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News / Health / Health Wire

WA paid $100 million over mental health delays. Here’s where it’s going

Much of the funding has gone to housing and organizations that help keep people with mental illnesses from cycling back through jails

By Jayati Ramakrishnan, The Seattle Times
Published: June 24, 2024, 8:35am

SEATTLE — Up to $100 million could soon be poured into building housing for patients recently released from Washington’s state psychiatric hospitals, with the hope that increasing housing supply will stop patients from returning to the criminal justice system.

The funds will come from a round of fines that a federal judge imposed on the state Department of Social and Health Services in 2023, after the agency failed to comply with a court order to quickly evaluate and treat patients who were waiting for a spot at one of the state’s psychiatric hospitals.

The state is now approaching compliance with the federal lawsuit that prompted the fines. But as it does, it’s banking on a swath of new permanent supportive housing — long-term housing paired with on-site staffing and services like ongoing mental health care — to keep people with mental illnesses from cycling back through jails and the state hospital.

The court is seeking applications from local mental health and housing organizations, and plans to distribute up to $100 million in grant funding this year. Applications are due June 24, and the court will award funds by September, according to the Washington State Health Care Authority.

“It just became very clear that the thing missing was big capital projects to increase housing capacity,” said Kim Mosolf, the class counsel in the court case.

The organizations that are awarded funding this year could use it for a variety of housing options: building new units, buying existing ones or paying for global leasing — contracting with landlords to rent out a block of units, which behavioral health clients can then get into without screening or application fees.

The state has been fined tens of millions over the past eight years for its failure to follow the court order, known as the “Trueblood” settlement, which requires it follow a strict timeline for evaluating and treating patients who’ve been charged with crimes but found mentally unfit to stand trial.

The court has distributed four rounds of funding since 2016, mostly to local organizations trying to keep patients from being charged with crimes again. The first three rounds went mostly to programs such as prosecutorial diversion, which diverts a person who has just entered the courts system into social services instead; a co-responder program, which sends mental health workers out to scenes with law enforcement to try to de-escalate, and rental subsidies.

In the fourth round, distributed last year, $22 million was available for housing projects.

At $100 million, this new round of funding is the largest infusion of funds, and marks the most significant investment so far toward long-term housing for patients.

Tom Kinlen, the forensic services director for the Department of Health and Social Services, said initially, the priority was just getting people out of the cycle of jail and the state hospital. The amount of money being distributed at the time, he said, may not have gone very far toward building new housing.

“I don’t know that there was actually a prohibition on it, but that wasn’t what we focused on,” Kinlen said. “Priority No. 1 was, how can we use money on a diversion process.”

Some housing and related services have already come on line: Using funds from the last round of grants, Frontier Behavioral Health in Spokane built a new 24-unit facility that houses only Trueblood patients.

And King County used some of the money, about $9 million, to help fund services for residents in its “Health through Housing” program, which builds housing for people experiencing chronic homelessness. The funds go toward providing medical, behavioral health and counseling services for the 687 residents in the program, including about 55 Trueblood class members, said Katie Rogers, the King County Department of Community and Human Services chief of staff.

While most of the money collected under the settlement has gone toward larger programs, it also created a mechanism for the state to make payouts to individual patients who were held in jail too long while waiting for services.

At the height of delays in late 2022, 490 people were stuck in jail for an average of more than three months while waiting for a spot at Western State Hospital so their court case could move forward — sometimes, languishing in jail for longer than their sentence would be if they pleaded guilty to the crime.

Ultimately, only a handful of people have been eligible to receive money directly.

In 2022, the state paid out more than $145,000 to nine patients who had waited in jail for mental health services intended to help them defend themselves in court. (The state has not finished paying out two of the patients yet).

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The payments ranged from $1,250 to $37,500, and were paid either to patients themselves or to Superior Court clerks on behalf of the patients. Most of the funds didn’t have restrictions, although one was earmarked for the patient’s housing and mental health support.

Though the state has invested money connected to the Trueblood case into a variety of different programs, a lack of long-term housing has made it hard for officials to continue tracking and working with the patients discharged from the state hospitals.

For example, a contempt of court settlement in 2020 resulted in a set of programs that connect recently released patients to services like medical care, behavioral health treatment and rental assistance.

But while the state has had relative success in getting patients into those services — more than a thousand patients were enrolled in the housing program between 2020 and 2023, and more than 600 enrolled in the case management program — it’s struggled to keep track of many of them.

Data maintained by the state shows that the most common reason patients are discharged from the program is “loss of contact.”

Because patients don’t have long-term or stable housing situations, they’re often very “transitory,” and may move elsewhere for services without informing staff members — making it difficult to keep track of them, said Nicole Mims, the Health Care Authority’s section manager for diversion and re-entry services.

“Because the nature of our program is temporary, we have housing options for people but they’re time-limited,” Mims said.

“We’re trying to connect all the folks in our program to mainstream behavioral health, mental health and substance use treatment, mainstream benefits, even. It’s a challenge to keep folks engaged sometimes.”

Mosolf said it’s too early to say if the housing programs funded by state fines are directly responsible for reducing the “churn” of patients through the system.

But she said the patients living in those units are seeing fewer interactions with police, and less frequent referral back to the criminal justice system.

“The literature on permanent supportive housing is really clear,” she said. “It’s the thing experts agree is most effective for people with serious behavioral complications.”