Progress and Ongoing Challenges in Washington State’s Mental Health System
Trueblood et al v. Washington State DSHS is an ongoing legal battle that continues to cast a spotlight on the deficiencies in Washington State’s mental health system. Defendants with psychiatric conditions often find themselves languishing in county jails for weeks or months, awaiting the mental health services they need before they can stand trial. In this post, we’ll explore the legal history of Trueblood, and the latest updates and challenges, highlighting the progress made and the hurdles that still lie ahead.
A Troubling Legal History
In 2015, a federal court order deemed Washington’s wait times for mental health evaluations and competency restoration services unconstitutional. Agreed to in 2018, the settlement requires the state to make changes in five specific areas:
- Competency evaluations
- Competency restoration services
- Crisis triage and diversion support
- Education and training
- Workforce development.
The settlement was expected to trigger reforms in phases, timelines from which aligned with each subsequent biennial budget, beginning in 2019, and concluding in 2025. The reforms were first expected in the Pierce, Southwest and Spokane Region, then in King County, and a final phase to make additional improvements and expand to other regions as needed.
However, the state has repeatedly found itself in contempt of this order, leading to significant fines. In July 2023, Judge Marsha J. Pechman imposed a $100 million fine, marking the third time the state has been held in contempt.
Progress on an Uncertain Path
The 2015 Trueblood order mandates that the state must offer mental health evaluations within 14 days, and competency restoration services within seven days for individuals who are found incompetent to stand trial. Most mental health evaluations now meet this timeline. However, the state has struggled to meet the seven-day treatment deadline. This standard has been met for only 10% of defendants in the past year.
DSHS has stated that wait times have been reduced significantly, down to less than two months across all state facilities. Prior waiting periods averaged 12 to 13 months. This update marks some progress for the state, but still fails to meet treatment standards.
Addressing Bed & Staffing Shortages
One of the key challenges in achieving compliance with the Trueblood settlement is the shortage of psychiatric beds and staffing. Despite plans to invest nearly $1.3 billion in acquiring new psychiatric beds, the state still faces a significant gap in capacity. In the past seven fiscal years, referrals for inpatient evaluations and competency restoration services have surged by 87%.
During a recent committee work session, DSHS presented a chart predicting that, by 2026, Washington would still have 168 fewer beds than patients need. The state currently has a gap of 386 beds as of July 2023.
Staffing shortages remain a concern for implementation of the Trueblood reforms. At Western State Hospital, vacancy rates range from 15% to 30%. The state is actively recruiting through partnerships with universities and contractors to fill these gaps.
Fines and Budget Outlook
Beginning in January 2024, the Washington State Legislature will develop supplemental budgets. These budgets will address emergencies, fix errors, and fund small projects not included in the biennial budget. Despite the smaller budget this year, DSHS will look Legislature to assist with paying the $100 million fine imposed by the court in July. The Department is also requesting a $14 million maintenance-level decision package for Trueblood-related fees and fines.
However, the state’s path to compliance remains uncertain. It remains unclear how many more fines will be imposed, as the conditions of the court order are still unmet.
The Path Forward
The Trueblood case stands as a testament to the challenges and complexities in reforming Washington State’s mental health system. Although progress has resulted in reduced wait times and expanded capacity, more challenges lie ahead. Many stakeholders, including local governments, are anticipating implementation of these reforms. Without these critical reforms, the state will continue to see impacts on an already overwhelmed criminal justice system, demand for supportive housing, and other crisis intervention services.
Advocates and stakeholders will watch to see how the state responds this session. The path toward compliance may include both advancement of public policy and investment of public funds.
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