King County is facing a major problem. It doesn’t have enough beds for mentally ill people going through the court system. The county has nowhere to send them, and some are being released without treatment.
The issue affects people charged with serious misdemeanors and are found not mentally competent to assist in their defense. When that happens, the next question is whether these defendants should be civilly committed. This requires an evaluation by a mental health professional, however, there’s no place to put them while they’re waiting to be evaluated.
Amnon Shoenfeld, director of King County’s Mental Health, Chemical Abuse and Dependency Services Division, says that a lack of beds isn't the only problem. "We have no evaluation and treatment facilities available. So the court is left with a situation where they have nowhere to send people to," he says. "And given the fact these are people who tend to have dangerous backgrounds, have committed serious offenses and are mentally ill, this is a major concern for public safety."
Shoenfeld explains there aren’t many facilities in the region that provide mental health evaluation and treatment. That leaves King County with few options.
One of the places the court sends these cases is the emergency department at Harborview Medical Center.
Darcy Jaffe is Harborview’s chief nursing officer. It’s noon, and the emergency department is relatively quiet. Jaffe says that's typical for this time of day. “It is part our mission to take care of the mentally ill and we’re very happy to do it. But there are limits to what we’re able to do,” he says.
Jaffe says even though they have experience working with mentally ill people, the court sends them cases that have a forensic component. The cases require an understanding of the judicial system and handling them in a way that complies with criminal procedures. Jaffe says initially there was a lot of scrambling because it was all new to them. Now they’ve had some experience to fall back on, but these cases affect the flow of things in the ER.
“The jail guards transport them up here and they’re done with them. So it’s up to us to determine how to make sure everybody’s safe because that was the first concern everybody has. And we’re able to do that, but it does require resources that we wouldn’t otherwise deploy,” she says.
Jaffe says patient care isn’t compromised, but it means patients who come in for medical emergencies may end up waiting a little longer. And it’s not just the ER staff who are stretched. The psychiatrists who do the evaluation are affected, too.
“It takes several hours to do the evaluation. On average about four to five hours," Jaffe says. "So the psychiatrist who may have already 10 patients, has to come down and do this evaluation that has a deadline, that has to be done in a certain period of time.”
Jaffe says the current way of processing defendants facing civil commitment is not sustainable in the long run.
King County wants the Legislature to change the current law that addresses the procedures for mentally ill defendants. It wants the statute to specify that these types of cases be sent to state hospitals. In fact, Western State Hospital has taken these referrals. But early last year, it limited the number of cases it would take.
Jane Beyer is with the Department of Social and Health Services, the agency that oversees Western. Beyer says it doesn’t have enough beds for all the forensic referrals that come from King County and from 22 other counties that it serves.
“There are many, many competing demands for a limited number of beds and we’re trying to balance those demands as best we can," she says. "Every biennium the Legislature decides how many wards will be funded at the state hospital, so we have a fixed number of beds.”
There’s a staffing issue, too. For example, in 2011, Western received more than 2,300 referrals for forensic evaluations. It has 24 evaluators to do the job. Beyer says it’s been difficult to attract psychologists and psychiatrists to work at Western. The state hospital can’t match private sector salaries, and the kind of psychologists and psychiatrists they’re looking for are harder to find.
“There’s an additional set of skills to do forensic evaluations that isn’t necessarily part of traditional training for psychologists,” says Beyer.
Hospital officials are meeting with representatives from King County, Harborview, the courts and law enforcement to come up with solutions. Everybody agrees the current system needs to change so people can get the mental health treatment they need. Beyer says the long term question is how to provide services in the community to prevent people from entering the criminal justice system in the first place.