Wash. bill seeks cap for sending people to state psychiatric hospitals

When a person is charged with a crime but found too mentally ill to participate in their defense, Washington state must offer them temporary treatment.

The process, known as "competency restoration," usually includes medication and basic education about the charges against them. The person is then sent back to jail and eventually goes to court.

The state is constitutionally required to offer these services. But in recent years, competency restoration has morphed from part of the court process to the main way people with serious mental illness get treatment, straining the mental health system.

People sat in overwhelmed county jails for months waiting for a spot at the state hospital for these short-term services. The backlog led to a lawsuit requiring the state to admit these patients quickly. Washington's failure to do so resulted in hundreds of millions of dollars in fines.

As the state has finally made progress and begun admitting people on time, a lawmaker is proposing a bill to help the state keep its momentum.

Rep. Darya Farivar, D-Seattle, wants to limit the number of competency restoration patients each county could send to state hospitals, and fine cities and counties that exceed those numbers.

The goal, she said, is to encourage local authorities to rely more on community mental health services, instead of waiting until a person's behavioral health issues escalate to the point they're charged with a crime.

"The legislation before you asks cities and counties to think carefully about who they're sending to competency restoration, and asks them not to buy into the myth that by sending folks into the system they'll get care," Farivar said in her bill's first hearing.

Reactions to House Bill 1218 are mixed, highlighting the tension between counties and the state over who is responsible for criminal defendants who need mental health treatment.

Representatives for city and county associations are concerned they would have to shoulder the financial responsibility for decisions outside their control. Derek Young, the interim director of the Washington Association of Counties, noted county leaders are not the ones deciding who needs competency restoration.

"Prosecutors and judges are separately elected," he said. "They're the ones making those decisions."

Others worry that limiting the number of people who can get competency restoration care will keep people from one of the few entry points to getting mental health treatment.

Supporters of the bill say competency restoration does not provide patients with anything more than immediate stabilization. To really help people, they say, the state and counties should focus on diverting patients away from the criminal system and into community-based treatment and housing programs.

"We owe it to the people who are suffering," Farivar said, "the people caught in this never-ending cycle."

HB 1218 would limit the number of patients each county can send to the state's two psychiatric hospitals — Western State in Lakewood and the much smaller Eastern State in Medical Lake — for competency restoration.

Starting in 2026, each county would have a cap, set by averaging the county's number of restoration orders from the previous two years. If a county exceeds its cap, it will be fined and the money would go to a newly created fund that would pay for diversion programs, such as housing assistance.

In the first year after the cap goes into effect, counties with more than two patients over the limit would pay a portion of bed costs for each new patient. If they exceed more than 10 patients over the limit, they would assume all costs for that patient's stay. Fines would continue to increase in subsequent years.

According to the state, it costs $1,637 a day to house a patient at the state hospital.

Data from Disability Rights Washington shows in 2023, more than 1,300 people were found to need restoration. In 2024, that number rose to more than 1,800.

Farivar said while the state is anticipating opening 350 beds at a new state hospital building in 2028, those will barely cover projected increases in patients who need this type of treatment.

"According to our projections, we'll only have 90 beds to spare," Farivar said. "In about four years, we're likely to run out of beds again and be out of compliance with the judge's orders."

Representatives for Washington's cities and counties said they want to see more diversion services. But they worried the proposed bill would financially strain them, as well as denying people the services they need.

"Our concern is that it will create an artificial cap, not really addressing the problem," said Candice Bock, the director of government relations for the Association of Washington Cities. "Then you get into the awkwardness of administering the cap, who's going to get beds first, and pitting cities and counties against one another."

Kim Mosolf, a lawyer who helped craft the bill, said the proposal doesn't deny people treatment. Instead, she said, it redirects them to more effective services.

Treating the competency restoration process as the standard path for mental health care does nothing to help competency restoration patients or their victims, Mosolf argued. Competency restoration patients have high rates of recidivism, she said, and usually are arrested multiple times.

"We shouldn't accept that this is the main door," Mosolf said. "The assumption that people access treatment through arrest, prosecution and competency restoration is factually inaccurate."

Mosolf said that instead, the state and local jurisdictions should be investing in diversion services.

A program in Spokane that has been providing permanent supportive housing to Trueblood class members has seen large decreases in recidivism, Mosolf said. The patients at that housing facility saw a 43% decrease in contact with crisis services. Patients had a 73% drop in new criminal charges. And there was an 89% decrease in new competency evaluation orders.

"This is what works," Mosolf said. "Housing, low-barrier services."

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