For the first time in years, Washington has been admitting mental health patients from jail to its state psychiatric facilities without significant delays.
The state is now effectively in compliance with a federal lawsuit known as the “Trueblood” case, which requires that the state quickly evaluate patients to see whether they’re mentally fit to stand trial, and move them from jail to the state mental hospital for treatment if they’re not.
But as the state marks a successful few months, it faces pressure to sustain its progress.
State officials must continue to keep up with the need for beds, and navigate admissions challenges that could come up.
It also must balance the needs of another type of patient who can compete for beds at the state hospital — civil conversion patients. Those patients are charged with crimes but found unable to aid in their own defense, and then are transferred to the state’s civil system.
“We’re at the point right now where, if everything stays the same, we’re doing exactly what we need to be doing,” said Tom Kinlen, the forensic services director for the Department of Social and Health Services. “But if there’s a pebble that gets thrown in there, because this is new, we need to address that pebble and make sure it doesn’t become a rock or a boulder.”
Kim Mosolf, the class counsel for Trueblood patients, said she’s pleased patients are getting their needs met.
But she said she hopes the state will look at long-term needs for beds, and build out other programs that meet people’s needs when they’re out in the community.
“We need to continue to work on diversion,” Mosolf said. “It’s not sustainable if we don’t do that.”
Previously, patients were often waiting weeks or months to be admitted to state hospitals — sometimes, likely spending longer in jail than they would if they pleaded guilty to the crimes they were arrested for.
State data shows that in June, Western State Hospital was ordered to evaluate seven patients for competency, a decrease from 11 the previous month. Those patients waited an average of 5.3 days — down from 5.9 in May. The state hospital was ordered to treat 91 patients who were found to need competency restoration, a decrease from 152 orders in May. Those patients waited an average of 6.5 days, an increase from 5.2 days in May.
The smaller Eastern State Hospital also admitted a handful of patients, with average wait times hovering between 6 and 7.5 days.
The state’s purchase of a new hospital specifically to house civil conversion patients has helped it reduce wait times for those in jail awaiting treatment.
The state health department bought Olympic Heritage Behavioral Health last summer, the Tukwila facility that previously housed privately owned Cascade Behavioral Health. That facility has 72 beds right now, and is expected to eventually add about 40 more, according to state health department spokesperson Tyler Hemstreet.
Purchasing Olympic Heritage allowed the state to begin moving civil patients there, freeing up space for more patients from the criminal legal system to stay at the state hospitals. The state is also relying on other smaller residential facilities, such as Maple Lane near Centralia and a not yet opened facility in Clark County, to help free up space at the state hospital. And on the Western State campus a new 350-bed hospital building is being built, which is scheduled to open in 2028 and will serve patients who are facing criminal charges.
Kinlen said to stay in compliance, the state must continue to evaluate and admit patients quickly. But it also must rely on other state programs that help keep patients from coming back into the system — including those offering patients medical care, outpatient behavioral health treatment and rental assistance.
“What can we do to build up more housing opportunities out in the community, and what other programs can be done in the community to treat various behavioral health conditions?” Kinlen said. “Ultimately, the judge will be the decider of what substantial compliance looks like. All we can do is get everyone admitted within seven days.”
Kinlen said he anticipates some challenges. As winter nears, he said potential infection outbreaks from influenza or COVID-19 could derail admissions.
As the state works to keep up its gains, it is still contending with ongoing court cases that highlight two populations with competing, but similar needs — patients waiting in jail for treatment, and civil conversion patients — those evaluated and found unable to aid in their own defense.
The state had shut down several wards at Western State Hospital, with plans to serve only forensic patients — patients coming through the criminal justice system. Civil patients would be dispersed into community facilities.
But the state ended up keeping many of those civil patients at Western State — particularly those civil conversion patients who had originally come to the hospital via the criminal legal system, but couldn’t be prosecuted and mental health professionals determined shouldn’t be released. Those patients were difficult to place at other, community-based facilities: They might have a history of violence, or medical needs that privately run residential facilities say they’re not equipped to handle. And so they continued to live in wards meant for forensic patients, leaving the latter waiting in jail, sometimes for months.
In mid-August, a person who was found to need competency restoration filed a tort claim against the state, alleging that starting in October 2022, he waited in the Pierce County Jail for nearly a year before the state admitted him to the state psychiatric hospital for treatment.
Hemstreet, the state Social and Health Services Department spokesperson, said the state couldn’t comment on potential litigation.
In court documents, the patient described uninhabitable conditions at the jail, including toilets overflowing, an overwhelming smell of raw sewage and black mold in the cell.
The patient alleged that the state placed him on a waitlist for the state hospital, without assessing the severity of his mental health needs to see if he needed to be admitted sooner.
The patient also alleged that he was delayed in getting a spot at the state hospital because state officials were prioritizing civil patients over those needing competency restoration.
That same issue was at the heart of U.S. District Court Judge Marsha Pechman’s decision to fine the state $100 million last summer, over its failure to admit patients for treatment within the required time frames.
After it was fined, the state said it would no longer admit most civil conversion patients. But the state’s effort to correct that problem resulted in another lawsuit.
Twenty-two Washington counties sued the state, saying local facilities were struggling to place civil conversion patients who were being released. That case is still pending a resolution.
Mosolf, the Trueblood class counsel, said it’s crucial that the state remember that competency restoration patients have a constitutional right to state hospital beds.
But she said the state must continue to think long-term about how to keep up with the growing populations of patients.
“It always requires balance between the need for civil and forensic populations,” she said. “I want to make sure the state is thinking long-term, and looking at the projection between what we need and the capacity we have.”
