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22 Washington counties sue state over lack of mental health care

A Washington Department of Social and Health Service office in Bellevue.
Washington Department of Social and Health Service
A Washington Department of Social and Health Service office in Bellevue.

Nearly two dozen counties are suing the state Department of Social and Health Services, which they claim is refusing to provide essential behavioral health treatment to hundreds of patients who are considered unfit for trial.

The Washington State Association of Counties, along with 22 counties, including King, Pierce, Snohomish and Spokane, filed the lawsuit in Pierce County Superior Court on Wednesday.

It alleges that the department’s decision to stop providing initial evaluation and treatment for a rising number of patients who exit the criminal legal system after they are determined unfit for trial is harmful to the patients and to public safety.

“It’s their duty,” David Hackett, general counsel to King County Executive Dow Constantine, told reporters Wednesday. “It’s their legal obligation to figure out how to get this done.”

The lawsuit asks the court to immediately order the department to comply with these requirements. The motion for preliminary injunction in the case likely won’t be heard until at least Sept. 8.

The lawsuit focuses on “civil conversion patients,” those who face criminal charges but are found unfit to stand trial and are transferred to DSHS to then determine if the patient should be civilly committed.

But the lawsuit alleges that the department continued to “selectively deny admission to civil conversion patients” through July 13. Since then, the department has denied all civil conversion patients, according to court documents.

In recent months, the department has faced bed shortages and an influx of patients due to the 2015 Trueblood settlement, which set guidelines and timelines that the state must follow for giving people competency evaluations.

A federal judge last month fined the state $100 million for breaching the Trueblood settlement and ordered the state to stop admitting civil conversion patients to Eastern and Western state hospitals so it could focus on other patients.

The department has since used the order to deny evaluation and treatment for all conversion patients, not just those who might be admitted for long-term stays, according to the lawsuit.

Mike Faulk, spokesman for Gov. Jay Inslee, wrote in an email that the governor’s legal counsel was still reviewing the filing but pointed to the federal order as “substantially impairing” the state’s ability to treat and care for these patients.

Faulk said the counties brought forth this complaint as if “no such court order exists.”

“These are challenging issues, but we reject any notion that the state is not committed to meeting its obligations under the Trueblood order,” Faulk wrote.

A statement from the Department of Social and Health Services pointed to similar issues with caring for these patients under the federal court order.

“The challenge of tackling this multi-tiered problem does not become easier when counties demand the state and the superior court ignore a federal court order,” according to the department statement.

The complaint from the counties says there is nothing in the federal order that preempts the department from evaluating these patients at state psychiatric hospitals. After evaluation, patients who need long term stays could then be contracted out to a private facility, Hackett said. A failure to take on these patients at all violates “clear statutory and court ordered legal requirements.”

‘Harmful cycle’ of recidivism

It’s rare that this many counties come together on one case, said Eric Johnson, executive director of the Washington State Association of Counties, but the problem is affecting every corner of the state.

Failure to help these patients puts them at risk, while also jeopardizing the safety of the counties, he said.

The counties argue that not completing these evaluations and treatments has left hundreds of individuals across the state without mental health treatment, which has led to “a harmful cycle” where these individuals are left to re-offend.

“What DSHS is doing is essentially washing its hands of the problem and putting them on already stressed county mental health systems, which don’t have tools to do this,” Hackett said.

The lawsuit alleges that the department has also begun releasing civil conversion patients in treatment into communities without proper notice to local officials and enforcement.

“When you have a good release plan, it ensures the patient’s success and community safety. Those things go hand in hand,” Hackett said.

As for the lack of bed space at the state’s hospitals, the complaint argues that it is “a problem of DSHS’s own creation.”

Hackett blamed a recent decision from the state to close six hospital wards, which eliminates 179 beds, while they build a new hospital. But that hospital won’t be ready for another six years.

Faulk, with the governor’s office, pointed to a number of new investments in the state’s behavioral health system. He said the state has invested more than $2 billion into expanding competency services since 2015 and recently added 278 beds with more on the way.

Hackett praised the state’s investments in behavioral health and the recent purchase of the Cascade Behavioral Health Hospital in Tukwila. But he said more “deliberate action” is needed sooner rather than later to expand capacity at facilities.

County officials say the state needs to make more investments at all levels, including the workforce, outpatient services and overnight stays.

“Every government faces limited finances and workforce shortages,” Constantine said in a statement. “Counties cannot now be asked to also shoulder the state’s long-time responsibility.”


This story was originally publishedby Washington State Standard.