Sue Lani Madsen: As jails overcrowd, more behavioral health treatment needed

When a defense attorney raises a question of a client’s competence to stand trial, it kicks in a process set up to protect the rights of the accused as well as safety of the public. When the victim of an attempted rape in Seattle’s Capitol Hill neighborhood was told the man who assaulted her might be released into the community because he was incompetent to stand trial, the system showed its incompetence and she was victimized again.

The bar for competence is pretty low, according to a conversation with Deb Conklin, candidate for Spokane County prosecutor. “The assumption for a finding of incompetence is that they are completely unable to assist their attorney,” Conklin said. The accused may have a mental health diagnosis or be psychotic, but are competent as long as they have “a lucid moment to talk to their attorney.”

In the case of Qyreek Singletary, charged in the Capitol Hill assault, there is no dispute over the basic facts. The victim was on the phone with her father as she retrieved a package and Singletary pushed his way into her apartment. Dad called 911. Singletary was caught in the act of assault, prepared to bind and gag the victim. Planned and almost carried out. Open and shut criminal case.

And yet the system seems unable to handle it.

“You can have the best system in the world and if the people implementing it don’t handle it responsibly, it doesn’t matter if you have the best system in the world,” Conklin said.

Current Spokane County Prosecutor and candidate Larry Haskell agreed the bar is low for competence, but “until the court-ordered evaluation is completed, the prosecution can’t do anything on the criminal side – not agree to a plea deal or anything else.” The Washington state Department of Social and Health Services is not competently keeping up with demand. “As the state population increases they are not opening any new facilities and existing facilities are understaffed. If we had more facilities we could get evaluations done quickly,” Haskell said.

Former Spokane County Prosecutor Don Brockett was blunt. “The grand experiment hasn’t worked,” said Brockett, referring to the deinstitutionalizing of mental health care. He referred to the impact of “One Flew Over the Cuckoo’s Nest” - a widely read novel made into an Academy Award-winning film - as part of the push to close awful institutions, but “instead of improving the institutions we closed them and dumped all the mentally ill people out on the streets in 1973. And lack of funding is not a partisan problem, there’s no will to act.”

Conklin agreed on the funding issue. “The promise was we’d close down these large expensive institutions and then no one – not Republicans or Democrats or anyone has ever funded the community mental health system adequately, and now jails are the largest mental health institutions in the country.”

It’s not just initial evaluations that are affected. There’s a need for institutions both for therapeutic restoration to competence to stand trial and for long-term civil commitment. “The Legislature needs to take a look at this, even the defense is interested,” Haskell said. “Adjusting the statutory scheme and increasing facilities would go a long way to solving the problems.”

Brockett said there are 12 to 15 defendants currently in the Spokane County Jail and 105 in Yakima, Tri-Cities and elsewhere waiting for evaluation at Eastern State Hospital. “West Side prosecutors might be dismissing minor cases, not even bothering to get in line” for a spot at beleaguered Western State Hospital.

There must be ramifications for bad behavior, even for someone living with a mental illness. One might be arrest and being ordered to treatment. But that doesn’t work if there is no treatment space. Brockett described the dilemma of a father seeking advice about a mentally ill daughter arrested on a violent charge - in her father’s evaluation a threat to herself and others. She had been in jail for two months with a projected five to six month wait for a competency evaluation so the case could proceed. If she was released on bond, she would be lower priority for evaluation and treatment and it might be as long as two years. Meanwhile, jail limbo is not a therapeutic environment and her condition is likely to deteriorate.

DSHS’s website assurances that more behavioral treatment in the community will reduce the demand for inpatient facilities is a false hope. We do need more community-based treatment, but also need inpatient institutions that aren’t county jails.

Brockett hopes to make a push for Gov. Jay Inslee to put mental health on the front burner. “There’s a lot of other causes out there but taking care of our own people when they’re mentally ill doesn’t count that much,” Brockett said. “It’s terrible to decide which is a priority but I would pick these people over global warming or anything else. Tap into emergency funds and put it into the budget to build more institutions.”

Meanwhile, the state of Washington could face more than $100 million in fines for inadequate facilities.

The state needs more space both for those who meet the high bar for civil commitment and those who seek it voluntarily. As an EMT, it’s heartbreaking to respond to someone who is lucid enough to know they need to be hospitalized and realize all they may get out of their call for help is “catch and release” from the ER. And in the case of Singletary, his victim would like the assurance of knowing he isn’t going to hurt anyone else. Ever.

Contact Sue Lani Madsen at rulingpen@gmail.com.