Washington state officials face a $100 million fine for failing to provide adequate mental health services to individuals with severe mental illnesses in the state's jails.
In a ruling Friday evening, Judge Marsha J. Pechman of the U.S. Western District of Washington issued a scathing decision, finding the Washington Department of Social and Health Services in breach of a settlement agreement known as Trueblood that established time frames for people in jail to get services at state psychiatric facilities.
"The primary reason [people who fall under the settlement's terms] suffered was DSHS's own lack of foresight, creativity, planning, and timely response to a crisis of its own making," Pechman wrote in her 52-page decision.
"The Court is unpersuaded that DSHS adequately planned for and took reasonable measures to address the bed shortage."
The ruling comes after a nearly decadelong legal battle and spotlights the state's ongoing challenges to end the warehousing of people in jails. This is the third time that officials have been found in contempt, and Pechman herself pointed out that "DSHS has never once been in compliance."
Under the terms of the settlement, defendants who were potentially incompetent to stand trial would be evaluated within 14 days and, if needed, start receiving restoration services — usually medicine and legal education at a state psychiatric facility — within seven days after that.
But the state has failed to meet those timelines: As of April, people in jail were waiting an average of 130 days before they could be admitted to a state facility for inpatient services.
Among other criticisms, Pechman said the state "effectively created a bed shortage" by shutting down wards at Western State Hospital that had housed patients committed through the civil court system. Officials said they needed to do that in order to build a new 350-bed hospital that will eventually serve patients coming from criminal courts, but Pechman said, "This was poor planning for the laudable goal of building a new hospital."
DSHS officials said they are "assessing the ruling and understanding what the court wants us to do," but did not offer further comment. The WA Attorney General's Office declined to comment, deferring to DSHS, and representatives from Gov. Jay Inslee's office as well as the Health Care Authority did not respond to requests for comment Friday evening.
"We know that competency services aren't the answer. We have seen over and over again that people with serious mental illness repeatedly cycle through jails after restoration," said Chris Carney, a lawyer with Carney Gillespie PLLP who joined plaintiffs Disability Rights Washington in the case, said in a statement.
"It's past time we try a new way, building housing and supports that actually keep people off the streets and out of jails."
As part of the judge's ruling, DSHS officials will have to comply with 10 key changes, most notably ceasing admission of a kind of patient known as a civil conversion to state hospitals. These are patients who are initially brought in on criminal charges from jails, but because they lack competency to stand trial are "flipped" to a separate, civil system.
These civil conversion patients have been taking valuable bed space needed for people receiving competency services. Under Pechman's order, DSHS must transfer or discharge these patients within 60 days, unless they were held on previous violent felony charges. It's not yet clear how many of those patients there are or where they will go.
Officials will also face fines if those patients are not discharged or transferred out of Western State Hospital or state facilities on time.
This has King County officials nervous. In a joint statement, Executive Dow Constantine and Prosecutor Leesa Manion said they supported timely mental health services.
"However, we are extremely concerned about parts of the ruling, as it appears the judge's decision will fracture another part of the system," their statement said. "That means these patients, who are required by state law to be placed in a secure mental health treatment facility, may be released without treatment, endangering public safety and endangering the patients themselves."
County officials said they would continue reviewing the decision and evaluating their next options.
The $100 million in fines would need to be paid within 30 days, though the ruling notes the state can request an installment plan. The court monitor will bring together a planning group to distribute the funds within 45 days. Previous fines in the case have gone toward mental health diversion programs.
