Policy Topics

Most of Washington’s counties are suing the state for refusing to provide necessary behavioral health treatment under state law

A major­i­ty of Wash­ing­ton’s thir­ty-nine coun­ties, along with the Wash­ing­ton Asso­ci­a­tion of Coun­ties, announced today they are suing the Wash­ing­ton Depart­ment of Social and Health Ser­vices, alleg­ing that the state has failed to ful­fill its oblig­a­tion to eval­u­ate and treat patients with behav­ioral health conditions.

The patients the dis­pute revolves around are crim­i­nal defen­dants whose men­tal com­pe­ten­cy can­not be restored. In such cas­es, tri­al courts — mean­ing, coun­ty supe­ri­or courts — dis­miss the charges against the defen­dants and they are com­mit­ted to the cus­tody of the Depart­ment of Social and Health Services.

DSHS is then sup­posed to eval­u­ate them for poten­tial civ­il com­mit­ment, and it has an oblig­a­tion to do so after the Supe­ri­or Court orders an evaluation.

“Nonethe­less, DSHS has selec­tive­ly refused admis­sion to civ­il con­ver­sion patients since at least Decem­ber 2022 and, on infor­ma­tion and belief, has refused to admit any civ­il con­ver­sion patients for statu­to­ri­ly required civ­il com­mit­ment eval­u­a­tions since July 13, 2023,” says the com­plaint, pre­pared by Lynn Allen Award Hon­oree Paul Lawrence of Paci­fi­ca Law Group and a long list of local chief civ­il deputy pros­e­cut­ing attor­neys from dozens of the state’s counties.

“By ignor­ing the dic­tates of the leg­isla­tive and judi­cial branch­es, DSHS is depriv­ing a par­tic­u­lar­ly at-risk pop­u­la­tion of the oppor­tu­ni­ty for nec­es­sary men­tal health treat­ment to the detri­ment of both patient well-being and com­mu­ni­ty safe­ty,” the intro­duc­tion states in one of its open­ing pas­sages. “In the face of DSH­S’s con­tin­u­ing con­tempt for both leg­isla­tive and judi­cial author­i­ty, Wash­ing­ton’s coun­ties have joined in an unprece­dent­ed coali­tion to enforce DSH­S’s legal obligations.”

The coun­ties par­tic­i­pat­ing direct­ly in the law­suit are:

  • Pierce
  • Asotin
  • Clal­lam
  • Cowlitz
  • Dou­glas
  • Grant
  • Grays Har­bor
  • Island
  • Jef­fer­son
  • King
  • Kit­sap
  • Klick­i­tat
  • Lewis
  • Lin­coln
  • Pacif­ic
  • Skag­it
  • Ska­ma­nia
  • Sno­homish
  • Spokane
  • Thurston
  • What­com
  • Yaki­ma

All four of the state’s largest coun­ties — King, Pierce, Sno­homish, and Spokane — are plain­tiffs, along with pret­ty much every oth­er pop­u­lous coun­ty in the state except for Clark. Addi­tion­al­ly, the Wash­ing­ton Asso­ci­a­tion of Coun­ties is a plain­tiff. Gov­er­nor Jay Inslee is not named as a defen­dant, but Jil­ma Mene­ses, his DSHS Sec­re­tary, is, along with the Depart­ment of Social and Health Ser­vices itself.

“For the ben­e­fit of the patient and the pub­lic, DSHS has a basic legal oblig­a­tion to pro­vide behav­ioral health treat­ment to those involved in the legal sys­tem,” said King Coun­ty Exec­u­tive Dow Con­stan­tine in a press release.

“The real­i­ty is that peo­ple in these cir­cum­stances are often failed by mul­ti­ple sys­tems that, rather than offer­ing hope and restora­tion, leave them untreat­ed and at risk of reof­fend­ing. It is the state’s respon­si­bil­i­ty in these cir­cum­stances to pro­vide peo­ple treat­ment and a chance to recov­er. Our behav­ioral health vision at King Coun­ty is for every­one to access care, any­where, at any time, even in a moment of cri­sis. That’s why we are active­ly work­ing to increase access to treat­ment through invest­ments in behav­ioral health facil­i­ties, mobile cri­sis treat­ment, and the vot­er-approved Cri­sis Care Cen­ters initiative.”

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

The full com­plaint is avail­able below.

Com­plaint against DSHS by Wash­ing­ton counties

The coun­ties say their motion for a pre­lim­i­nary injunc­tion could be heard as ear­ly as Sep­tem­ber 8th. The venue for their action is Pierce Coun­ty Supe­ri­or Court.

After receiv­ing the coun­ties’ release, NPI reached out to Gov­er­nor Jay Inslee’s com­mu­ni­ca­tions team to ask if they or DSHS have any com­ment on the lawsuit.

“Our legal coun­sel are still review­ing this fil­ing,” Inslee spokesman Mike Faulk told us in reply. “These are chal­leng­ing issues, but we reject any notion that the state is not com­mit­ted to meet­ing its oblig­a­tions under the True­blood order.”

“While we respect all judi­cial deci­sions, by order­ing DSHS not to admit these patients into state hos­pi­tals a fed­er­al court has sub­stan­tial­ly impaired our abil­i­ty to treat and care for patients such as these. (See para­graph 33a of the order.) The coun­ties bring this action as if no such court order exists.”

“We have tak­en actions nec­es­sary to com­ply with the court’s orders and those mul­ti-pronged efforts con­tin­ue in the face of sig­nif­i­cant challenges.”

“The state has invest­ed more than $2 bil­lion into expand­ing capac­i­ty for com­pe­ten­cy ser­vices since 2015. The state has recent­ly added 278 beds with at least anoth­er 680 in the works. But local gov­ern­ments and courts are refer­ring sig­nif­i­cant­ly more peo­ple for com­pe­ten­cy ser­vices – for exam­ple, refer­rals increased 40% from 2021 to 2022 for a total of 8,596 indi­vid­u­als, rough­ly triple the num­ber being referred a decade ago.”

“To cre­ate and staff the num­ber of facil­i­ties required to meet such a rapid increase in patients will take time, and also requires reforms to the over­all sys­tem. This year, the gov­er­nor called on leg­is­la­tors to pass reforms and in May signed SB [Sen­ate Bill] 5440 to reduce refer­rals by pro­vid­ing more options for ser­vices out­side the courts, as well as improv­ing access to care while peo­ple wait.”

“This month, the Depart­ment of Social and Health Ser­vices final­ized the pur­chase of the for­mer Cas­cade Behav­ioral Health facil­i­ty in Tuk­wila, and is work­ing as quick­ly as pos­si­ble to add about 100 beds for indi­vid­u­als in need of behav­ioral health ser­vices, includ­ing those in need of ser­vices through the civ­il con­ver­sion process. Mul­ti­ple new facil­i­ties are cur­rent­ly in the process of being devel­oped and opened to serve thou­sands of addi­tion­al patients every year.”

“Much work remains ahead for us in part­ner­ship with the Leg­is­la­ture, state agen­cies, local gov­ern­ments and the many stake­hold­ers involved to meet the state’s over­whelm­ing demand for com­pe­ten­cy services.”

Note that the links in the quot­ed text above were pro­vid­ed by Gov­er­nor Inslee’s office; we’ve left them in place because they pro­vide con­text to Faulk’s comments.

Andrew Villeneuve

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