WA paid $100 million for mental health delays. That’s where you’re going

Up to $100 million could soon be poured into housing for patients recently released from Washington state psychiatric hospitals, in hopes that increasing the housing supply will stop patients from returning to the criminal justice system.

The funds will come from a round of fines that a federal judge imposed on the state’s Department of Health and Human Services in 2023 after the agency failed to comply with a court order to quickly assess and treat patients waiting for a place in one. of state psychiatric hospitals.

The state is now moving closer to complying with the federal lawsuit that triggered the fines. But as it happens, it’s relying on a range of new permanent supportive housing — long-term housing with on-site staff and services like ongoing mental health care — to keep people with mental illness from returning home. bike through state prisons and hospitals.

The court is seeking applications from local mental health and housing organizations and plans to award up to $100 million in grant funds this year. Applications are due June 24, and the court will award funds by September, according to the Washington State Health Care Authority.

“It just became very clear that what was missing was major capital projects to increase housing capacity,” said Kim Mosolf, class counsel in the lawsuit.

Organizations receiving funding this year can use it for a variety of housing options: building new units, buying existing ones or paying for global rent – contracting with landlords to rent out a block of units in which health clients of behavior can come in afterwards. no review or application fees.

The state has been fined tens of millions over the past eight years for its failure to follow the court order, known as the “Trueblood” settlement, which requires it to follow a strict timeline for evaluating and treating patients who are charged with crimes but found mentally unfit to stand trial.

The court has distributed four rounds of funding since 2016, mostly to local organizations trying to prevent patients from being charged with crimes again. The first three rounds went mostly to programs such as prosecutorial diversion, which diverts a person who has just entered the court system to social services; a collaborative response program, which sends mental health workers to scenes with law enforcement to try to de-escalate and rent subsidies.

In the fourth round, distributed last year, $22 million was available for housing projects.

At $100 million, this new funding round is the largest infusion of funds and marks the most significant investment to date in long-term patient housing.

Tom Kinlen, director of forensic services for the Department of Health and Human Services, said initially, the priority was simply to get people out of the state prison and hospital cycle. The amount of money being distributed at the time, he said, may not have gone very far toward building new housing.

“I don’t know that there was actually a ban on it, but that wasn’t what we focused on,” Kinlen said. “Priority no. 1 was, how can we use the money in a diversionary process.”

Some housing and related services have already come online: Using funds from the latest grant round, Frontier Behavioral Health in Spokane built a new 24-unit facility that houses only Trueblood patients.

And King County used some of the money, about $9 million, to help fund services for residents in its Health Through Housing program, which builds housing for people experiencing chronic homelessness. The funds go toward providing health, behavioral and counseling services to the 687 residents in the program, including about 55 members of the Trueblood class, said Katie Rogers, chief of staff for the King County Department of Community and Human Services.

While most of the money raised under the deal has gone to larger programs, it also created a mechanism for the state to make payments to individual patients who were held in jail too long while waiting for services.

At the peak of the delays in late 2022, 490 people were stuck in jail for an average of more than three months as they waited for a place at Western State Hospital so their court case could go ahead – sometimes, serving more time in prison than their sentence would have been if they pleaded guilty to the crime.

After all, only a small fraction of people were eligible to receive money directly.

In 2022, the state paid more than $145,000 to nine patients who had been waiting in jail for mental health services intended to help them defend themselves in court. (The state has not yet finished paying two of the patients).

The payments ranged from $1,250 to $37,500 and were paid either to the patients themselves or to Supreme Court clerks on behalf of the patients. Most funds were uncapped, although one was earmarked for inpatient housing and mental health support.

Although the state has invested money related to the Trueblood case into a number of different programs, the lack of long-term housing has made it difficult for officials to continue to follow up and work with patients discharged from state hospitals.

For example, a 2020 court settlement override resulted in a variety of programs that connect recently released patients with services such as medical care, behavioral health treatment, and rental assistance.

But while the state has had relative success getting patients into those services — more than a thousand patients enrolled in the housing program between 2020 and 2023, and more than 600 enrolled in the case management program — it’s difficult to keep track of many of them.

State-maintained records show that the most common reason patients are discharged from the program is “loss of contact.”

Because patients don’t have long-term or stable housing situations, they are often very “transient” and can move elsewhere for services without notifying staff members — making it difficult to monitor them, said Nicole Mims, health care. Manager of the Authority’s diversion and re-entry services section.

“Because the nature of our program is temporary, we do have housing options for people, but they are limited in time,” Mims said.

“We’re trying to connect all the people in our program to behavioral health, mental health and substance use treatment, mainstream benefits, even. It’s a challenge to keep people engaged sometimes.”

Mosolf said it’s too early to say whether housing programs funded by state fines are directly responsible for reducing the “churn” of patients through the system.

But she said patients living in those units are seeing fewer interactions with police and fewer frequent referrals to the criminal justice system.

“The literature on permanent supportive housing is really clear,” she said. “It’s the thing that experts agree is most effective for people with serious behavioral complications.”