Mental Health Crisis and Commitment ServicesKing County Crisis and Commitment Services (KC CCS) is a part of the Mental Health, Chemical Abuse and Dependency Services Division of the King County Department of Community and Human Services. Its duties include evaluating people with mental disorders for possible involuntary detention in psychiatric facilities according to the mental illness law in the State of Washington. This is RCW 71.05 for adults and RCW 71.34 for youths 13 through 17 years of age. KC CCS staff who perform these duties are all County Designated Mental Health Professionals (CDMHPs) under this law. In addition, CDMHPs are responsible for all initial crisis outreach services for unenrolled persons in King County. The services of KC CCS are available 24 hours a day. Most often it is the family and others close to the person with psychiatric problems who first notice the changes that indicate of the need for professional help. One early warning sign can be a change in sleep patterns. The person with problems might wake up many times during the night, sleep a lot during the day, or seem to sleep hardly at all. Some people seem to withdraw, stop seeing their friends and lose interest in their appearance. Often the person is unable to function in school or at work. You might notice that your family member talks about things that don't make sense to you or laughs or mumbles to her/himself. Sometimes his/her speech is very fast and the person seems to jump from one subject to another. Frequently the person who is experiencing severe psychiatric disturbances has beliefs that others are after him/her or plotting against him/her; s/he might believe that his/her mind is being controlled by an outside force or that someone is putting thoughts into his/her mind. It is important to keep in mind that this kind of experience is often extremely frightening and painful. It is common for the person to express fear and pain through anger and suspicion towards those closest to him/her. It is, therefore, important that the family try to focus on his/her feelings rather than on angry behavior; and the person might respond to their suggestion that he/she get professional help, either on an outpatient basis or in the hospital. Frequently, however, the mentally disturbed person cannot accept the need for help. You should then contact the Crisis Clinic at (206) 461-3222. This is the centralized access point for all telephone crisis services in King County, including for children (For more information specific to youth and families in crisis, see below). A trained Crisis Clinic volunteer worker who is supervised by a professional person will gather information from you about the person's recent behavior, previous problems and treatment, and assess how acute the situation is. If the situation needs an immediate outreach, your case will be referred to KC CCS. The CDMHP on duty will then contact you and arrange to see the person as soon as possible. (If the person is able and willing to go to an agency for a walk-in or scheduled appointment, your case will be referred to the nearest agency.) When the outreach team sees your family member, they will evaluate his/her mental condition and the need for treatment. They may discuss the possibility of hospitalization. Every effort will be made to arrange for outpatient treatment, short-term crisis stabilization, or voluntary hospitalization. These are always the first choices. If the person refuses all voluntary help, s/he may be appropriate for involuntary treatment: if s/he has threatened harm towards others or her/himself; or s/he has substantially damaged someone else's property; or s/he is endangered because s/he is not caring for his/her basic needs such as eating, sleeping, clothing and shelter due to his/her mental disorder; or s/he shows severe deterioration in functioning ability and is not receiving essential care. It is important to remember that a mental disorder alone is not sufficient to justify an involuntary detention. There also needs to be evidence that the individual is a danger to self, others, or the property of others, or is gravely disabled under the definition of the law before an individual may be sent to an involuntary treatment facility against his/her will. If it appears that involuntary detention is necessary, the CDMHP evaluating the person will take a written statement, called a declaration, from the person who has witnessed first hand the behavior providing evidence for detention. It is important to understand that this document is a certified statement of facts and that the person who gives the statement is agreeing to testify in court under oath, at a commitment hearing. If the person evaluated is appropriate for involuntary treatment, one of the following will happen:
A member of the immediate family will be verbally advised and/or given or mailed a notice of detention, and the team will arrange for involuntary hospitalization at a local treatment facility or, very rarely, at Western State Hospital. The team will arrange for transportation from the person's location to the hospital after he/she has been involuntarily detained. People can be sent for involuntary treatment only to certified Evaluation and Treatment Facilities: Harborview Medical Center, West Seattle Psychiatric Hospital, Northwest Hospital Geropsychiatric Unit, and Fairfax Hospital (mainly juveniles). The inpatient care is for an initial period of 72 hours. If the facility staff decide that further inpatient care is necessary, they must petition the court and the commitment hearing will take place. At the court hearing the patient is present with either his/her private attorney or an appointed attorney. The County prosecuting attorney represents the facility. A Superior Court Commissioner or Judge presides, hears the evidence presented by witnesses, and makes the decision. S/He may do one of the following:
Sometimes the mentally ill person needs more time in the facility or in outpatient treatment after the 14-day period and continues to refuse this on a voluntary basis. It may then be possible to file a petition for 90 days of court-ordered treatment. For each additional commitment period another court hearing is required. The court has to be persuaded each time that the person still needs involuntary treatment and meets the legal criteria. This is to protect the patient from inappropriate commitment. The main purpose of inpatient care for psychiatric patients is to provide safety for the person and others, as well as to evaluate and treat the acute symptoms of the person's mental disorder. The involuntary treatment law is intended to provide short-term care. Control of the acute symptoms is at this time best accomplished with medication and a structured environment. The family can be expected to be involved in the treatment, when that is appropriate, by attending family conferences. A major task for the facility staff is to make proper discharge plans; they should be expected to facilitate alternative living situations and follow-up care. The educational needs of the family and the mentally ill person regarding his/her particular disorder and what to expect in the future must also be addressed. Therapists should teach them how to best manage the disorder, minimizing the need for frequent rehospitalization, and maximizing the person's functioning in the community. The Crisis Clinic serves as the entry point to crisis services for children, in addition to adults - ensuring a single, countywide, integrated and comprehensive system of crisis response for residents of all ages. The Young Men's Christian Association (YMCA) of Greater Seattle provides the 24-hour mobile outreach, stabilization beds and services, and linkages to community supports needed by youth and families in crisis. The Children's Crisis Outreach Response System focuses on safely and quickly containing the crisis, and developing an individualized service plan maximizing the involvement of the child and family. Contact Information: King County Crisis & Commitment Services |
Updated: July 7, 2007
