Office of Forensic Mental Health Services

 

The Office of Forensic Mental Health Services is a division of the Department of Social and Health Services’ Behavioral Health Administration that was created in 2015 to oversee the state’s adult forensic mental health system. It has nine regional offices and three residential treatment facilities.

As part of DSHS’ Behavioral Health Administration, the OFMHS strives to transform forensic mental health throughout Washington state by partnering with communities and law enforcement in areas such as mental health resources in jails, competency restoration, diversion programs, and community resources to better support people living with mental illnesses who come into contact with the criminal court system.

The programs provide forensic services, defined broadly as the intersection of law and psychology. These services include competency evaluations, care and treatment for competency restoration, forensic navigator services, diversion work, and more.

Workforce development

OFMHS provides forensic workforce development and jail technical assistance programs. The mission of the forensic workforce development team

is to help develop sufficient availability of mental health professionals to provide an array of services in Washington’s communities, inpatient facilities, and law enforcement or correctional settings, including jails and prisons. The jail technical assistance program provides training and guidance manuals focused on best practices to assist jail staff in areas such as treatment planning, suicide prevention, and crisis de-escalation. These trainings may also have relevance for others working within the criminal court system. The jail technical assistance team will work to ensure that these other partners are aware of and have access to such trainings.

Trueblood v. DSHS

Much of the office’s efforts are aimed at coming into substantial compliance with orders in the Trueblood v. DSHS lawsuit, which focuses on ensuring jail-based competency evaluations and inpatient competency services occur in a timely manner. This includes the work of forensic evaluators, who evaluate Trueblood class members who are in jails, inpatient facilities, and the community, and report to the court on their findings.

Forensic navigators

As a result of a Trueblood settlement of contempt agreement, a new position in Washington was created. Forensic navigators began working with clients on July 1, 2020. These navigators have two main functions: 1) help divert forensically involved clients out of jails and inpatient treatment settings and into community-based treatment settings, and 2) provide a variety of roles and functions to those who are ordered into outpatient competency restoration.

For more information about the DSHS Office of Forensic Mental Health Services, click here

 

Best Practices for Behavioral Health Services in Jail Settings Telehealth Implementation Guidebook Washington Forensic Competency Evaluation Report Guidelines
image of two people sitting Health Guidebook forensic guide competency

 

What We Do

Diversion

We work in collaboration with the Governor’s office, state agencies, community partners, and stakeholders to lead and implement robust diversion efforts which to prevent citizens with mental illness from unnecessarily entering or further penetrating the criminal justice system. We have a vested interest in the protection of defendant rights, the efficient delivery of necessary behavioral health services, and public safety. We focus on diversion initiatives around four goals:

  1. Preventing individuals with behavioral health issues from recidivism and frequent involvement in the criminal justice system;

  2. Reducing the demand for competency services;

  3. Reducing long-term incarceration for individuals with behavioral health issues; and

  4. Serving defendants in the least restrictive environment possible.

Currently, OFMHS is managing three prosecutorial diversion contracts for fiscal year a2018 in King, Spokane, and the Greater Columbia regions. The purpose of these programs are to divert individuals from the criminal justice system through prosecutorial diversion and receive services in the community.

Furthermore, members of our team serve on the panel to create, review, and provide input on Request for Proposals related to the use of any money collected as a result of being in contempt with the Federal District Court’s order(s) in providing additional diversion services for potential and current Trueblood et al v. DSHS class members.

Triage

The Triage Consultation and Expedited Admissions (TCEA) process is a mechanism by which a defendant who is in custody could be admitted to the hospital more quickly if it is determined they require additional psychiatric intervention. Effective April 1, 2018, jails, prosecutors, or assigned defense attorneys may request a Triage Consultation for any inmate on a court order awaiting forensic services from the State Hospital if they believe they require additional psychiatric intervention because they are currently at serious risk of harm to self or related to:

  • Psychotic symptoms compromising immediate health and safety; and/or

  • Active suicidal intent, actions or serious self-injury – as differentiated from suicidal ideation without intent or self-harm not resulting in serious injury

Additional information

 

Competency Evaluations

Washington State law requires that a defendant be mentally competent to stand trial. In following the Dusky Standard definition (adopted by Washington), the defendant must have a rational and factual understanding of the charges and the penalties associated with the charges against them. They must be able to meaningfully assist their attorney in their own defense. When competence is questioned, the court may order a competency evaluation. Our office perform these specialized competency evaluations both in jails, the communities, as well as at the state hospitals and residential treatment facilities.

 

Community competency evaluations—evaluations conducted in the community, not by DSHS evaluators, may be ordered by courts and are reimbursed by DSHS, per WAC 388-875-0040.  The rates of reimbursement are set out, as determined fair and reasonable by the Secretary, in a fee schedule that will be reviewed by OFMHS at least annually, and adjusted at the discretion of OFMHS.  Please refer questions regarding the procedure for billing DSHS for reimbursement to Rusty Horton at rusty.horton@dshs.wa.gov.

Competency Restoration Treatment

After a competency evaluation is completed and the individual is found not competent to stand trial, the court may order the person into competency restoration treatment. DSHS provides competency restoration treatment at Western State Hospital, Eastern State Hospital, and two Residential Treatment Facilities located in Yakima and Thurston counties.

 

Not Guilty by Reason of Insanity (NGRI) Assessment and Treatment

A defendant is found Not Guilty by Reason of Insanity (NGRI) when the court finds a person is unable to assist in their own defense due to their mental state at the time of the alleged offense. Meaning, the defendant was either not able to perceive the nature and quality of the act with or not able to tell right from wrong with reference to the particular act in which they are charged. Persons found NGRI are typically individuals who were experiencing severe symptoms of mental illness at the time of the offense, gravely impairing their capacity to perceive reality or think coherently. For example, the defendant might describe suffering from delusions or hallucinations that directly led them to commit the alleged crime. If the court finds the individual NGRI, then the individual is remanded to the custody of DSHS and typically the Department of Corrections. Once in DSHS custody, the individual is likely to be admitted to an NGRI treatment ward at either Western State Hospital or Eastern State Hospital.

In 2010, a series of new state laws added restrictions to the release process for NGRI patients. The new laws generally required the NGRI patients to obtain a court order to leave the hospital, including for family visits or taking a walk off of hospital grounds, even if doctors recommend this for treatment and recovery. These laws also created the Public Safety Review Panel—an advisory panel composed of a psychiatrist, a psychologist, a prosecutor, a law enforcement representative, a consumer and family advocate representative, and a public defender. This panel provides an additional layer of review before NGRI patients are permitted to leave the secure areas of the state psychiatric hospitals.

Because the changes in the law delayed the treatment and recovery process, plaintiffs brought the lawsuit—now referred as the Ross Settlement—in an effort to ensure timely clinical decision-making while respecting the safety of patients and the public. As a result of the Ross settlement both state psychiatric hospitals have either updated or created new policies that address the following nine areas:

  • Individualized treatment plans

  • Grounds privileges

  • Release processes

  • Restraints used only when clinically indicated

  • Patients’ role in treatment and release planning

  • Personal property

  • Strip searches prohibited without a doctor’s order

  • Prohibition of staff retaliation

A level system using a dynamic risk-based measure will be used as part of the on-going treatment planning process to increase patient privileges as they make progress or, conversely, reduce privileges due to negative behaviors and follow through with treatment.

Quality Improvement

The OFMHS Quality Team conducts quality reviews of forensic services that fulfill statutory obligations under RCW 10.77.280. The quality reviews focus on best practices and inform improvements to the quality of forensic mental health services within the state of Washington. Quality reviews include the review of forensic evaluation and treatment services. These forensic services are provided throughout the state including the Washington State Psychiatric Hospitals and the licensed Residential Treatment Facilities that provide competency restoration services.

Workforce Development and Training

Essential for an effective forensic mental health care system is a well-trained, competent, and quality-focused workforce. The OFMHS develops, implements and oversees a statewide, systematic and comprehensive forensic mental health services workforce development program, to include competency evaluation, competency restoration, forensic risk assessment and NGRI treatment. In addition to training the workforce, the OFMHS recognizes the value of training the broader community regarding forensic mental health services and processes. Training is also provided to the courts, attorneys, legislative staff, and other involved stakeholders.