TACOMA — Some of Washington’s mentally ill are strapped to gurneys in emergency rooms awaiting beds in psychiatric hospitals, while others sit in jail for months waiting for competency evaluations and treatment. And some are getting trapped in both broken systems.
One court already has ruled that warehousing mentally ill patients in emergency rooms is unlawful. But while the state tries to find solutions to its overcrowded psychiatric facilities, some of these distressed patients respond badly to the hospital settings and end up getting charged with assault.
That lands them on the jail competency wait lists — the target of a federal lawsuit that goes to trial in March.
Until the state changes the way it funds services for Washington’s mentally ill, these patients-turned-inmates will remain in what some call inhumane conditions — trapped in stark concrete cells peering out of tiny windows.
Mentally ill people acting in a dangerous manner can be held against their will under a civil commitment in order to be stabilized and treated. The state allows facilities that are not certified as official treatment sites, like emergency rooms, to take them in.
But in August, the state Supreme Court declared that “psychiatric boarding” was unlawful because these patients were not receiving treatment.
The court gave the state until Dec. 26 to find solutions. Gov. Jay Inslee authorized up to $30 million for the problem but only $1.5 million has been spent so far. At the time of the August ruling, the state estimated about 200 mentally ill people were boarded.
When mentally ill people are jailed and a judge orders a competency evaluation to see if the inmate can help his defense, the state has seven days to get that done. If the inmate is found incompetent, the state has another seven days to get them to treatment so their competency can be restored.
But that’s not happening.
As of Oct. 3, about 155 people were on wait lists that went well beyond the one-week limit, according to Disability Rights Washington, an advocacy group for the mentally ill. The average wait time is 51 days, the group said in its federal lawsuit against the Department of Social and Health Services.
Abbey Perkins, an attorney with the King County Regional Mental Health and Veterans Court, said many people start out as Involuntary Treatment Act patients — people who are a danger to themselves or others — and commit assaults while they’re at the hospital.
The charge can result from everything from spitting at a nurse to hitting or attacking their caregiver, Perkins said.
“I’ve had clients who thought the blood draws were vampires trying to get them,” she said.
David Carlson, a lawyer with Disability Rights Washington, said health care workers who routinely handle mental illness have techniques for keeping themselves safe, but many health care providers who work with the general public lack those skills.
“If you’re not trained, if you don’t have the staffing to interact with people in that type of crisis, that’s when people end up getting hurt,” he said.
Patients in jail
No one collects data on how many psychiatric boarding patients are ending up in jail, but jail officials and lawyers involved in these cases said they’ve seen it happening across the state.
“There are people who are civilly detained or in the process of being detained, they’re suicidal or having a psychotic episode, and get charged with assault after acting out against a health care worker,” said Judy Snow, mental health manager at Pierce County Jail.
Daron Morris, a deputy division director at the King County Department of Public Defense, called the situation “a special horror” that results when the state fails to adequately fund mental health.
“Strapping someone to a gurney and failing to provide them with proper psychiatric services would certainly seem to increase the risk they will act aggressively,” Morris said. “We should be ashamed.”
In most circumstances, a spit, a slap, a punch would result in misdemeanor assault charges, but when they involve a health care worker, the charges are enhanced to a felony “assault three,” he said.
Besides the tougher charges, the backlog for people needing competency evaluations and then treatment to restore their competency means most of these mentally ill people are spending more time in a cell than a person who intentionally committed a crime.
Grim jail settings
The Pierce County Jail’s psychiatric unit has two levels that are shaped in a half-circle and surrounded by fencing. The air is thick with the smell of cleaning fluid— inmates often ignore the toilets. During a recent visit, one man paced naked in his cell while chattering nonsensically.
They spend 23 hours a day in their tiny, stripped-down rooms. They can be there for months.
Michael Stanfill, in charge of psychiatric operations at the King County Correctional Facility and Maleng Regional Justice Center, oversaw a three-year study of the 27,000 people in his two facilities. They found that mentally ill inmates made up 20 percent of the population and they spent three times as much time in jail as those not mentally ill.
Of an average daily population of 1,800 inmates, about 120 fill psychiatric housing beds and between 400 and 600 are receiving ongoing psychiatric care, he said. Caring for these inmates stresses justice system budgets, Stanfill said.
State officials continue to try to resolve the psychiatric boarding problem. They spent $1.5 million to secure beds at three sites for a limited period, said Andi Smith, the governor’s senior policy adviser.
The funds bought 12 beds at Fairfax Hospital in Kirkland, 18 beds at Cascade Behavioral Health in Tukwila and two beds at Navos Mental Health in Seattle, she said.
But the money only covered from Aug. 7 to Oct. 31, she said. And the state is already facing a $3 billion budget shortfall as it responds to a court order to increase funding for education.
Officials changed the rules to allow Residential Treatment Facilities and medical/surgical hospitals with voluntary psychiatric wards to accept involuntary commitment patients. But the rule change will open fewer than 10 beds.
Lawyers in the federal case also continue to press for a solution.
They asked U.S. District Judge Marsha Pechman for a restraining order to force the state to act quickly. She denied the request, but said the wait list raises serious constitutional issues. She ordered the case to trial March 16.
Snow said the state must find the funding to ensure the mentally ill don’t stay in her jail for months.
“The human cost of the suffering due to marked delays is heart wrenching,” Snow said.
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