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Q. When was the involuntary treatment law enacted?
In January of 1974, with subsequent amendments. The last amendments to the adult law were enacted in
2004. The law pertaining to minors was last amended in 1998.
Q. What was the law intended to accomplish?
The law was intended to:
- Put an end to inappropriate, indefinite commitment of the mentally ill;
- Provide prompt evaluation and short-term treatment;
- Safeguard individual rights;
- Provide continuity of care;
- Promote and encourage community-based care;
- Protect the public safety.
Q. Under the law, what is the definition of a mental disorder?
The law defines a mental disorder as, "Any organic, mental, or emotional impairment which has substantial adverse effects on an individual's cognitive (thought) or volitional (action) functions."
Q. What are the criteria for commitment?
The criteria are as follows:
- HARM TO SELF: A substantial risk of serious harm indicated by threats (written or verbal) or attempts to commit suicide or inflict physical harm on one's self.
- HARM TO OTHERS: Behavior that has caused harm or places others in reasonable fear of sustaining harm. Can be written, verbal, or actual assaultive acts.
- PROPERTY DAMAGE: Behavior that has caused substantial loss or damage to the property of others.
- GRAVELY DISABLED: Behavior that results in the individual being in danger of serious physical harm resulting from the failure to provide for his/her needs of health and safety or, the individual has shown a deterioration in routine functioning which is evidenced by a repeated and escalating loss over his/her actions and is not receiving necessary care for health and safety needs.
Q. Can physicians or family members commit their patients or relatives?
NO. Only County Designated Mental Health Professionals (CDMHPs) can initiate the process for adults. In King County, there are 27 CDMHPs who have the sole responsibility for detention of individuals who fall within the purview of the Involuntary Treatment Law (RCW 71.05).
Q. How does a person get detained?
Initial referral can be from anyone, such as police, family, neighbor, landlord, hospital emergency room, hospital in-patient unit. The CDMHP interviews the person(s) making the referral, takes declarations, and gathers all pertinent information. The person referred is then evaluated by the CDMHP, who determines whether there are appropriate alternatives to hospitalization, and whether the person would accept voluntary hospitalization. If neither are an option, the CDMHP could then detain the person, if the evidence warrants detention.
Q. Where does a committed patient go?
Facilities certified for the hospitalization of adults committed in King County are: Harborview Medical Center, West Seattle Psychiatric Hospital, Northwest Hospital Geropsychiatric Unit, and Fairfax Hospital (mainly juvenile). If those facilities are full, patients
may be sent to Western State Hospital.
Q. What does the law say with respect to juveniles?
Commitment criteria for juveniles are essentially the same as for adults. The "At Risk Youth/Runaway Bill" of 1995 amended the juvenile detention statute. The amendments did not change CDMHP authority to legally detain minors but it did change the age of consent for treatment to age 18. This means parents can sign a child, through age 17, into a hospital without the child's consent. The law does not require a hospital to accept the child, however, nor does it guarantee payment.
Q. How long can a person be held?
The initial detention period is for 72 hours. During this period the person's mental disorder is further assessed, he/she is provided with treatment (primarily medication and counseling), and a decision is made whether the person needs further treatment.
If the person would benefit from further treatment and still meets legal criteria, a court hearing is held at the end of the 72 hours to hear testimony from the relevant witnesses regarding the person's need for additional treatment. If the court finds that the patient is committable under the law, he/she
may be held for an additional 14 days (or 90 days of outpatient treatment for adults).
At the end of the 14 days, the treatment facility may ask the court to order further treatment (on an inpatient or outpatient basis) for a period of 90 days (180 days in the case of juveniles). Again, a court hearing is held. At the end of 90 days, a hearing may be held to commit the patient for 180 days. Under the law, no one may be held for longer than 180 days without a court hearing to review his/her status.
A child who has been signed in to the hospital by his or her parents does not have the same legal protections as when a person is detained by the CDMHP. The length of stay in the former case is determined by the hospital, along with medical necessity criteria or any limits imposed by private insurance providers.
Q. Can a committed person be forced to take medication against his/her will?
The law has changed several times on this issue. Since the 1991 amendments to the law, it is possible for the hospital to medicate a committed person against his/her will for short-term treatment (up to 30 days) if there is a second, concurring medical opinion approving medication. For continued treatment beyond 30 days a special court hearing is required to determine if there is legal justification for compelling the administration of medications.
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