AB v DSHS (Trueblood): Reforming Washington’s Forensic Mental Health System

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Background and History of Case

All people charged with a crime have the constitutional right to assist in their own defense. If a court believes a mental disability may prevent someone from assisting in their own defense, the court puts the criminal case on hold while an evaluation is completed to determine the person’s competency and whether they need treatment to restore competency. The Washington State Department of Social and Health Services (“DSHS” or “State”) has the obligation under state law to provide these competency evaluation and restoration services.

Each year, thousands of people with disabilities, especially mental illness, sit for weeks and even months in jails across the state waiting for competency evaluation and restoration services. Their time in jail is often spent in solitary confinement with very limited or no mental health treatment, which often leads to deterioration in the person’s mental health. Some people spend more time in jail awaiting competency evaluation and restoration services than they would have if convicted of the crime and sentenced to jail time. This problem affects people charged with serious crimes and those charged with nonviolent misdemeanors.

A.B. by and through Trueblood et. al. v Washington State DSHS, No. 15–35462 (often referred to simply as Trueblood) is a class action lawsuit that enforces a person’s constitutional right to timely competency evaluation and restoration services. Class members are all people waiting in jail for court-ordered competency evaluation and restoration services.

After a trial in 2015, the U.S. District Court ruled that DSHS was violating class members’ constitutional rights and ordered DSHS to offer competency evaluation and restoration services within seven or fourteen days. The Court has since found DSHS in contempt three separate times and imposed hundreds of millions of dollars in monetary sanctions based on DSHS’s ongoing failure to comply with the Court’s Orders. Class members continue to wait for weeks and months in jail, often experiencing needless harm and suffering.

Monthly data and report on DSHS’s compliance with the Court’s Orders can be found on the State’s Trueblood website here.

2018 Settlement Agreement

Since 2015, Washington State has failed to follow the Federal Court Order in the Trueblood case. This Order requires the State to move individuals facing criminal charges out of jail and into treatment facilities within seven or fourteen days when they are eligible for competency evaluation and restoration services. Demand for these services continues to rise and people with serious mental illness continue to suffer and decompensate as they sit in jail waiting for help.

In January 2018, the parties in Trueblood decided to work together to find creative solutions to this problem. The parties spent several months talking to stakeholders all over the state, including class members and their advocates, about their experiences with Washington’s mental health care system. We heard from many people about the challenges in this system and ways that we can better meet those challenges. A summary of stakeholder input can be found in a report issued in May of 2018.

Parties in the case reached a settlement agreement of the contempt order in late 2018, approved by the court. The agreement improves the competency evaluation and restoration services system, but also emphasizes arrest diversion and community-based supports for people with mental illness. The agreement requires the State to make changes in five substantive areas: competency evaluations; competency restoration services; crisis triage and diversion support; education and training; and workforce development.

The changes described in the agreement will roll-out in phases in different regions of the state that correlate with the Managed Care Organization (MCO) and Administrative Service Organization (ASO) regions. Phase One, 2019-2021, includes Pierce, Spokane, and Southwest Washington regions. Phase Two, 2021-2023, includes the King County Region. Phase Three, 2023-2025, includes Thurston, Mason, Kitsap, Jefferson, and Clallam counties. Any additional phases may include improvements to programs in existing regions, or the addition of other regions. The agreement also creates a system to monitor what the State is doing and to make sure the changes are working. If the State is not achieving the goals set out in the agreement, Plaintiffs may go back to the Court to seek additional fines and Orders.

Read the party’s Implementation Plan for Phase One of the settlement agreement.

Read the party’s Implementation Plan for Phase Two of the settlement agreement.

Read the party’s Implementation Plan for Phase Three of the settlement agreement.

2023 Breach of Settlement Agreement and Further Contempt

In late 2022, Plaintiffs filed a motion seeking a finding of material breach of the 2018 settlement agreement and additional contempt against the State. The basis of this motion was the State’s dedication of inpatient competency/restoration beds to long term civil commitment patients instead of Trueblood class members.

After a week-long hearing in June of 2023, the Court found the State had breached a portion of the 2018 settlement agreement and made an additional finding of contempt against the State. The Court ordered DSHS to transfer long term civil commitment patients out of competency/restoration beds and ordered the State to pay an additional $100 million in contempt fines, among other things. Read the Court’s July 2023 Order here, and its August 2023 modification of this Order here.

Diversion Funding for Service Providers

Since 2016, the State of Washington has paid many millions of dollars in contempt fines for failing to comply with the Court’s Orders in Trueblood. The Court ordered this money be used to fund programs that serve class members, focusing on treatment and housing instead of arrest and incarceration. The Court created a Trueblood Diversion Workgroup – comprised of Plaintiff and Defendant counsel, representatives from DSHS, the Court Monitor Danna Mauch PhD, and additional experts to assist Dr. Mauch – to oversee selection and performance of these programs.

This Workgroup has since identified and funded service providers from around the state who are working to divert current and former Trueblood class members from the criminal system. Since late 2016, the Trueblood Diversion Workgroup has released four separate Requests for Proposal and has funded 18 projects statewide.

On November 8, 2023, the Trueblood Diversion Workgroup released a new solicitation for letters of interest available here, from providers who currently or recently have: 1) operated housing for people with significant behavioral health conditions, or 2) operated programs specifically targeted to Trueblood Class Members. For additional background and context, the 2021 Phase IV Request for Proposals is available here.

Phase I, operational July 1, 2017:

Comprehensive Mental Health Services
Great Rivers Behavioral Health Organization
King County
Kitsap Mental Health Services
Sunrise Services

Phase II, operational March 1, 2018:

Catholic Charities
Pierce County
Thurston-Mason Behavioral Health Organization

Phase III, operational July 1, 2018:

Comprehensive Mental Health Services
Frontier Behavioral Health
Lourdes Health Services
King County/LEAD/DESC/CHMHA
Pierce County

Phase IV, operational July 1, 2021:

Columbia River Mental Health Services
Frontier Behavioral Health
King County
Lifeline Connections
Olympic Health and Recovery Services

The Trueblood diversion grant program is separate and apart from the programs outlined in the 2018 settlement agreement. Trueblood diversion grant programs are funded by the contempt fines paid to the Court by the State; the grant programs are overseen by the Court and its experts. The funding for settlement agreement programs is provided through the state budget process and administered by state agencies.