David D. Luxton

The number of people with mental illness waiting for competency restoration treatment in Washington state is the highest it’s ever been.

According to the Washington State Department of Social and Health Services data, there were 2,397 orders for inpatient evaluation and treatment services for people waiting in Washington jails this year, a 37% increase from the year before. The latest data show that waiting time in jail for inpatient treatment at Western State Hospital or Eastern State Hospital now exceeds two to three months on average.

While the uptick is partly due to service disruptions during the COVID-19 pandemic, it should not be an excuse for this ongoing crisis. A multiyear trend line on the jail waiting time data reveals a consistent upward trajectory regardless of the pandemic.

The contempt fines from the Trueblood et al. v. Washington State DSHS class-action lawsuit have also soared. State records show if the total amount of fines currently held in abeyance had to be paid today, they would total an estimated $300 million, according to an Oct. 19 news story by KING5 reporter Susannah Frame.

In a 2017 Seattle Times op-ed before the Trueblood settlement, I wrote that throwing money at costly buildings to increase hospital bed capacity would not solve the crisis. While the state’s investment in additional hospital capacity, diversion programs and services such as community and peer support are helpful, this crisis will worsen and grow increasingly expensive unless the upstream problems that contribute to untreated mental illness and criminal behavior are also addressed. Some of these problems result from misguided policies that can be remedied.

Misguided policies

Easy access to drugs and governmental complacency with use in our communities exacerbates the crisis at hand. The percentage of justice-involved persons who use illicit drugs, such as fentanyl, has been steadily increasing. Substance use can trigger and worsen psychiatric illnesses and is associated with crime. We must stop the influx of fentanyl and other illicit drugs across our nation’s borders and into Washington communities, enforce laws, and make treatment and recovery services more accessible.

De-investment in law enforcement and lax arrests and prosecution for misdemeanor crimes in Washington state has undoubtedly contributed to crime and caused harm to our communities, including persons with mental illness. Reduced police presence enables criminal behavior and makes our communities less safe. Investment in our police officers and jail staff, including training on de-escalating and managing interactions with people in psychiatric crisis, is a much wiser policy.

Enabling homelessness

Another problem is the policies that enable homelessness rather than address it. Homelessness worsens psychiatric conditions and substance use, and increases the risk for trauma and physical or sexual abuse. With food, housing and energy costs on a historic rise, as well as the looming economic turmoil ahead for Washington state, we should expect the problem of homelessness and joblessness to worsen. Construction of affordable housing and creation of jobs here in Washington rather than overseas should be a long-term goal. Moreover, moving homeless persons from one jurisdiction to another is not an adequate or moral solution.

Washington was one of six states with a pandemic-related “vaccinate or terminate” mandate for state workers. According to the state Office of Financial Management data, hundreds of Washington state employees in health care and social service positions who served during the pandemic were purged from the workforce. There’s already a workforce shortage, and the state will need more staff to fill the jobs at its new competency restoration treatment facilities in the years ahead. The public health data does not justify the current mandate for state employees and exacerbates the mental health crisis in Washington. Again, an example of a bad policy.

This crisis has multiple contributing factors and is without easy solutions. We can do better, however, by exposing and correcting bad policies at all governmental levels. Persons with mental illness and all Washingtonians deserve better.