Nearly a year after Washington was fined $100 million for failing to quickly evaluate and treat certain mental health patients at its state psychiatric hospitals, the state is nearing compliance with the federal lawsuit that prompted the censure.
Data from the Department of Social and Health Services shows average wait times to get into Western State Hospital have decreased and are now hovering near the time limits mandated by a 2014 court order known as the “Trueblood” settlement, which aims to prevent people from languishing in jail without mental health treatment.
DSHS spokesperson Tyler Hemstreet said the agency is “extremely pleased” with its progress in reducing the waitlist for competency restoration patients, or those who’ve been charged with crimes but require evaluation to see whether they’re mentally fit to stand trial. As of last week, he said, not a single patient will wait more than seven days, within the parameters of the court order, to be admitted to either Western State or Eastern State Hospital.
But he said they’re not yet ready to declare victory.
“While we have come a long way over the last year, we know these gains are extremely fragile because the demand for behavioral health treatment is growing and the demand from the judicial system to admit patients continues to rise,” Hemstreet said in a written statement. “We are building new and renovating existing facilities, but those will not be completed for a while, so access to available beds now is very important.”
The Trueblood settlement, named for the case’s original plaintiff Cassie Cordell Trueblood, a public defender, requires that the state evaluate patients to see whether they’re mentally fit to stand trial within 14 days. If not, they must be admitted to begin competency restoration treatment within another seven days.
But the state has struggled for years to keep up with those time frames. Last July, U.S. District Court Judge Marsha Pechman found the state was in violation of the 2014 order, and said in her statement that the state had “never once been in compliance.” State data showed that as of last April, patients had been waiting as long as 130 days in jail before being admitted.
After being hit with a $100 million fine last summer over the violations, the state has gradually brought down wait times for competency restoration patients.
Data from the state health department shows that in April, Western State Hospital evaluated 11 patients, who waited for an average of 6.4 days. Of those patients, 91% were evaluated before the 14-day requirement.
And the state hospital admitted 116 patients for treatment, with those patients waiting an average of 5.3 days. The court order requires that patients begin treatment no more than seven days after they’re evaluated.
The smaller Eastern State Hospital also evaluated and admitted a handful of patients, who waited an average of less than a week for assessment and treatment.
Kim Mosolf, the class counsel for Trueblood patients, said the decrease in wait times could be attributed to the state’s management of civil conversion patients — patients who were charged with crimes but are found unable to aid in their own defense, and transferred to the state’s civil system.
The state planned to transition long-term patients into smaller facilities in their own communities. But as it closed nearly 200 beds at Western State Hospital, it didn’t open local facilities at the same pace. As a result, she said, civil conversion patients were sitting in forensic wards. Patients charged with crimes and waiting for evaluations, in turn, were waiting in jail for treatment, sometimes for months.
“The state was essentially prioritizing civil patients over (Trueblood) class members,” Mosolf said. “But class members have a constitutional right to those beds.”
Hemstreet said the state acted quickly to begin dispersing those civil conversion patients once it bought Olympic Heritage Behavioral Health in Tukwila last summer, formerly the privately owned Cascade Behavioral Health Hospital. The state reopened the facility, and is continuing to add beds.
The state also has added civil beds at its Maple Lane campus near Centralia. And it’s constructing another facility in Clark County, which is expected to add another 48 beds for civil patients next year.
Eastern State Hospital also has added more beds for both forensic and civil patients, Hemstreet said.
Mosolf said the number of court orders for criminally charged patients needing evaluations and treatment has also dropped, after reaching 38% in 2022 — likely due to a backlog of cases early in the pandemic, she said.
The state has also increased its investment in diversion services, Mosolf said, attempting to prevent patients from re-entering the criminal justice system. The fines the state had to pay have gone toward various programs for patients, including permanent supportive housing.
Even as the state hospital system whittles down its waitlist, it’s still grappling with how to handle the influx of patients with a wide range of needs.
Twenty-two Washington counties sued the state last August over its handling of civil conversion patients. After it was fined for its failure to admit forensic patients on time, the state said it would no longer accept most civil conversion patients due to bed shortages, and its legal obligation to quickly accept competency restoration patients.
County officials objected, saying their local facilities were struggling to find appropriate placements for those being released.
Hemstreet said the state is still in the middle of negotiations with the counties over that case.
