The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team.

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.”

Mental health and the courts

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.

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The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team.

“We are in a tough spot right now, no doubt,” Kevin Bovenkamp, the assistant secretary of the Washington Department of Social and Health Services acknowledged in federal court Wednesday, speaking about the lengthy delays people in jail are facing while waiting for beds at state psychiatric hospitals.

“You were in a tough spot eight years ago,” Judge Marsha J. Pechman of the U.S. Western District of Washington replied wryly. 

Washington officials and advocates have been locked in a legal struggle for nearly a decade over how to ensure people with mental illnesses aren’t being warehoused in jails while their court cases stall. In four days of federal court testimony this week, advocates accused the state of not living up to its end of a settlement meant to resolve the issue. 

Throughout the hearing, Pechman appeared frustrated with the state’s efforts. She reminded them that while the previous settlement established seven- to 14-day timelines for people to receive timely services, officials have in fact never been able to meet those timelines in the history of the case.  

“Does anybody at DSHS think about the money?” Pechman asked, referencing the nearly $100 million in fines that have been leveraged against the state for their failure. 

“Whose attention do I need to get?” she asked. 

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Get in touch with us at mentalhealth@seattletimes.com.

The Trueblood settlement, stemming from a civil dispute between DSHS and Disability Rights Washington, aimed to protect the constitutional rights of detained people with severe mental illnesses, by ensuring they could receive services that determine their competency to stand trial, as well as treatment. 

The last settlement, which imposed the seven- to 14-day timelines, occurred in 2018. But earlier this year, plaintiffs with Disabilities Rights Washington accused state officials of being in breach of that agreement: According to the court monitor’s early data from April, people in jail are now waiting an average of 130 days before they’re admitted to a state facility for inpatient services. 

Disabilities Rights Washington is asking the court to increase the state’s fines in order to bring them into compliance, as well as prevent certain lower level felony, misdemeanor and civil patients from taking up beds at state facilities. They are also asking DSHS to make plans to divert 90 civil patients from Western State Hospital to make room for people who fall under the settlement agreement.  

At this week’s hearing, representatives for the state pointed to challenges they’ve faced in resolving the backlogs, including the effects of COVID-19, the time it takes to get new facilities up and running, and most importantly, the surging demand they’re facing from local jails. 

That surge is largely due to county and municipal prosecutors creating a unique patient known as a “civil conversion,” where defendants switch from a criminal track to a civil one, and are committed to involuntary treatment. State facilities have struggled to keep up with the demand, and ultimately gave civil conversion patients priority for beds, instead of the criminal defendants who fall under the court settlement.

Snohomish, King and Pierce counties were represented as amicus curiae or friends of the court and complained that DSHS’ failures have affected local criminal legal systems across the state.

Pechman is expected to issue a ruling in the case in a couple of weeks, but could ultimately decide to force the state to pay increased fines, change who is accepted as a patient at Western State Hospital or come up with a new settlement agreement. 

At one point, after suggestions from the counties, Pechman wondered out loud if she should force DSHS to purchase a hospital to deal with the backlogs. Earlier in the week, officials shared that they planned to tour Cascade Behavioral Health, a 137-bed facility, as a possible alternative to deal with the flow of patients coming from jails. 

Dr. Danna Mauch, the federal court monitor assigned to the class-action settlement, testified that the current wait times for defendants are the longest she’s seen. She also pointed to 2022 data that found 55% of people at the heart of the case experience homelessness or are unstably housed. 

State officials are asking that Pechman finds them not in breach of the settlement. On behalf of the counties, King County Deputy Prosecutor David Hackett asked the judge to reconsider the settlement, or to push state officials to speed up the construction of new facilities. 

In a declaration submitted to the court, Hackett wrote, “King County consulted with a real estate broker and was readily able to find two properties that appeared suitable to provide inpatient mental health services. It took just a couple weeks to identify two properties,” remarking to the judge that DSHS has “not shown urgency” for the current crisis. 

Reporter Michelle Baruchman contributed to this story. 

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