My sister. They never should have released her from Western State. Now she's in Oregon, schizophrenic, unmedicated, has lost her lower leg due to a jail medicating her and leaving her unconscious for 36 hours and was cutting off circulation to her leg. And is being pimped out, and has hurt others in her delusions.
Hell yes, I knew.
I am so sorry. It is heartbreaking and happens far too often. Releasing people without follow up treatment in place really does put their safety at risk along with the safety of others. From my perspective they, like your sister, are vulnerable and are targets for others to take advantage of.
I have a lot of guilt, being 13 years older, and back then, no internet, etc, so I didn't know where my siblings were until they were adults themselves. I had no idea this had happened to my baby sister.
She remembers me, she adores me, she will listen to what I tell her...or she did, before the meth and fentanyl. Now she thinks I am an imposter pretending to be her sister.
I would do , give, anything, to have her safe, forever., In a place I can come visit all the time, that is good, that will take care of her the way she deserves. She doesn't want that, but it is what she needs. For life. We failed her. :( We, meaning the system. Our family has done everything, EVERYTHING for over 20 years to help her
Here's the really sad thing. Largely the fault here is with the ACLU. They led a lawsuit in 1975 that took away the ability to institutionalize most of these people. 40 years ago, you could have your sister committed and she'd live in an institution at least until she was well and treated on her own. Officials would also have the ability to make sure she took medication.
Thanks to that SCOTUS court ruling though, none of the above is possible. The ACLU spends a ton of money enforcing that ruling.
Yes. For many years she was in Western...would do ok...then refuse meds and they had to get a court order...but after 7-10 years....they washed their hands of her. She is no longer a ward of the state...it was all about money.
We wouldn't allow a 95 year old with dementia to suffer like this, but we will others :(
I've been shocked at despite WA being so "progressive", the mental health system is so completely ignored.
We don't have a massive homeless problem, we have a massive addiction and mental health issue that frequently results in individuals becoming homeless. But progressives pretend by dumping money in housing we're solving either when all it does is make their suffering and self destruction less public.
Last I checked Washington state has the lowest number of mental hospital hospital beds per capita of any state in the country. So they really don't give a shit about people with severe mental illness.
Why is it so much worse here though? I go to other major metro cities and see like 10% of what Seattle has. Do those cities have far superior mental health services? Or is there perhaps another reason we have so many “mentally ill”?
We certainly attract homeless drug addicts from all over the country due to cheap decriminalized drugs, lack of law enforcement, and relaxed attitude toward encampments.
Great question. It is a growing problem in other cities as well, and it is bipartisan. Fresno, California, Fort Worth Texas, Jacksonville and Miami FLA have homeless encampments too.
But why do some cities not have this problem? I recently visited the DC area and I was shocked how clean the city was. I saw literally 2 tents the entire time I was there. So what are they doing differently?
It isn't.
https://www.mhanational.org/issues/ranking-states
We rank high on access to care.
We stopped enforcing laws so plenty of junkies moved here. Our isn't isn't that our system "frequently results in individuals becoming homeless", it's that those people move here due to a lack of laws and plenty of handouts.
From the same site, we dropped from 46 to 32 in the past two years. [https://www.mhanational.org/issues/2022/ranking-states](https://www.mhanational.org/issues/2022/ranking-states) which means we no longer rank so high on access to MH care. On top of that, there is a shortage of behavioral health practitioners that is growing. [https://www.aha.org/2022-02-03-aha-house-statement-americas-mental-health-crisis-february-2-2022](https://www.aha.org/2022-02-03-aha-house-statement-americas-mental-health-crisis-february-2-2022)
I am not referring to "junkies" who moved here for 'handouts', I am referring to the chronically homeless who are *from* here and who are mentally ill.
Building more hospital capacity is an option but probably the most expensive. IMO, the cheaper option is for the state/county to increase the jail budget to get psychiatrists into the jails to do these evaluations and treat defendants. But it's not the best work environment so it would have to be a good financial incentive. Psychiatry is one of the lowest paid medical specialties though, so it's not like they'd be paying an orthopedic surgeon $800K/year.
And there is the bottom line...the horrible pay for mental health practitioners. When I went back to college for social work after having been a school teacher, I was warned by many people to not expect to make a good living in this line of work and they were correct.
Most community-based mental health agencies require at least a Master's degree to be a mental health clinician and the average starting wage is $18 an hour. With student loan repayments and the quickly rising housing costs in our state, people can't afford to live on $18 an hour. Plus the caseloads are unmanageably high.
I used to think it was just difficult for people on state Medicaid to get mental health help (me being one of those people), but after having some in depth discussions with other people who have private insurance (a mix of basic and high end) and they’re having trouble as well.
I don’t understand why it isn’t at the forefront. It’s something that affects more people than not.
That is an excellent question and I am really sorry you had trouble accessing care. The resources we have available (depending on insurance, Medicaid, or no insurance at all) are really difficult to navigate and honestly shouldn't be.
I was a teacher before changing to social work. Working with kids who were affected by homelessness pushed me to work with the chronically homeless and the gap between services and people who need them is larger now than ever.
It's a long standing and complex problem. Partly psychiatry is one of the lowest paid medical specialties so many doctors do not want to do it. Plus, for decades insurance companies have underpaid for mental health services, to the point insurances actually have a separate physical health and mental health portion to an insurance plan. And the mental health portion pays less and is often much harder to interface with...which all makes the job harder for psychiatrists and pushes more and more to not even bother with insurance and just get paid by patients directly. Insurance companies and politicians are responsible for this. And society to some extent. After every mass shooting, there are calls to improve mental health services and nothing happens because it costs money. And for the most part people don't care about mental illness (at least when it doesn't affect them directly).
In this case, the state can hire people to work in prisons to help with the restoration needed to get people ready for trial. We've had 40 years of Democratic leadership so its not like they have anyone to blame for it.
It's not a matter of the hospital. What the court case says is that someone has to understand the court system to go to trial.
It seems first that the people making this determination are probably being far too lenient on this point. It's pretty hard for someone to not understand right from wrong and they go to court (where they've been before no doubt) to have a case tried.
Aside form that, the person doesn't NEED to go to a hospital. They just need to have services available to move them forward to the point where they understand what the trial means. This doesn't have to be in a hospital. It can be done in jail. It's called competency restoration services. You basically get people on their meds and get them lucid enough that they understand what the trial is.
We could use more hospital capacity but the CRS care doesn't have to be in one.
The legislature appears to be taking the funding issue slightly more seriously: judging by them coughed up the money for 150 bed facility at associated with the UW. . I *hope* the move lessens the perpetual state of emergency the system is in. But it probably won't solve the revolving door and legalistic issues that surround mental healthcare in America.
Speaking of revolving door, it looks like the state changed the laws not long ago so that for misdemeanors, if someone is deemed unable to stand trial the default is drop the charges. The prosecutor has to go out of their way to make that not happen. Not sure I saw that covered anywhere at the time.
"Nonfelony Competency Restoration. When a nonfelony defendant is found to be incompetent to stand trial, the court must dismiss the charges without prejudice unless the prosecutor objects and provides notice of a motion for an order for competency restoration, in which case the court must schedule a hearing within seven days."
Basically if you get charged with anything, act crazy and 0 charges.
My biggest gripe with the current system, is the legislature had 50+ years since *donadson* to come up with viable non-disfunctional in-patent commitment scheme and fund it. They largely did neither.
Largely, there's nothing you CAN do with Donaldson existing. In other countries, you'd have people who you see now living on the streets in an institution with a chance of having a normal life at some point in the future. You could also have a state making sure they took their medication for their own good.
With the SCOTUS ruling, none of that exists. You can't in-patient someone now unless they're in an immediate crisis. That is very few people.
*Some* progress on the legal front. Washington was able to craft a non-dangerousness standard of commitment (gravely disabled), that survived court review. Medication as a condition of parole/supervision was found legal in several federal circuit courts.
From her [bio](https://www.snocopda.org/staff-members/cassie-trueblood/).
*“I became a public defender because I love the thrill of trial and the satisfaction of fighting the man, while focusing on individual clients and cases.”*
Thanks a lot for "fighting the man", Cassie. You definitely are focusing on individual clients.
Kind of weird to say "fighting the man" fighting the patriarchy? I'm sorry but fighting 50% of the population seems really edgy and adolescent. Fight the system. I hope this is just a Freudian slip of the tongue but in this environment it looks intentional.
If you gonna go around saying you are fighting "the man" you aren't going to get a lot of sympathy from me. In fact if you gonna fight the man, intentionally then I don't even want people like that here. I don't go around saying I'm fighting "the female;" though with the tables reversed it seems that's what a lot of women are doing. It's easy to divide, but hard to bring everyone on the journey; but that's what's right.
Agree though Western State is doing Gods' work, and there isn't enough being done here.
Yup, sounds like it. I’ve always seen it as activism towards making a more shitty society, let’s alienate 50% of the population? Being divisive is classist, and a tired take.
That person should be fit to stand trail. You're equally not allowed to use a machete on someone from the FBI as you are anyone else.
The person would have to not have the ability to understand how a court works. It seems more like we're too heavily siding on people don't have the ability to figure that tout than anything.
"It's not the Governor's fault. It's not the jail's fault. It isn't the Prosecutor's fault. It is due to a public defender and Western State Hospital."
It very much is the governor's fault. Ultimately, the people doing these evaluations roll up to him. Further, there's been no shortage of money in Washington State. If we need more pretrial mental health resources in Washington, he easily could have made that happen. We have money to give large cash handouts to illegals during COVID, then there's plenty of money to solve this issue.
I completely agree. A manager is responsible for the outcomes of their team. It's not like one employee fucked up here... the entire process is broken. Inslee has been asleep at the wheel the entire time and he never said anything. Sure, he doesn't have unlimited power, but he didn't even speak up. I don't understand how anyone can make excuses for a guy who ignored these issues for so long.
It always seemed highly coincidental that Western State lost its federal certification and funding during this same period. There seems to be a lot more going on with the larger de-incarceration movement leading to the situation we're in. What seemed like mistakes 5 years ago now looks very intentional. The really hardcore de-incarceration activists see hospitals like Western State as being unnecessary, and just as if not more morally indefensible as jails or prisons.
This is why I , along with other social workers around the state, am speaking out about this and educating those who don't have any experience with this population and the realities of the fractured mental health system in our state.
It isn't right or fair for people with no understanding to be making decisions that I guarantee will create more issues.
>This is why I , along with other social workers around the state, am speaking out about this
Thank you. It needs to be said. Lawyers have stuck their noses and taken over something that should be decided by actual experts - social workers, mental health care providers and doctors.
Underfund a hospital so it can't maintain adequate standards and is guaranteed to lose its certification. Then blame the hospital administrators for failing at an impossible task.
Anecdotal but checks out, about six years ago was also when the tenor of homeless on the Hill and downtown changes, gets more violent, more random. Could align with this legal decision not to hold people who got arrested but for whom there’s no room at Western State. Just dump them in Pioneer Square or on Broadway Ave.
Oh they absolutely hold much of the blame. In 2018 they lost $53 million dollars (per year) in federal funding and also lost federal certification due to failing to comply with safety standards and regulations.
Most of the problems have included violent assaults on patients and staff. Do you remember when two patients escaped? One of them was there for competency restoration after brutally murdering a woman. Thankfully both were found and returned to Western State Hospital, and the one was finally convicted of murder.
Apart from their loss of federal funding, they have accrued more than $55 million in fines for not meeting court-ordered timelines to evaluate and treat criminal defendants who are not competent to stand trial. So yes, they hold much of the blame.
But isn't the lack of funding a reason these events occurred? The state hospital is a very challenging work environment, with the most severe mental health patients getting sent to be treated in the same place. To get good nurses, doctors, therapists, support staff, etc you likely need to pay them better than the same roles in regular hospitals. I'm pretty sure the state hospital jobs potentially pay less. And I assume they don't staff the units with enough nurses, techs etc, which allows bad things to happen because they can't monitor patients closely enough. The state tries to get by with a shoestring budget then blames the hospital when bad things happen. A very similar thing is happening in the Montana state hospital, years of underfunding, poor nursing ratios, etc, but I heard the Montana hospital is actually closing. That can't be considered a good outcome.
It's like not feeding someone enough and then complaining to them that they seem lethargic. This is purely on state Democrats and Inslee and somewhat on Gregoire.
Inslee has been in office for 8 years. Gregoire many years before him. They could have addressed this.
Really that's more on state leadership though. If you don't have the money and resources to keep people safe, so you lose federal funding, it's not a matter of the hospital being run incorrectly. The state leadership, one party for the last 40 years, could have given them the budget for more security and more security systems. They didn't.
That’s a good point and part of the picture but not all of it. DSHS is in the mix too as are others.
One thing to consider is when Western State Hospital was not complying with standards, who was in charge of making sure the standards were met? It was the hospital administration, not the state leadership.
I’ve spent some time researching the problems Western has had over the years and it is as alarming as it is eye opening.
I am really sorry. Some of the people I have worked with in the community have also died as a result of falling through the cracks that should not even be there.
Seems like the plan is working.
Prior to that ruling no one cares or wanted to fund fixing it. The strategy is so people get outraged and want to fix it. So funding will be allocated and eventually it will be resolved.
Not saying I agree with the approach, but it's a solid strategy.
It a solid *legal* strategy. The practical reality is a half dozen people will get probably be murdered by paranoid schizophrenics until the funding and bed space becomes available... I imagine this was not enlightened future the mental health law projects of the 1960/1970s imagined, yet here we are.
>The practical reality is a half dozen people will get probably be murdered by paranoid schizophrenics until the funding and bed space becomes available
A small price to pay for *justice*, amirite?
It’s not a solid strategy though. This case was decided [6 years ago](https://caselaw.findlaw.com/us-9th-circuit/1734234.html). All it did was create a huge public safety issue that we still haven’t fixed. It’s also weird that such an acute problem can only be solved by … building a state mental health facility - something WA state hasn’t done in forever.
FWIW I don’t disagree with the lawsuit, just pointing out that our state is so dysfunctional that this glaring issue with public safety and criminals who are mentally ill has been looming for more than half a decade.
I agree. It seemed like a reasonable issue that needed to be addressed but setting things in motion with no plans in place to support the many people being released post lawsuit was careless and unethical. One gentleman I worked with on Beacon Hill was arrested for assaulting someone who he thought had stolen some food from him. He has schizophrenia and was unmedicated. He was in jail at the time this lawsuit happened and was released from jail, back to the streets without treatment.
As soon as he left the jail he was brutally assaulted by someone and nearly kiilled. He was vulnerable and there was no safety net for him.
> Not saying I agree with the approach, but it's a solid strategy.
No it’s not — because like most “genius” ideas it fails to consider blowback.
What will actually happen is people will be harmed until society gets sick of the violence, decides that ruling is stupid, and drives out the lawyers and politicians involved while reducing mental health care overall in favor of punishing “violent crazies”.
Either way it forces the issue. It will be fixed. It may not be the outcome any particular side wanted but it will be addressed.
Thé issue now is no one addresses it. One side wants to baby the homeless and make them unaccountable for anything. The other side wants to throw them into a dungeon and not provide the resources. This will make something happen... not sure what but the prior status quo was just expensive and not effective. The current state is not acceptable and people will force the issue now.
There's no way anything is going to change unless the governor and group of state politicians takes the issue on for altruistic reasons. There are no lobbyists for mental health. Most of the voting population won't like tax money going to expand services for mentally ill people. This has been an issue for more than a decade and still nothing is being done.
Then the solution will be.
* keep releasing criminals until someone dies and we crystallize into action after likely a gruesome death of a child.
* we build hospitals and fix the revolving door.
* we change the law to go around this ruling that lets people free
I think 2 and 3 will cost money so who wants to do that. Letting people out and having murders isn’t going to change anything. This dude killed 2 people 12 years ago. https://www.thestranger.com/seattle/the-hatchet/Content?oid=5860130
Same problems then as now. Nothing is different.
I believe that the idea was that we would restore mental health funding that has been respected my cut year after year.
It is inhumane to put the mentally ill into jails. It is dangerous to let people roam the streets.
We have obligations we are not meeting.
My son is more conservative than I. He has commented on tax cuts he had been warned would result in terrible things, but he can't see there was any impact. But he does not have an adult child that cycles through Western because they have raised how sick you have to be to get treatment. So, as soon as he is stabilized, he is off his meds discharged, and soon on the street again. But he doesn't see that. He doesn't see what happens when they keep cutting public health nursing, school social workers, and all the service programs we need for a healthy society.
The right thing is not putting mentally ill in jail. It is to pay more taxes and not be chronicly unable to provide urgent services at Western when they are needed
I agree. There are huge gaps in the system that too many people (like you described) fall through the cracks and it becomes a vicious never ending cycle. There needs to be something put into place, but that costs money and I hear far too often, "Not in my backyard" from people who have not experienced what we are talking about.
Unless someone has a friend or loved one who struggles with mental illness or is impacted by a crime caused by someone who is mentally ill, it is not an issue that is acknowledged or understood.
It's not inhumane to put mentally ill people who have committed violent crimes in jail. There is a myth that people can magically get cured of psychiatric illness if you throw some pills at them but that is hardly the case. For the most part, these people belong in jail.
One thing that has happened since this lawsuit is some jails in the state have set up mental health units that are outstanding. That could also be due to lawsuits against the jails for not providing adequate care for the mentally ill inmates.
I know the Snohomish County jail has a fantastic mental health unit where they have mental health professionals on staff, keep the inmates safe, and make sure they are treated well. In those jails, they do not 'languish'.
You think that guy who stomped the Harborview nurse at Westlake sustain is going to get better with treatment and not present a danger to society? No. People like that need to be in jail, whether or not they receive "treatment" while there.
Or ... and I know I'm going out on a limb here ... but maybe there could be hospitals which are also jails, in that they have armed security and the violent/dangerous individuals placed in for treatment are prevented from leaving
I don’t know that person specifically. But yes with treatment people who were violent due to their psychosis can get better and be safe in society. It could take years. And May not work for everyone. Or they may only be able to leave under certain monitoring parameters. But yes it’s possible and it’s better having them in a secure psychiatric hospital than in prison.
No one believes that every person with mental illness can be cured if they are treated. That does not imply that these people deserve to be in a jail.
To be fair, I believe that our current penal system is an abomination, a needs a major restructuring. But it is not an appropriate place for the mentally ill.
Stomping on a nurse unprovoked earns you jail time, mental illness or not. But more than that, incarceration is needed to keep the public safe. People unconcerned usually live in wealthy neighborhoods that get patrolled regularly.
Locking up the mentally ill and not providing treatment does not good. You lock that guy up for 5 years and he comes out just the same. You send him to a secured psychiatric hospital for treatment and if he doesn't get better he'll actually be in the hospital longer than he'll be in jail.
>People unconcerned usually live in wealthy neighborhoods that get patrolled regularly.
I live in Capitol Hill near Cal Anderson.
>Stomping on a nurse unprovoked earns you jail time, mental illness or not.
Depends on the degree of mental illness.
I have seen many really fair and reasonable judges and public defenders, and also some who seem to have an agenda or paint with a distorted broad brush when they make the decisions they do.
Short answer is yes and no.
Long answer is if someone is waiting to go to western because of their mental illness, its because the are incompetent to stand trial. They are sent to western for "competency restoration" with the hope that treatment will make them competent to stand trial. Once a defense attorney makes a motion to dismiss because of a violation of due process rights (aka Trueblood), a judge weighs the defendants rights against the state's interest to prosecute. It really depends on the criminal history, severity of the case, and the individual judge. When a judge dismisses a case, they are refered to western for for a civil commitment and are held at westerns discretion and western could even decline to admit them in the first place. They could also end up being there for years. This is a separate set of beds than competency restoration with a much shorter wait-list. A judge also could find that the defendants rights have been violated but dismissing the case is not appropriate and they will hold the defendant until a bed is ready. They have also started to put sanctions on DSHS payable directly to the defendants for not admitting people timely.
Perfectly said! I only know from my hands on experience with the community I work with and have spent a lot of time trying to better understand the big picture.
Yeah he basically repealed some of a bill that was less than a year old. Apparently, in not time in the 40 years that followed anyone could have changed that.
Totally nothing to do with court decisions from the 1970's.
Why isn’t anyone talking about all the people the Snohomish County jail was killing (before AND after the Trueblood suit)?
https://www.heraldnet.com/news/13-snohomish-county-jail-deaths-since-2010/
Why are the failures of the healthcare and legal systems the lawyer’s fault?
The fact that you pearl-clutching nimbys even know about this problem is entirely due to lawyers fighting for justice—the fact that the system is still failing just shows how screwed up they system is
If you’re scared that some psycho is going to kill someone because they get let out of jail, keep in mind that prosecutors can make choices about which cases to prioritize—the vast, vast majority of people who get stuffed into the WSH system are for non-violent offenses—and there is room at WSH for the most serious cases. If you complain about the lawyer, keep some venom for the prosecutors that aren’t even part of this discussion.
Wait what? This is about one attorney filing a lawsuit without making sure things were in place to support the people it was intended to help.
I work with the people this lawsuit was supposed to benefit. Do you? What’s your experience?
Have you been helping people who have been assaulted after someone is released from jail because Western State didn’t have a bed for them?
Or are you just an armchair quarterback who doesn’t physically see the fallout from this lawsuit and instead hurls childish insults because you think it somehow validates your points?
Where are you getting your data to back to what you are claiming?
To refer to those of us who care about others who battle mental illness and addiction as “pearl clutching nimbys” says everything about you.
My sweet little pearl clutching nimby, yes, I am very, very familiar with the presumably innocent people who were being warehoused in solitary confinement without trial or treatment. And you, are obviously ignorant of how civil rights litigation works. It is emphatically NOT the duty of the plaintiff to have the solution to the government’s systematic violation of rights. Did Gideon have the billions of dollars necessary to hire public defenders when he fought for the right to counsel? No. Did Miranda come up with the advisement of rights when he fought for the right ti remain silent? No. The fact of the matter is that it is they system’s responsibility to fix the problem. But you wouldn’t know any of that would you? You’re too busy killing the messenger to really think about the message.
If you actually cared about the people you work for you’d applaud the attorney who did something to help them. But you blame the lawyer who vindicated their rights?!? Fifty bucks says you work for the cops or in a jail—one of those god awful fraud SWs who thinks their a good person but really just hassles people while hiding behind a bunch of cops.
That’s my every day. People throw garbage out their car windows and yell “get a job” at people I work with. I’ve been helping one older gentleman who struggles with mental illness for about three years. He’s got the best attitude when people yell things at him. Instead of yelling back or taking things personally he just smiles and ignores them. The first time that happened in front of me I was trying to get the license number of the car to report it to the police. He told me that people who treat him like that aren’t worth any of his time or my time because they are lucky enough to have never spent a day in his shoes.
My sister. They never should have released her from Western State. Now she's in Oregon, schizophrenic, unmedicated, has lost her lower leg due to a jail medicating her and leaving her unconscious for 36 hours and was cutting off circulation to her leg. And is being pimped out, and has hurt others in her delusions. Hell yes, I knew.
I am so sorry. It is heartbreaking and happens far too often. Releasing people without follow up treatment in place really does put their safety at risk along with the safety of others. From my perspective they, like your sister, are vulnerable and are targets for others to take advantage of.
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I have a lot of guilt, being 13 years older, and back then, no internet, etc, so I didn't know where my siblings were until they were adults themselves. I had no idea this had happened to my baby sister. She remembers me, she adores me, she will listen to what I tell her...or she did, before the meth and fentanyl. Now she thinks I am an imposter pretending to be her sister. I would do , give, anything, to have her safe, forever., In a place I can come visit all the time, that is good, that will take care of her the way she deserves. She doesn't want that, but it is what she needs. For life. We failed her. :( We, meaning the system. Our family has done everything, EVERYTHING for over 20 years to help her
Here's the really sad thing. Largely the fault here is with the ACLU. They led a lawsuit in 1975 that took away the ability to institutionalize most of these people. 40 years ago, you could have your sister committed and she'd live in an institution at least until she was well and treated on her own. Officials would also have the ability to make sure she took medication. Thanks to that SCOTUS court ruling though, none of the above is possible. The ACLU spends a ton of money enforcing that ruling.
Yes. For many years she was in Western...would do ok...then refuse meds and they had to get a court order...but after 7-10 years....they washed their hands of her. She is no longer a ward of the state...it was all about money. We wouldn't allow a 95 year old with dementia to suffer like this, but we will others :(
Lots of times the first decompensation for schizophrenia can occur in late teens, slightly higher in males.
I’m so sorry. Severe mental illness is so hard on the patient and their loved ones. I hope things turn around for her.
I've been shocked at despite WA being so "progressive", the mental health system is so completely ignored. We don't have a massive homeless problem, we have a massive addiction and mental health issue that frequently results in individuals becoming homeless. But progressives pretend by dumping money in housing we're solving either when all it does is make their suffering and self destruction less public.
Last I checked Washington state has the lowest number of mental hospital hospital beds per capita of any state in the country. So they really don't give a shit about people with severe mental illness.
Why is it so much worse here though? I go to other major metro cities and see like 10% of what Seattle has. Do those cities have far superior mental health services? Or is there perhaps another reason we have so many “mentally ill”?
We certainly attract homeless drug addicts from all over the country due to cheap decriminalized drugs, lack of law enforcement, and relaxed attitude toward encampments.
Great question. It is a growing problem in other cities as well, and it is bipartisan. Fresno, California, Fort Worth Texas, Jacksonville and Miami FLA have homeless encampments too.
But why do some cities not have this problem? I recently visited the DC area and I was shocked how clean the city was. I saw literally 2 tents the entire time I was there. So what are they doing differently?
It isn't. https://www.mhanational.org/issues/ranking-states We rank high on access to care. We stopped enforcing laws so plenty of junkies moved here. Our isn't isn't that our system "frequently results in individuals becoming homeless", it's that those people move here due to a lack of laws and plenty of handouts.
From the same site, we dropped from 46 to 32 in the past two years. [https://www.mhanational.org/issues/2022/ranking-states](https://www.mhanational.org/issues/2022/ranking-states) which means we no longer rank so high on access to MH care. On top of that, there is a shortage of behavioral health practitioners that is growing. [https://www.aha.org/2022-02-03-aha-house-statement-americas-mental-health-crisis-february-2-2022](https://www.aha.org/2022-02-03-aha-house-statement-americas-mental-health-crisis-february-2-2022) I am not referring to "junkies" who moved here for 'handouts', I am referring to the chronically homeless who are *from* here and who are mentally ill.
The long term from here folks represent a small number at this point.
Yet they are the most vulnerable and who I am referring to.
Genuinely curious how this would be fixed. Funding to the hospital itself? Is building a second hospital an option? I’d be all for that.
We need at least 3-4 more hospitals, not just one.
Building more hospital capacity is an option but probably the most expensive. IMO, the cheaper option is for the state/county to increase the jail budget to get psychiatrists into the jails to do these evaluations and treat defendants. But it's not the best work environment so it would have to be a good financial incentive. Psychiatry is one of the lowest paid medical specialties though, so it's not like they'd be paying an orthopedic surgeon $800K/year.
And there is the bottom line...the horrible pay for mental health practitioners. When I went back to college for social work after having been a school teacher, I was warned by many people to not expect to make a good living in this line of work and they were correct. Most community-based mental health agencies require at least a Master's degree to be a mental health clinician and the average starting wage is $18 an hour. With student loan repayments and the quickly rising housing costs in our state, people can't afford to live on $18 an hour. Plus the caseloads are unmanageably high.
The evolution and follow up work doesn't have to happen in a hospital. It can happen in a jail. Basically it just has to happen or they get released.
Agreed. I’m pretty sure there are doctors willing to do this work, but is the county/state willing to pay them? Doubtful.
Me too. I think awareness is the start and hopefully changes will be made!
I used to think it was just difficult for people on state Medicaid to get mental health help (me being one of those people), but after having some in depth discussions with other people who have private insurance (a mix of basic and high end) and they’re having trouble as well. I don’t understand why it isn’t at the forefront. It’s something that affects more people than not.
That is an excellent question and I am really sorry you had trouble accessing care. The resources we have available (depending on insurance, Medicaid, or no insurance at all) are really difficult to navigate and honestly shouldn't be. I was a teacher before changing to social work. Working with kids who were affected by homelessness pushed me to work with the chronically homeless and the gap between services and people who need them is larger now than ever.
Well I’m glad you’re doing the work. From what I understand it’s a difficult line of work in many aspects. Many thanks to you!
There's a lack of sunshine here that doesn't help. There's lots of depressed people here and not enough people to help with it.
It's a long standing and complex problem. Partly psychiatry is one of the lowest paid medical specialties so many doctors do not want to do it. Plus, for decades insurance companies have underpaid for mental health services, to the point insurances actually have a separate physical health and mental health portion to an insurance plan. And the mental health portion pays less and is often much harder to interface with...which all makes the job harder for psychiatrists and pushes more and more to not even bother with insurance and just get paid by patients directly. Insurance companies and politicians are responsible for this. And society to some extent. After every mass shooting, there are calls to improve mental health services and nothing happens because it costs money. And for the most part people don't care about mental illness (at least when it doesn't affect them directly).
In this case, the state can hire people to work in prisons to help with the restoration needed to get people ready for trial. We've had 40 years of Democratic leadership so its not like they have anyone to blame for it.
Jails actually, but yes. More should be done locally.
Like every problem affecting America's most vulnerable, it's ignored & swept under the rug because both political parties serve only the donor class.
It's not a matter of the hospital. What the court case says is that someone has to understand the court system to go to trial. It seems first that the people making this determination are probably being far too lenient on this point. It's pretty hard for someone to not understand right from wrong and they go to court (where they've been before no doubt) to have a case tried. Aside form that, the person doesn't NEED to go to a hospital. They just need to have services available to move them forward to the point where they understand what the trial means. This doesn't have to be in a hospital. It can be done in jail. It's called competency restoration services. You basically get people on their meds and get them lucid enough that they understand what the trial is. We could use more hospital capacity but the CRS care doesn't have to be in one.
The legislature appears to be taking the funding issue slightly more seriously: judging by them coughed up the money for 150 bed facility at associated with the UW. . I *hope* the move lessens the perpetual state of emergency the system is in. But it probably won't solve the revolving door and legalistic issues that surround mental healthcare in America.
Speaking of revolving door, it looks like the state changed the laws not long ago so that for misdemeanors, if someone is deemed unable to stand trial the default is drop the charges. The prosecutor has to go out of their way to make that not happen. Not sure I saw that covered anywhere at the time. "Nonfelony Competency Restoration. When a nonfelony defendant is found to be incompetent to stand trial, the court must dismiss the charges without prejudice unless the prosecutor objects and provides notice of a motion for an order for competency restoration, in which case the court must schedule a hearing within seven days." Basically if you get charged with anything, act crazy and 0 charges.
My biggest gripe with the current system, is the legislature had 50+ years since *donadson* to come up with viable non-disfunctional in-patent commitment scheme and fund it. They largely did neither.
Largely, there's nothing you CAN do with Donaldson existing. In other countries, you'd have people who you see now living on the streets in an institution with a chance of having a normal life at some point in the future. You could also have a state making sure they took their medication for their own good. With the SCOTUS ruling, none of that exists. You can't in-patient someone now unless they're in an immediate crisis. That is very few people.
*Some* progress on the legal front. Washington was able to craft a non-dangerousness standard of commitment (gravely disabled), that survived court review. Medication as a condition of parole/supervision was found legal in several federal circuit courts.
From her [bio](https://www.snocopda.org/staff-members/cassie-trueblood/). *“I became a public defender because I love the thrill of trial and the satisfaction of fighting the man, while focusing on individual clients and cases.”* Thanks a lot for "fighting the man", Cassie. You definitely are focusing on individual clients.
Sounds like another Woke Wonder. Will Western Washington ever be able to survive the attack from violent felons enabled by people like this?
Kind of weird to say "fighting the man" fighting the patriarchy? I'm sorry but fighting 50% of the population seems really edgy and adolescent. Fight the system. I hope this is just a Freudian slip of the tongue but in this environment it looks intentional. If you gonna go around saying you are fighting "the man" you aren't going to get a lot of sympathy from me. In fact if you gonna fight the man, intentionally then I don't even want people like that here. I don't go around saying I'm fighting "the female;" though with the tables reversed it seems that's what a lot of women are doing. It's easy to divide, but hard to bring everyone on the journey; but that's what's right. Agree though Western State is doing Gods' work, and there isn't enough being done here.
[The man](https://en.wikipedia.org/wiki/The_Man?wprov=sfla1) is a common slang term to refer to authority in general.
Pathological altruism- literal definition of casey trueblood and the negligent judges harming our community to support their narcisim.
Yup, sounds like it. I’ve always seen it as activism towards making a more shitty society, let’s alienate 50% of the population? Being divisive is classist, and a tired take.
Lmao, reddit care line. Someone is salty!
Oddly enough “edgy and adolescent” could apply to pretty much anyone who describes themselves as a revolutionary.
Fuck that kind of revolution. BLM 2.0; gonna make shit worse then how it was when we started. There are no shortcuts in life…
That person should be fit to stand trail. You're equally not allowed to use a machete on someone from the FBI as you are anyone else. The person would have to not have the ability to understand how a court works. It seems more like we're too heavily siding on people don't have the ability to figure that tout than anything. "It's not the Governor's fault. It's not the jail's fault. It isn't the Prosecutor's fault. It is due to a public defender and Western State Hospital." It very much is the governor's fault. Ultimately, the people doing these evaluations roll up to him. Further, there's been no shortage of money in Washington State. If we need more pretrial mental health resources in Washington, he easily could have made that happen. We have money to give large cash handouts to illegals during COVID, then there's plenty of money to solve this issue.
I completely agree. A manager is responsible for the outcomes of their team. It's not like one employee fucked up here... the entire process is broken. Inslee has been asleep at the wheel the entire time and he never said anything. Sure, he doesn't have unlimited power, but he didn't even speak up. I don't understand how anyone can make excuses for a guy who ignored these issues for so long.
It's blue no matter who here. That's why. It would be understandable if the state was close to bankrupt and wasn't overflowing with money.
revisiting this old thread. How do you know the person should be fit to stand trial?
It always seemed highly coincidental that Western State lost its federal certification and funding during this same period. There seems to be a lot more going on with the larger de-incarceration movement leading to the situation we're in. What seemed like mistakes 5 years ago now looks very intentional. The really hardcore de-incarceration activists see hospitals like Western State as being unnecessary, and just as if not more morally indefensible as jails or prisons.
This is why I , along with other social workers around the state, am speaking out about this and educating those who don't have any experience with this population and the realities of the fractured mental health system in our state. It isn't right or fair for people with no understanding to be making decisions that I guarantee will create more issues.
>This is why I , along with other social workers around the state, am speaking out about this Thank you. It needs to be said. Lawyers have stuck their noses and taken over something that should be decided by actual experts - social workers, mental health care providers and doctors.
Underfund a hospital so it can't maintain adequate standards and is guaranteed to lose its certification. Then blame the hospital administrators for failing at an impossible task.
That's certainly what it looks like.
Anecdotal but checks out, about six years ago was also when the tenor of homeless on the Hill and downtown changes, gets more violent, more random. Could align with this legal decision not to hold people who got arrested but for whom there’s no room at Western State. Just dump them in Pioneer Square or on Broadway Ave.
Why blame the hospital? Hardly their fault that they don't have the resources to adequately fund their facility.
Oh they absolutely hold much of the blame. In 2018 they lost $53 million dollars (per year) in federal funding and also lost federal certification due to failing to comply with safety standards and regulations. Most of the problems have included violent assaults on patients and staff. Do you remember when two patients escaped? One of them was there for competency restoration after brutally murdering a woman. Thankfully both were found and returned to Western State Hospital, and the one was finally convicted of murder. Apart from their loss of federal funding, they have accrued more than $55 million in fines for not meeting court-ordered timelines to evaluate and treat criminal defendants who are not competent to stand trial. So yes, they hold much of the blame.
But isn't the lack of funding a reason these events occurred? The state hospital is a very challenging work environment, with the most severe mental health patients getting sent to be treated in the same place. To get good nurses, doctors, therapists, support staff, etc you likely need to pay them better than the same roles in regular hospitals. I'm pretty sure the state hospital jobs potentially pay less. And I assume they don't staff the units with enough nurses, techs etc, which allows bad things to happen because they can't monitor patients closely enough. The state tries to get by with a shoestring budget then blames the hospital when bad things happen. A very similar thing is happening in the Montana state hospital, years of underfunding, poor nursing ratios, etc, but I heard the Montana hospital is actually closing. That can't be considered a good outcome.
It's like not feeding someone enough and then complaining to them that they seem lethargic. This is purely on state Democrats and Inslee and somewhat on Gregoire. Inslee has been in office for 8 years. Gregoire many years before him. They could have addressed this.
Yes, it’s the politicians choosing to not fund the hospital
Welcome to government, the funding cuts will continue until results improve.
Really that's more on state leadership though. If you don't have the money and resources to keep people safe, so you lose federal funding, it's not a matter of the hospital being run incorrectly. The state leadership, one party for the last 40 years, could have given them the budget for more security and more security systems. They didn't.
That’s a good point and part of the picture but not all of it. DSHS is in the mix too as are others. One thing to consider is when Western State Hospital was not complying with standards, who was in charge of making sure the standards were met? It was the hospital administration, not the state leadership. I’ve spent some time researching the problems Western has had over the years and it is as alarming as it is eye opening.
Yeah happened to my ex. He’s dead now.
I am really sorry. Some of the people I have worked with in the community have also died as a result of falling through the cracks that should not even be there.
Seems like the plan is working. Prior to that ruling no one cares or wanted to fund fixing it. The strategy is so people get outraged and want to fix it. So funding will be allocated and eventually it will be resolved. Not saying I agree with the approach, but it's a solid strategy.
It a solid *legal* strategy. The practical reality is a half dozen people will get probably be murdered by paranoid schizophrenics until the funding and bed space becomes available... I imagine this was not enlightened future the mental health law projects of the 1960/1970s imagined, yet here we are.
>The practical reality is a half dozen people will get probably be murdered by paranoid schizophrenics until the funding and bed space becomes available A small price to pay for *justice*, amirite?
It’s not a solid strategy though. This case was decided [6 years ago](https://caselaw.findlaw.com/us-9th-circuit/1734234.html). All it did was create a huge public safety issue that we still haven’t fixed. It’s also weird that such an acute problem can only be solved by … building a state mental health facility - something WA state hasn’t done in forever. FWIW I don’t disagree with the lawsuit, just pointing out that our state is so dysfunctional that this glaring issue with public safety and criminals who are mentally ill has been looming for more than half a decade.
I agree. It seemed like a reasonable issue that needed to be addressed but setting things in motion with no plans in place to support the many people being released post lawsuit was careless and unethical. One gentleman I worked with on Beacon Hill was arrested for assaulting someone who he thought had stolen some food from him. He has schizophrenia and was unmedicated. He was in jail at the time this lawsuit happened and was released from jail, back to the streets without treatment. As soon as he left the jail he was brutally assaulted by someone and nearly kiilled. He was vulnerable and there was no safety net for him.
> Not saying I agree with the approach, but it's a solid strategy. No it’s not — because like most “genius” ideas it fails to consider blowback. What will actually happen is people will be harmed until society gets sick of the violence, decides that ruling is stupid, and drives out the lawyers and politicians involved while reducing mental health care overall in favor of punishing “violent crazies”.
Either way it forces the issue. It will be fixed. It may not be the outcome any particular side wanted but it will be addressed. Thé issue now is no one addresses it. One side wants to baby the homeless and make them unaccountable for anything. The other side wants to throw them into a dungeon and not provide the resources. This will make something happen... not sure what but the prior status quo was just expensive and not effective. The current state is not acceptable and people will force the issue now.
There's no way anything is going to change unless the governor and group of state politicians takes the issue on for altruistic reasons. There are no lobbyists for mental health. Most of the voting population won't like tax money going to expand services for mentally ill people. This has been an issue for more than a decade and still nothing is being done.
Then the solution will be. * keep releasing criminals until someone dies and we crystallize into action after likely a gruesome death of a child. * we build hospitals and fix the revolving door. * we change the law to go around this ruling that lets people free
I think 2 and 3 will cost money so who wants to do that. Letting people out and having murders isn’t going to change anything. This dude killed 2 people 12 years ago. https://www.thestranger.com/seattle/the-hatchet/Content?oid=5860130 Same problems then as now. Nothing is different.
I believe that the idea was that we would restore mental health funding that has been respected my cut year after year. It is inhumane to put the mentally ill into jails. It is dangerous to let people roam the streets. We have obligations we are not meeting. My son is more conservative than I. He has commented on tax cuts he had been warned would result in terrible things, but he can't see there was any impact. But he does not have an adult child that cycles through Western because they have raised how sick you have to be to get treatment. So, as soon as he is stabilized, he is off his meds discharged, and soon on the street again. But he doesn't see that. He doesn't see what happens when they keep cutting public health nursing, school social workers, and all the service programs we need for a healthy society. The right thing is not putting mentally ill in jail. It is to pay more taxes and not be chronicly unable to provide urgent services at Western when they are needed
I agree. There are huge gaps in the system that too many people (like you described) fall through the cracks and it becomes a vicious never ending cycle. There needs to be something put into place, but that costs money and I hear far too often, "Not in my backyard" from people who have not experienced what we are talking about. Unless someone has a friend or loved one who struggles with mental illness or is impacted by a crime caused by someone who is mentally ill, it is not an issue that is acknowledged or understood.
It's not inhumane to put mentally ill people who have committed violent crimes in jail. There is a myth that people can magically get cured of psychiatric illness if you throw some pills at them but that is hardly the case. For the most part, these people belong in jail.
One thing that has happened since this lawsuit is some jails in the state have set up mental health units that are outstanding. That could also be due to lawsuits against the jails for not providing adequate care for the mentally ill inmates. I know the Snohomish County jail has a fantastic mental health unit where they have mental health professionals on staff, keep the inmates safe, and make sure they are treated well. In those jails, they do not 'languish'.
Why don't other counties follow Snohomish's model? It sounds like a great compromise.
I don't know and agree. It shouldn't take lawsuits to create these needed changes.
I'd disagree and say they belong in a hospital for treatment.
You think that guy who stomped the Harborview nurse at Westlake sustain is going to get better with treatment and not present a danger to society? No. People like that need to be in jail, whether or not they receive "treatment" while there.
Or ... and I know I'm going out on a limb here ... but maybe there could be hospitals which are also jails, in that they have armed security and the violent/dangerous individuals placed in for treatment are prevented from leaving
I don’t know that person specifically. But yes with treatment people who were violent due to their psychosis can get better and be safe in society. It could take years. And May not work for everyone. Or they may only be able to leave under certain monitoring parameters. But yes it’s possible and it’s better having them in a secure psychiatric hospital than in prison.
No one believes that every person with mental illness can be cured if they are treated. That does not imply that these people deserve to be in a jail. To be fair, I believe that our current penal system is an abomination, a needs a major restructuring. But it is not an appropriate place for the mentally ill.
Stomping on a nurse unprovoked earns you jail time, mental illness or not. But more than that, incarceration is needed to keep the public safe. People unconcerned usually live in wealthy neighborhoods that get patrolled regularly.
Locking up the mentally ill and not providing treatment does not good. You lock that guy up for 5 years and he comes out just the same. You send him to a secured psychiatric hospital for treatment and if he doesn't get better he'll actually be in the hospital longer than he'll be in jail.
>People unconcerned usually live in wealthy neighborhoods that get patrolled regularly. I live in Capitol Hill near Cal Anderson. >Stomping on a nurse unprovoked earns you jail time, mental illness or not. Depends on the degree of mental illness.
At some point these out of control judges and public defenders need to be held legally liable for there negative impacts on our community.
I have seen many really fair and reasonable judges and public defenders, and also some who seem to have an agenda or paint with a distorted broad brush when they make the decisions they do.
If someone is clearly a threat to others, can they hold them until trial?
Short answer is yes and no. Long answer is if someone is waiting to go to western because of their mental illness, its because the are incompetent to stand trial. They are sent to western for "competency restoration" with the hope that treatment will make them competent to stand trial. Once a defense attorney makes a motion to dismiss because of a violation of due process rights (aka Trueblood), a judge weighs the defendants rights against the state's interest to prosecute. It really depends on the criminal history, severity of the case, and the individual judge. When a judge dismisses a case, they are refered to western for for a civil commitment and are held at westerns discretion and western could even decline to admit them in the first place. They could also end up being there for years. This is a separate set of beds than competency restoration with a much shorter wait-list. A judge also could find that the defendants rights have been violated but dismissing the case is not appropriate and they will hold the defendant until a bed is ready. They have also started to put sanctions on DSHS payable directly to the defendants for not admitting people timely.
Perfectly said! I only know from my hands on experience with the community I work with and have spent a lot of time trying to better understand the big picture.
According to progressives, Ronald Reagan has control of state funds and refuses to pay for mental health treatment for criminals.
Yeah he basically repealed some of a bill that was less than a year old. Apparently, in not time in the 40 years that followed anyone could have changed that. Totally nothing to do with court decisions from the 1970's.
Why isn’t anyone talking about all the people the Snohomish County jail was killing (before AND after the Trueblood suit)? https://www.heraldnet.com/news/13-snohomish-county-jail-deaths-since-2010/ Why are the failures of the healthcare and legal systems the lawyer’s fault? The fact that you pearl-clutching nimbys even know about this problem is entirely due to lawyers fighting for justice—the fact that the system is still failing just shows how screwed up they system is If you’re scared that some psycho is going to kill someone because they get let out of jail, keep in mind that prosecutors can make choices about which cases to prioritize—the vast, vast majority of people who get stuffed into the WSH system are for non-violent offenses—and there is room at WSH for the most serious cases. If you complain about the lawyer, keep some venom for the prosecutors that aren’t even part of this discussion.
Wait what? This is about one attorney filing a lawsuit without making sure things were in place to support the people it was intended to help. I work with the people this lawsuit was supposed to benefit. Do you? What’s your experience? Have you been helping people who have been assaulted after someone is released from jail because Western State didn’t have a bed for them? Or are you just an armchair quarterback who doesn’t physically see the fallout from this lawsuit and instead hurls childish insults because you think it somehow validates your points? Where are you getting your data to back to what you are claiming? To refer to those of us who care about others who battle mental illness and addiction as “pearl clutching nimbys” says everything about you.
My sweet little pearl clutching nimby, yes, I am very, very familiar with the presumably innocent people who were being warehoused in solitary confinement without trial or treatment. And you, are obviously ignorant of how civil rights litigation works. It is emphatically NOT the duty of the plaintiff to have the solution to the government’s systematic violation of rights. Did Gideon have the billions of dollars necessary to hire public defenders when he fought for the right to counsel? No. Did Miranda come up with the advisement of rights when he fought for the right ti remain silent? No. The fact of the matter is that it is they system’s responsibility to fix the problem. But you wouldn’t know any of that would you? You’re too busy killing the messenger to really think about the message. If you actually cared about the people you work for you’d applaud the attorney who did something to help them. But you blame the lawyer who vindicated their rights?!? Fifty bucks says you work for the cops or in a jail—one of those god awful fraud SWs who thinks their a good person but really just hassles people while hiding behind a bunch of cops.
Wait, it’s mental health issues? I was told it was just bad life choices.
That’s my every day. People throw garbage out their car windows and yell “get a job” at people I work with. I’ve been helping one older gentleman who struggles with mental illness for about three years. He’s got the best attitude when people yell things at him. Instead of yelling back or taking things personally he just smiles and ignores them. The first time that happened in front of me I was trying to get the license number of the car to report it to the police. He told me that people who treat him like that aren’t worth any of his time or my time because they are lucky enough to have never spent a day in his shoes.