard [to deal with]—they can’t keep impacting the neighborhood the way they do because it’s terrifying of folks who are stuck in one place,” such as behind the counter at a retail store. “If you get to a point in the neighborhood where people are doing that every day, it has a cumulative impact.”

The Downtown Seattle Association, which supported previous efforts to crack down on drug dealing and sales of stolen goods such as the short-lived Operation New Day, also supports the high utilizers initiative. But the group’s CEO, Jon Scholes, says simply arresting people and releasing them back into the community without health care and housing won’t address the impact high utilizers have on the neighborhood or help them access the services and housing they need. “There’s very few people in our constituency who want to lock up mentally ill people forever—they they want to reduce the impact [and] they want a better outcome.”

Unlike the University District and SoDo neighborhoods, which have access to case conferencing, Scholes said the city and service providers “haven’t set that kind of table with us and other [business] groups. We’ve never set aside the housing and other services that are really needed for this population. …A list is just a list if there’s no meaningful intervention that’s being offered.”

Both Katie and Peter, along with many others on the high utilizers list, are connected with case managers from groups like REACH and LEAD, which work with unhoused people facing charges and those who have co-occurring behavioral health conditions, including mental illness and addiction. But identifying appropriate housing and services for people with huge, sometimes lifelong, challenges takes time, even years, and in the meantime, the prescription from the city attorney’s office often prioritizes immediate neighborhood demands. 

And even some homeless service providers say there are times when jail is justified. Staffers for the Downtown Emergency Service Center, which has provided (or currently provides) shelter or housing for many of the people on the high utilizers list, call police when a client assaults another client or threatens guests or staff—as happened earlier this month, when a man on the list exposed himself to residents and staff at DESC’s Hobson Place apartments.

“When I first heard about the so-called high-utilizers program,” Municipal Court Judge Damon Shadid said, he hoped Davison’s office would “gather certain information on people who are having a high impact on the community” and “figure out how to address them in a useful way. That is not what happened. Instead, we were handed a list of people who we were told were not eligible for the primary diversion program at the court, and we were not offered a solution other than the primary solution of putting people in jail.”

“We’re supposed to [call police] not just when we’re upset at a lack of compliance or cooperation, but when it’s reached a point where we’re unable to manage the situation safely and effectively,” Malone said. “There may be a reason to incarcerate a person to keep them away from everybody else and stop them from doing that [behavior] for some period of time. But does state punishment itself cause a positive change in people? I think the answer is clearly, no, it does not.”

Richard said going in and out of jail all the time can cause “tremendous” harm—”jail is not a therapeutic place.” At the same time, jail can provide “a sort of break from everything they’re usually doing,” she added. “Sometimes if we’ve had trouble finding that client, that’s a way we can contact them. It is sometimes the only opportunity that we have to be able to meet with certain folks who we have not been able to find on outreach.”

Seattle Municipal Court Judge Damon Shadid oversees community court, an alternative to mainstream criminal court that offers access to services such as mental health and addiction treatment, occupational therapy, and life skills classes. He says the city attorney’s office needs to demonstrate, with clear evidence, that jail is helping not just businesses and neighborhood residents but the people who are being jailed over and over again with few visible results. “If they’re going to charge these people more, they need to prove that they’re having a positive impact.” So far, he said, they haven’t done so.

Instead, Davison took action early in her term to specifically deny access to community court to anyone on the list, arguing that people who commit the same offenses repeatedly need strict accountability, not treatment and classes. Davison, and Lindsay, especially objected to the fact that community court is a “release first” model, which gives people who enter the program the benefit of the doubt instead of, as Khandelwal put it recently, keeping people in jail “simply because they are too poor to post bail.” Continue reading “Seattle’s “High Utilizers Initiative” Targets Frequent Offenders for Prosecution. Could It Be Put to Better Use?”

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.

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.

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.

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.

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.

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.”

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”

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.

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”