Inslee signs Trueblood fix to improve competency services
Criminal defendants have the right to remain silent, the right to counsel, and the right to a trial by jury. They also have the right to understand their charges and assist in their own defense. Some defendants with behavioral health issues or disabilities do not understand their charges. In those cases, defendants have the right to expedient competency evaluation and restoration before they face prosecution.
Since a 2015 decision in Trueblood v. DSHS, the state has invested significant effort to serve a rapidly-growing number of patients awaiting competency services. In his State of the State address this past January, Inslee called on legislators to help with further reforms to the broken system. On May 15, Gov. Jay Inslee signed SB 5440 to overhaul the competency system and reduce an impossible volume of referrals.
A runaway train
Competency restoration is not long-term treatment. It rehabilitates to a point — readiness for trial — and goes no further. It is treatment for the purpose of fair prosecution.
But in recent years, the state Department of Social and Health Services has been consumed by surging demand for competency services. More and more defendants are being referred for competency evaluation and restoration. Referrals for competency restoration increased by 40 percent in just one year from 2021 to 2022 for a total of 8,596, nearly triple the figure from a decade ago.
“This exponential growth in court orders and referrals is not manageable or sustainable,” said Gov. Jay Inslee. “Nor is our criminal justice system an effective way to connect people to the treatment they need.”
By late last year, wait times for competency restoration commonly lasted ten months or longer. Still, court orders for competency restoration accelerated. In effect, defendants waited in jail indefinitely absent verdict, absent sentence, and with uncertain access to treatment.
SB 5440, a bill that was requested by the governor and sponsored by Sen. Manka Dhingra, initiates several reforms to improve access to care, provide more options for services outside the court system, and improve efficiency.
New clinical intervention specialists will help ensure time spent in jail contributes to the process of recovery. The specialists provide technical assistance to jails and preserve medication access so defendants don’t destabilize outside of treatment.
New diversion programs will benefit defendants with disabilities, injuries, or illnesses that affect their cognition. Defendants with a history of competency examinations are also prioritized for diversion.
New admission flexibility and shorter stays for certain cases will improve the system’s overall efficiency, as will a new requirement for courts to find genuine doubt over competency before ordering competency services.
All of these new investments and policies will help more defendants break their cycle of involvement in the criminal justice system and begin a path to durable recovery.
Opportunities for diversion
About 14 percent of defendants ordered to competency restoration face only misdemeanor charges. Under the new law, more non-felony defendants may be diverted to outpatient care. This will prioritize the most serious cases, reduce delays, accelerate time-to-trial, and begin treatment faster.
Defendants with developmental or intellectual disabilities comprise another 13 percent of those awaiting competency restoration. Under the new law, these defendants may also be offered diversion.
Diversion programs introduce defendants to services and can result in the dismissal of their charges. For defendants with behavioral health issues, diversion programs may include crisis stabilization, peer counseling, housing supports, or other programs to address behavioral health.
The governor will soon sign a budget for the next biennium that includes substantial investments in diversion services and even a new diversion facility. The Legislature approved a final operating budget that retains that emphasis, investing $81 million to support Trueblood-related investments, including in diversion programs.
More beds, more workers, more services
Since 2015, the state has invested aggressively to expand capacity for forensic commitments, investing more than $2 billion dollars. More than 200 new beds have been created since then, and at least 550 more beds will open in years to come as new facilities come online.
The latest state budgets include extraordinary investments in behavioral health capacity. The final operating budget includes $182 million to expand the behavioral health workforce. Thousands of Washingtonians sorely need expert behavioral health care, and workforce investments will help develop more experts to deliver that care. An additional sum of $81 million will expand opioid treatment and prevention services, as chemical dependency and behavioral health issues are often interlinked.
The state is opening new community-based behavioral health facilities and planning to retire Western State Hospital in favor of an entirely new forensic hospital. A new behavioral health teaching hospital at the University of Washington will contribute new psychiatric talent. The state is investing in diversion programs and alternative supports, contracting to expand capacity, and increasing provider rates.
The requirements within SB 5440 will reduce the extraordinary flow of court orders for inpatient treatment, helping the state’s new beds serve patients that need care the most.
Another important part of the state’s behavioral health efforts is the advancement of its 988 Suicide and Crisis Lifeline.
As of 2022, the dialing code 9–8–8 now connects callers across the country to National Suicide Prevention Lifeline call centers. Washington state has aimed higher, establishing 988 as a true lifeline for all sorts of people experiencing all sorts of crises. Operators can help callers access local services, and dedicated hotlines support veterans, Native Americans and Alaska Natives, and LGBTQ+ youth.
On Monday, the governor signed HB 1134 to take the next step towards using 9–8–8 to establish a statewide crisis behavioral response system. The bill will increase the number of mobile crisis response teams statewide and create new behavioral health crisis centers to decisively respond to 988 callers needing immediate intervention.
