12/11/2022
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The Spokesman-Review
Could WA follow NYC’s footsteps and force people into mental health treatment?
KREM
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The Spokesman-Review
Could WA follow NYC’s footsteps and force people into mental health treatment?
By Esmy Jimenez - SEATTLE TIMES
New York City Mayor Eric Adams unveiled a controversial policy last month to force people with severe mental illnesses off city streets and into hospitals. Already the Bazelon Center for Mental Health and other patients’ rights advocates are pushing back, worried the policy focuses more on reducing visible homelessness than helping people access mental health care.
The situation also hearkens to a long-standing dilemma in the mental health world: how to balance the right to refuse treatment with the social responsibility of cities to care for some of their most vulnerable residents – even when they decline care.
Here is where Washington state currently stands when it comes to treatment and what policies in New York could mean for Seattle and Washington state.
What does Washington’s current law say about committing people against their will?
Under Washington’s Involuntary Treatment Act, a person may only be involuntarily committed to care if a designated crisis responder, or DCR – a mental health professional with the specific role of determining whether someone should be committed – assesses them and finds them to be a threat to themselves, others or property, or if they are “gravely disabled.” That standard means the person with mental illness is not able to care for basic needs like sleeping, bathing or eating, and is getting worse.
Many families struggling to get loved ones into treatment complain that the bar is too high, and say they’re told nothing can be done if there’s not an immediate safety threat. DCRs in Washington are also often overextended and can’t respond quickly to calls from community members.
Other people, though, advocate fiercely for people’s right to have control over their own medical care and warn of a slippery slope toward warehousing people in psychiatric institutions.
“I have a lot of concerns about how we’re reaching quickly for commitment legislation,” said Laura Van Tosh, a local advocate and leader in patients’ rights, who also has a bipolar diagnosis.
She sees the recent moves as an effort to just get rid of visible homelessness.
“All of this has come with (a) different political flavor than care,” she said.
In 2018, Ricky’s Law went into effect, aimed at helping people with substance use disorders who meet a similar threshold to the one outlined under the Involuntary Treatment Act. Under Ricky’s Law, people are involuntarily taken to secure withdrawal management and stabilization facilities to detox, typically from alcohol, methamphetamines or opiates.
According to a report from the Washington Health Care Authority, 961 people received treatment through Ricky’s Law between October 2020 and September 2021.
What does the New York City law say? Has this been tried before?
New York City’s new policy is still playing out. While mental health advocates agree there’s a desperate need for improved access to mental health care, some point to research that finds forced treatment can be traumatizing and lead to worse outcomes for people with mental illnesses.
In many states, courts stipulate people must be in “imminent danger” as part of the threshold for commitment.
Mayor Adams is now citing a memo that was released by New York’s Office of Mental Health in February, stating law enforcement is able to detain people with severe mental illnesses and transport them to a psychiatric hospital “even when there is no recent dangerous act.”
The proposal is already being challenged in court: The New York Times reports that a civil rights law firm argues the mayor’s plan would lead to people being “forcefully – often violently – detained” by officers with “little to no expertise” in handling mental health crises.
New York City has made similar attempts before and met resistance. In 1987, Mayor Ed Koch announced a similar program to force people with severe mental illnesses into treatment, but advocates with the New York Civil Liberties Union stepped in and ultimately the policy was rescinded.
What other issues pose a challenge for this kind of effort?
If people are pulled off the street and detained, there needs to be a place for them to go to receive care. But there is a severe shortage of psychiatric beds for people in crisis around the country, especially for youth and people with dual diagnoses that include substance use or intellectual and developmental disorders. Washington is no exception in needing more psychiatric beds: In King County alone, there are 111 fewer residential mental health beds today than there were in 2018.
Workforce issues are a major factor: Even when there are beds, it’s difficult to staff them. The need for more mental health professionals spans all types of care, from therapy to inpatient.
The Kaiser Family Foundation estimates the U.S. needs an additional 7,800 psychiatrists to meet the current need, and the National Center for Health Workforce Analysis estimates that by 2030, the country will need about 12-15% more social workers, addiction counselors and psychiatric nurse practitioners to meet future demands.
What do Seattle and Washington state officials say about this move?
Could we see something like that here in Washington? It’s unlikely, at least in the near term.
Gov. Jay Inslee’s mental health efforts have been aimed at building up care options in the community, rather than expanding the state’s large psychiatric institutions. For example, while Western State Hospital is undergoing a major renovation project, the state is transitioning the facility to focus on serving people coming through the criminal court system. People who haven’t been accused of a crime but are committed involuntarily through the civil courts should go to community-based facilities instead, under the plan – though there are questions about how available those options will be.
Asked about the New York City proposal, Inslee’s office told The Seattle Times: “Involuntary commitment is a last resort – we need to put first things first in Washington. Our behavioral health and hospital systems are over capacity. Our priority must remain capacity-building.”
The governor’s office also said it would like to see more investment in wraparound services – aimed at not only helping people with mental health concerns but also providing social supports like housing or employment assistance – and community- based behavioral health, as well as more support for mental health workers. The governor’s office said Inslee’s upcoming budget proposal, to be announced next week, will prioritize behavioral health.
Seattle Mayor Bruce Harrell’s office told the Times, “Seattleites feel the impacts of our capacity constrained behavioral health system on the streets far too often.”
But to address those issues, he pointed instead to building out the local crisis care system: King County and Seattle-area officials recently proposed a tax levy to fund five walk-in crisis centers across the region if voters approve the measure come April. Those centers would serve people seeking care voluntarily.
“Our priorities include a focus on delivering care to those most in need, ensuring there are suitable places for people to go, and increasing treatment capacity,” Harrell’s office said in a statement. “We’re committed to advancing proven solutions like those proposed in the King County plan to invest in behavioral health.”
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KREM
After a fourth month of waiting, people are finally moving into the Catalyst Project on Sunset Boulevard. Most of them are coming from the I-90 homeless encampment.
SPOKANE, Wash. — After months of work and backlash, Catholic Charities' Catalyst Housing Project opened its doors this week.
Lead peer supporter for Jewels Helping Hands Sharyl Brown said she couldn't be more excited about the Sunset Boulevard Project.
"Feels so good. There's been a rollercoaster of emotions. There's still some bumps in the road, but they're working with us. So I feel like it's going to be successful as long as we work together," Brown said.
Brown said she refers people from the homeless encampment, who she knows will step up for the program.
One person who's moving in is Mikhail Kly. He said he's looking forward to a new start.
"I know I'm going to miss this place, but honestly, I'm just ready to have access to a shower and a warm bed," Kly said.
More people are expected to make the move in the coming weeks.
But Julie Garcia with Jewels Helping Hands said the recent warnings to clear the camp are hurting their work.
"It's actually impeding work that we're actually doing," Garcia said. "Every time they come, we have to stop what we're doing. Our day shuts down, everything shuts down."
The building is expected to house up to 100 people.
People who qualify for the Catalyst Housing Project will have a room to stay in and then get support to transition into permanent housing.
"It's just a safe place to go, it's warm. I'm going to use it as transition, try to get a job, stay working," Kly said.
Jewels Helping Hands hopes to fill up the Catalyst Housing Project within a month.
Jewels Helping Hands will move about four people into the Catalyst Housing Project every day, and they hope to increase that number once they become more familiar with the intake process.
Attorney General Bob Ferguson notified the court about law enforcement going to the camp unannounced and distributing flyers telling people the camp is closing.
SPOKANE, Wash. — Washington State Attorney General Bob Ferguson is weighing on the federal lawsuit that was filed against the City of Spokane and Spokane County over the homeless camp along I-90, commonly known as Camp Hope.
Jewels Helping Hands, several residents of the encampment and Disability Rights Washington filed the lawsuit in October. On Wednesday, the petitioners filed for an emergency temporary restraining order against the defendants. The request seeks to "prevent irreparable harm to plaintiffs and the exceptionally vulnerable residents of Camp Hope."
On Friday, Ferguson filed a statement of interest in the case to provide the Court with information “which WSDOT believes is germane to the Court’s consideration of the Plaintiffs’ request for a Temporary Restraining Order (TRO), and to respond to certain statements made within the briefing pending before the Court.”
In the statement, Ferguson provides the court with information about how the camp was started, shelter space in Spokane, and the legal action the city and county are taking against the Washington State Department of Transportation (WSDOT), which owns the land where the camp is located. He also touched on the state’s plans on getting campers off state property and into stable housing.
“Simply put, the Legislature has pivoted away from—when reasonably practicable—forceful sweeps in favor of holistic, longer-term solutions and services when addressing encampments on State-owned rights of way,” Ferguson said. “Although slower than the local jurisdictions’ preferred option of immediately closing/’sweeping’ the site, WSDOT and Commerce’s plan is consistent with this approach. In contrast, the undefined ‘plan’ at issue, in this case, to immediately remove people and property frustrates the Legislature’s goals and would likely result in scattering the unhoused into the streets and neighborhoods of Spokane.”
Ferguson said WSDOT’s decision not to take legal action to close the site “should not be constructed as, and is not, permission by WSDOT for the individuals living at and the property located at the site to remain, let alone indefinitely.”
Regarding the motion for the emergency temporary restraining order, Ferguson notified the court about law enforcement going to the camp unannounced and distributing flyers telling people the camp is closing.
“The law enforcement officers provided no specific date of closure, which was purportedly an intentional decision,” Ferguson wrote. “The visits were immediately decried as intimidation and a show of force by those at the site, and interrupted the efforts of service providers retained by the State to progress its transitional housing policy decisions (including those from The Catalyst Project finalizing paperwork for individuals scheduled to move there).”
In the motion for the restraining order, the plaintiffs ask for two forms of relief:
Maintaining the status quo by temporarily restraining the City and County from disbanding Camp Hope at its present location
Temporarily restraining Defendants from, absent a search warrant, conducting helicopter overflights and/or using infrared imaging or similar technology to surveil or record those located on Camp Hope
Ferguson writes WSDOT does not take issue with the second request for relief.
“WSDOT does not object to the general maintenance of the status quo pending the Court’s resolution of the motion for preliminary injunction scheduled for early January,” Ferguson wrote. “However, WSDOT respectfully requests the Court’s order explicitly provide that any Camp Hope individual on site may nonetheless be removed from WSDOT property for any violation of law or any provision of an agreement setting behavioral requirements. In short, WSDOT requests that any order issued by this Court be narrowly tailored and not hinder the work of WSDOT and its partner agencies (including local law enforcement as necessary)—in accordance with and as contemplated by Washington law—in implementing its mitigation plan to address encampments on State-owned rights of way.”
On Thursday evening, people who live at the camp gathered at Spokane City Hall to protest the presence of law enforcement on WSDOT property.
Spokane City Council President Breean Beggs also called for an executive, closed-door session with the city's legal team on Thursday. Beggs believes removing people without the state's permission could result in lawsuits against the county, city and even individual officers.
Another argument is that despite the Catalyst building opening this week and additional capacity being added to the Trent shelter, there still won't be enough shelter space for everyone at the camp.