AB v DSHS (Trueblood): Reforming Washington’s Forensic Mental Health System
Table of Contents:
A. History and background  of A.B. by and through Trueblood et. al. v Washington State D.S.H.S., No. 15–35462 (“Trueblood”).
B. 2018 Settlement Agreement 
D. Case Documents 
E. Press 
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) 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 and imposed tens 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.
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 August of 2018 which received final approval by the Court on December 11, 2018 . 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, and any additional phases may include improvements to Phases One and Two, 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.
The State of Washington has paid many millions of dollars in fines for failing to comply with the Court’s Orders in Trueblood. In 2016, the Court ordered this money be used to fund programs that keep class members out of jail, creating a Trueblood Diversion Workgroup comprised of Plaintiff and Defendant counsel, representatives from DSHS, the Court Monitor Danna Mauch PhD, and an additional expert to assist Dr. Mauch.
This Workgroup has since identified and funded service providers from around the state who are working to divert people with mental illness and other disabilities from the criminal system. Since late 2016, the Trueblood Diversion Workgroup has released three separate Requests for Proposal and now funds multiple projects statewide.
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
The Trueblood diversion grant program is separate and apart from the settlement agreement approved by the Court in December of 2018.
- August 18, 2020 – Trueblood Quarterly Implementation Status Report [PDF] 
- June 27, 2019 – Trueblood Implementation Plan [PDF] 
- December 11, 2018 – Order Approving Trueblood Settlement Agreement [PDF] 
- October 25, 2018 – Proposed Comprehensive Settlement Agreement of the Contempt Order [PDF] 
- October 19, 2017 – Order re Plaintiffs’ Second Motion for Civil Contempt – 506 [PDF] 
- August 15, 2016 – Order Modifying Permanent Injunction [PDF] 
- July 7, 2016 – Order of Civil Contempt [PDF] 
- February 8, 2016 – Order Modifying Permanent Injunction [PDF] 
- April 2, 2015 – Court Order Determining Remedy and Wait Time [PDF] 
- September 12, 2014 – Second amended complaint – 24 [PDF] 
The Olympian: With $50M in fines piled up over help for mentally ill, the state is seeking a settlement
The News Tribune: With $50M in fines piled up over help for mentally ill, the state is seeking a settlement 
The News Tribune: Contempt order and more fines for agency slow to provide mental-health evaluations
The Seattle Times: Judge hold Washington state mental-health agency in contempt, orders fines
The Spokesman-Review: Judge holds Washington state mental health agency in contempt, orders fines
The Spokesman-Review: Federal judge scolds state for treatment of mentally ill
TDN Op-Ed: Friday Free Form – State Fines Growing
The Lewiston Tribune: State accrues $7.5M in contempt fines
The Bellingham Herald: State accrues almost $7.5 million in contempt fines
Seattle PI: State pays thousands in fines as jailed patients wait in limbo
The Spokesman-Review: Judge gives Washington mental hospitals more time to fix programs
KOMO News: Federal Judge gives state time to help inmates with mental illness
The Spokesman-Review: State seeks clarity on ruling about holding
Wall Street Journal: Mental Health treatment for defendants dogged by delays
AP: Judge: Washington must fix problem with jailing mentally ill
The Seattle Times Editorial: DSHS should be mitigating, not litigating, mental health problems
The Seattle Times: Federal trial to tackle state’s mental competency waitlists
Reuters: Washington judge hears testimony over long jail holds for mentally ill
NPR: Mentally ill languish in Washington jails; Federal trial set to begin 
The Spokesman-Review: Eastern State Hospital sanctioned over delayed mental health evaluations
The Oregonian: Judge says Washington wrong to jail mentally ill awaiting competency hearing
The Seattle Times Editorial: Defending the “indefensible” in the mental-health system
The Seattle Times Editorial: Escaping the mental-health abyss
WSH RN.net: Trueblood v. DSHS