November 19, 1997
King County Executive
Mentally Ill Offenders Task Force
Final Report

Process Work Group Recommendations: Principles of the Mentally Ill Offender Network, Summary of Recommendations | Outcome of the Legislative Work Group: Civil Commitment (RCW 71.05), Criminal Competency (RCW 10.77) | Conclusion | Appendices

I. Background

King County Executive Ron Sims appointed a special task force to review and address issues related to mentally ill offenders and commitment laws which were raised following the tragic fatal stabbing of a retired Seattle firefighter in August 1997. The focus of the Task Force was on the mentally ill who are a danger to others and a threat to public safety. The Task Force was assigned three areas of review:

1. cross system protocols for responsibility and transfer of information regarding mentally ill offenders;
2. assessment of the adequacy of current competency laws for misdemeanants; and
3. assessment of issues regarding the Involuntary Treatment Act for mentally ill offenders.

The Task Force worked to develop recommendations to improve and strengthen the systems that handle mentally ill offenders and to identify legislative solutions for consideration during the next state session.

The County Executive selected a diverse group of individuals to review these issues. Task force members represented the key treatment and legal service systems involved with this population including judges, prosecutors, public defenders, police, mental health professionals, mental health board, family advocates and government officials. See Appendix I for a complete listing of Task Force members.

Retired Supreme Court Justice Robert Utter was selected by Executive Sims to serve as the Chair of the Task Force. Sims cited his judicial experience, intellect, humanity and high level of credibility. Utter was a Washington State Supreme Court Justice for 24 years before retiring in 1995.

The first meeting of the MIO Task Force took place on September 24, 1997. Justice Utter opened the meeting with a statement that "the measure of a society is the manner in which it treats its less fortunate. And yet there are realities that every community must face when it seeks solutions to the challenges posed by the mentally ill and in particular, those who pose a danger to others and to public safety." He emphasized that the charge of the Task Force was not to find fault in the Dan Van Ho case, but to examine the systems in which the mentally ill offenders are processed and to examine current mentally ill offender laws. The Task Force formed two work groups to study the issues.

The Process work group was charged to explore current cross-system processes and identify procedural and/or communication gaps between Western State Hospital, judges, prosecutors and the King County Jail. They were also asked to make recommendations for strengthening information sharing procedures and improving collaboration. This group was chaired by Dr. Eric Trupin, Director, Department of Child Psychiatry at Children's Hospital and Medical Center.

The Legislative work group was charged with reviewing the criminal and civil statutes and discussing possible revisions to the Involuntary Treatment Act (RCW 71.05) and the Criminally Insane Statute (RCW 10.77). Washington State Senator and chair of the Human Services and Corrections Committee, Jeanine Long of Mill Creek chaired this work group. The challenge of the legislative work group was to find a delicate balance between civil rights of individuals and protecting public safety, while meeting this challenge in a fiscally prudent manner.

The two work groups took a very aggressive approach quickly but thoughtfully in identifying issues and, in some cases, developing recommendations. Barbara J. Gletne, Director of the King County Department of Community and Human Services, took responsibility for coordinating staff support to the Task Force with assistance from other county departments including the King County Prosecuting Attorney's office and the Departments of Adult Detention and Public Health.

II. Process Work Group Recommendations

Through a series of five meetings, the Process work group studied the flow of mentally ill defendants among and through organizations included in the criminal, civil and treatment systems. The work group referred to this collection of entities as the "Mentally Ill Offender (MIO) Network". Organizations in the definition of the MIO Network included:

• Police agencies
• Jails
• Municipal and District Courts
• Public Defenders
• Prosecutors
• Legal Offender Unit at Western State Hospital
• County Designated Mental Health Professionals (CDMHPs)
• Evaluation and Treatment Facilities, local psychiatric hospitals, and Western State Hospital
• Washington State Department of Corrections
• Mental Health outpatient providers

During the group discussions, four basic principles emerged. These principles were used as descriptions of the optimum model against which the current system was compared.

Principles of the Mentally Ill Offender Network

• Criminal, civil and treatment organizations must provide continuous and seamless services to ensure that mentally ill offenders receive dispositions appropriate to their situation.
• Communication among organizations in the "Mentally Ill Offender Network" must be direct, timely and concise.
• Defendants must be diverted or moved from the criminal system into the civil commitment or community treatment system in a way that protects the community and individual, and ensures ongoing treatment in an appropriate environment.
• Mental health specialists must provide treatment and disposition planning for the mentally ill defendant at the earliest possible opportunity.

The following recommendations resulted from the work group's comparison of existing to optimum movement and disposition of defendants within the MIO Network. These recommendations include alterations to current programs and protocols as well as the implementation of new programs.

Figure 1 depicts the recommendations, and the intended impact on an individual's movement through the MIO Network. It is overlaid on a basic flow diagram of the MIO Network. The numbers in the bold recommendation boxes on Figure 1 correspond to the numbered recommendations below.

Appendix II includes a basic description of the work teams to be involved in developing and implementing many of the recommendations as well as proposed milestone dates.

Summary of Recommendations

1. Establish a program that provides aggressive outreach to mentally ill individuals at large in the community. Expand on the model piloted by the King County Access Project (case management for homeless mentally ill) to engage mentally ill individuals "on the street."

   Intent: Identify and engage mentally ill individuals at large in the community whose behavior suggests that public or personal safety is increasingly at risk. Divert them to appropriate treatment options or civil commitment. Such a program would be a complement to current Mental Health Division efforts and the new Seattle Police Department program whereby 100 officers will be specially trained to work with individuals who are mentally ill and/or chemically addicted.

2. Create a "no refusal" triage center to serve individuals with mental illness and/or substance abuse emergencies.

   Intent: Provide a program that can be used by police officers as an alternative to jail booking for individuals who are mentally ill and/or chemically addicted and who may be charged with a misdemeanor. Immediate referral from the criminal justice system and placement in an appropriate treatment setting, including civil commitment as an option, will be the result. This program will also complement the Seattle Police Department Program noted above.

3. Review the application of "standards" used for 72 hour detention under RCW 71.05.

   Intent: Determine whether King County Designated Mental Health Professionals (CDMHPs) and King County Superior Court evidentiary "standards" for 72 hour detention are consistent with "standards" observed in other counties in Washington.

4. Perform misdemeanant competency and sanity evaluations locally.

   Intent: Increase the information available locally regarding mentally ill defendants, save time and effort involved in transit to and from Western State Hospital (transfer involves King County Adult Detention, King County Public Safety, Pierce County Sheriff, and Western State Hospital), and facilitate reduced bed space utilization through coordination with courts to schedule hearings promptly. This recommendation does not entail the transfer of defendants from other local jails in King County to the King County Jail for purposes of evaluation.

5. Create crisis outreach and service referral protocols to ensure responsiveness to district and municipal courts.

   Intent: Provide a direct linkage between judges in district and municipal courts and the CDMHPs who can act as brokers for the community treatment system and perform crisis intervention and civil commitment investigation/detention services. This will assist judges to achieve a disposition appropriate to community and individual safety for mentally ill misdemeanants who are ordered released from custody.

6. Pilot a Mental Health Court in King County.

   Intent: Focus mental illness specialists (judges, defenders, prosecutors as well as community resources) on the mentally ill misdemeanor defendant thereby greatly increasing coordinated management of mentally ill offenders.

7. Assign a liaison from the voluntary and involuntary treatment systems to the King County Jail.

   Intent: Promote efficient investigation of referrals for civil commitment and increase the likelihood of linking mentally ill inmates to an appropriate service provider prior to release from jail.

8. Redesign the King County Jail Alternative Services Program (JAS) to broaden eligibility and improve diversion capabilities by strengthening post release connections to the long term care system including residential options.

   Intent: Increase the capacity of this existing program to assist in the diversion of mentally ill individuals from the criminal justice system to the treatment system.

9. Develop a "no refusal" procedure to ensure that mentally ill defendants remain engaged, or become immediately re-engaged, or are authorized to receive service with an appropriate community service provider.

   Intent: The county, in concert with the treatment community, must enact procedures which greatly strengthen the critical linkage from the criminal justice system to the community treatment system. Individuals who are participants in the community treatment system must be followed into and through the criminal justice system to ensure that service appropriate to the individual's need is available at the time of release. For individuals who are not currently enrolled, eligibility screening and enrollment (for individuals who are eligible) must take place prior to release from jail.

10. Develop a discharge planning program for mentally ill individuals released from Washington State Department of Corrections (DOC) and Juvenile Rehabilitation Administration (JRA) facilities to ensure that they are engaged by community resources appropriate to their need including, but not limited to, mental health, financial aid and involuntary treatment screening.

    Intent: A significant number of individuals return to King County communities each month subsequent to release from DOC and JRA facilities. Many of these individuals are mentally ill and, due to the length of time spent in these state facilities, have no link to community treatment resources and other services necessary to ensure a functional community existence. Discharge planning work, similar to that currently performed for individuals scheduled to be released from Western State Hospital and similar to that suggested above for individuals scheduled to be released from the King County Jail, must be undertaken. At a minimum, services must include eligibility determination, assignment to a community provider (for eligible individuals), development of a case management plan (coordinated with probation staff), and referral for civil commitment investigation if necessary.

11. Improve the monitoring of Least Restrictive Alternative court orders (LRA) by community providers; ensure that providers follow clients through the entire period of the order. Develop a range of options to employ when less restrictive orders are violated including standards for revocation.

    Intent: Each individual placed on an LRA must be monitored by a community provider for the full length of the order. A range of options for action must be developed and employed for circumstances where the individual is found to be non-compliant with the LRA.

12. Revise the standard form of the competency evaluation court order to specify that Western State Hospital should provide the report required by RCW 10.77 directly to Jail Health staff as well as the court, prosecutor and defense.

    Intent: Increase the amount of information available to King County Jail Health staff to increase the likelihood that a mentally ill inmate returning to the Jail from Western State Hospital will receive services and community treatment or civil commitment referrals appropriate to their needs. Legislation may be offered in the 1998 session to require this transfer of information.

13. Develop continuing education curriculum and information resources to increase interested professionals' understanding of the Mentally Ill Offender Network. The Internet and electronic technology should be used whenever possible to provide ease of access to critical information

    Intent: Increase the knowledge base and access to current information in each segment of the MIO Network, thereby increasing the probability that mentally ill individuals will experience "seamless" transition among participating organizations.

III. Outcome of the Legislative Work Group

The bill draft and summary provided in this report are the result of several meetings of the legislative work group. Senator Jeanine Long, Chair of the group asked for comments from all task force members concerning possible revisions to RCW 71.05 and RCW 10.77. Senator Long emphasized that the goal of the group was to identify potential legislative initiatives which would help assure that mentally ill individuals who may be a danger to the community receive the treatment they need. She also emphasized that fiscal impact would be considered in proposing any new legislation.

Based on the input she received, bills were drafted and discussed by the work group. The recommendations were diverse. On one hand, some members asserted that no new legislation was required as current law was sufficient to address mentally ill offender issues. Some members wanted more sweeping changes than are outlined here.

The final draft bill is a combination of the civil commitment and criminal competency proposals which was prepared at the request of Senator Long. Numerous sections of the bill have been modified to address comments and concerns voiced at the work group meetings. The draft bill still contains some issues which will require additional work. The most notable unresolved issue concerns competency treatment for persons charged with a misdemeanant offense (Section 30). The legislative proposal was not voted on by the work group or the task force. It is a beginning point for discussion before and during the legislative session as issues surrounding the mentally ill who pose a potential danger to public safety are addressed.

The following is a section-by-section analysis of the legislative proposal. See Appendix III for a complete copy of the draft bill.

Section 1.
Overall statement of legislative intent. The bill is intended to focus on public safety, increased sharing of information, and provide additional opportunities for treatment of mentally ill offenders.

CIVIL COMMITMENT (RCW 71.05)
(Sections 2 - 19)

Section 2.
Update to the intent section.

Section 3.
The definition for "likelihood of serious harm" is expanded to include situations where an individual, who has a history of violent acts, makes threats to the physical safety of another.

Sections 4, 6, 16 & 17.
Technical changes are made.

Sections. 5, 11 & 12.
Focuses on whether the person poses a danger to public safety rather than whether his or her action constituted a felony offense.

Section 7.
Requires the county-designated mental health professional (CDMHP) to investigate whether to file a civil commitment petition for persons who were determined to be incompetent to stand trail and who have failed to regain their competence.

Sections 8 & 9.
Persons who are alleged to have a mental disorder and alleged to be gravely disabled are required to answer questions from the court. The inquiries must be related to the alleged mental disorder.

Section 10.
The court, when making a determination of whether a person poses a likelihood of serious harm, shall give "great weight" to the following evidence: (1) A recent history of violence; or (2) a recent history of one or more prior civil commitment orders, entered because the person posed a "likelihood of serious harm."

Section 13.
A person who is on a conditional release will have their condition reviewed on the basis of whether there has been a substantial decompensation and whether there is a reasonable [versus high] probability that the condition can be reversed by inpatient treatment.

A conditionally released person shall be taken into custody if: (1) They fail to adhere to treatment, or their condition decompensates; and (2) they present a likelihood of serious harm.

Section 14.
An involuntarily detained person has the right to refrain from testifying at any hearing regarding involuntary medication or electroconvulsant therapy.

Section 15.
A patient's consent is not necessary in order for a professional to communicate with, or provide records to, professional staff at a correctional facility where the patient is now confined.

Section 18.
The court shall enter findings when it does not grant a petition for civil commitment.

Section 19.
The Department of Social and Health Services (DSHS) shall develop state-wide protocols for use by CDMHPs. The protocols shall be updated at least every three years.

CRIMINAL COMPETENCY (RCW 10.77)
(Sections 20 - 41)

Sections. 18, 20,25, 31, 33, & 35.
Focuses on whether the person poses a danger to public safety rather than whether his or her action constituted a felony offense.

Sections 21 & 24.
Moves a substantive law out of the definitions and into Section 24. Provides definitions of "expert or professional person" and "violent act."

Sections 22 & 23.
Moves a language own section for purposes of clarity. Provides that when a person has not discharged from confinement, prior to the maximum possible period of confinement allowable under chapter 10.77 RCW, they shall be referred to a CDMHP.

Section 26.
Authorizes deferral of bail pending evaluations for sanity or competency. Provides standards for setting bail. Grants the department the authority to contract-out sanity or competency evaluations.

Section 27.
An orders committing a defendant for a sanity or competency evaluation shall be transmitted to the CDMHP located in the county where the defendant was charged.

Defendants who have been committed for sanity or competency evaluations, shall be referred for civil commitment evaluations if: (1) They have a history of one or more violent acts; (2) pose a threat to public safety; (3) have been previously acquitted by reason of insanity or diminished capacity; or (4) have been previously found incompetent under chapter 10.77 RCW.

CDMHP shall provide notice of evaluation results to specified persons.

Secs. 28, 29, 32, 34 & 38.
Technical corrections.

Section 30.
Criminal defendants who have been found incompetent to stand trial may be placed in a treatment facility for the purpose of gaining competency. This provision applies to defendants who: (1) Have been acquitted by reason of insanity or diminished capacity; (2) have a history or pending charge of one or more violent acts; or (3) have been previously found incompetent regarding a offense which caused harm to another.

Placement is limited to 30 days for non-felony charges.

Non-felony charges may be stayed or dismissed under specified circumstances. The court is required to provide notice of a hearing on the issue of a dismissal.

CDMHP shall provide notice of evaluation results to specified persons.

Section 36 & 37.
Relevant records and reports, as defined by the DSHS, shall be made available to law enforcement.

Section 39.
Relevant records and reports, as defined by the DSHS, shall accompany a defendant who is transferred to a mental health facility or correctional facility.

Section 40.
Outpatient mental health treatment providers shall be notified of their patient's release from a correctional facility. Records and reports shall be made available to the treatment provider upon request.

Section 41.
A defendant's criminal history shall identify acquittals by reason of insanity or diminished capacity and dismissals due to lack of competency.

Sections 42 & 46.
Code reviser directions.

Section 43.
Outdated sections are repealed.

Section 44.
Effective date: July 1, 1998.

Section 45.
Unspecified appropriation clause.

Section 47.
Severability clause.

IV. Conclusion

Justice Utter convened the final meeting of the Mentally Ill Offenders Task Force on November 11, 1997. The Task Force unanimously approved the Process work group recommendations as presented by Dr. Eric Trupin. Members were briefed on the draft proposed legislation. Senator Jeanine Long reemphasized that the proposed legislation will continue to be fine-tuned prior and during the next legislative session. Justice Utter thanked Task Force members and staff for their wisdom, time and tenacity to debate difficult issues that arose during the work group meetings while continuing to maintain a delicate balance of protecting the civil rights of individuals and protecting public safety.

Appendices
Appendix 1 (.pdf) - 5.71KB
Figure 1 (.pdf) - 33.75KB
Appendix 2 (.pdf) - 12.31KB
Appendix 3 (.pdf) - 114.63KB

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