Press Release

For Immediate Release
December 14, 2021

Contact: Alexandra Deas
(206) 324-1521 x117

Disability Rights Washington’s (DRW) newest report examines the gaps in Washington’s behavioral health treatment and crisis response systems, and the systemic failures in the involuntary civil commitment system that has resulted in the increased use of harmful Single Bed Certifications (“SBCs” ) and No Bed Reports (“NBRs”). The report, titled ALL OR NOTHING Ending Washington’s Dependence On Involuntary Civil Commitment, sheds light on the state’s over-reliance on involuntary civil commitment via Washington’s Involuntary Treatment Act (“ITA.”), which is the most expensive and restrictive form of behavioral health treatment available. Since that system is Washington’s only well-resourced way of providing care to people in behavioral health crisis, it has become strained beyond capacity. Ironically, those patients with the most complex or pressing need for treatment are often denied care by that very system.

Disability Rights Washington monitors facilities that provide involuntary, inpatient behavioral health care and facilities that provide care via SBC. DRW drew upon this knowledge and experience for this report, but also obtained and reviewed state records related to administering the ITA, including contracts and correspondence between the Health Care Authority and Managed Care Organizations/ Behavioral Health Administrative Services Organizations. In addition, DRW conducted individual investigations of patients receiving treatment via a SBC by interviewing these patients, observing their care firsthand, and reviewing their clinical records.

Disability Rights Washington recently investigated the experience of Christopher*, an individual with both a psychiatric diagnosis and developmental disability who was held on an emergency ITA basis. Christopher had been in several different state-run institutional settings for the past few years. Most recently, he was detained under the ITA at a local hospital but then released to a homeless shelter without additional safety planning. At the shelter, Christopher was almost immediately assaulted and had his belongings stolen. This led to him again being held on an emergency ITA basis, but in a different hospital. While at this second hospital, he was repeatedly put in restraints. The state contacted a total of 14 facilities statewide trying to secure Christopher a licensed inpatient treatment bed or, alternatively, a SBC placement. All of the facilities declined to admit Christopher. Five of them declined him solely and specifically due to his diagnosis of developmental disability. One indicated they “ruled out for IQ under 70.”


  • Washington does not have adequate behavioral health treatment and crisis response systems.
  • The Involuntary Treatment Act system often fails those most vulnerable and in need.
  • Single Bed Certifications and No Bed Reports are harmful and lack oversight.

Disability Rights Washington’s ALL OR NOTHING report provides clear, sensible action steps Washington can take to deliver the right care at the right time.


  • Washington must build robust community-based behavioral health treatment and crisis response systems to prevent and mitigate crisis and reduce reliance on the ITA system. In 2021’s HB 1477, the legislature acknowledged an intent to fund this system.
  • The state must effectively target existing bed capacity to those most vulnerable and in-need, not build more costly inpatient beds. Currently, licensed inpatient behavioral health treatment facilities are not obligated to treat people or even to provide an explanation as to their refusal to admit.
  • The state must provide oversight, accountability, and a path to end SBCs and NBRs. We have seen significant increase in the use of both SBCs and NBRs, neither of which are intended to be long-term, permanent responses to behavioral health treatment needs. The state does not provide any meaningful oversight of SBCs and NBRs and does not have a clear plan to halt their use.

Read the full report here.

*In the interest of protecting this person’s privacy, Christopher is not his real name.