Trueblood et al v. Washington State DSHS

Washington is in the midst of a mental health crisis. The demand for all forms of mental health services far outweighs what is available including competency evaluation and restoration services.

In response to the increase in demand, the Washington Department of Social and Health Services is working to grow capacity so people who experience mental illness and await competency evaluations and restoration services while incarcerated receive them in a timely manner and in an appropriate setting.

To the extent that forensic services lag, the delay is often due to factors outside the department’s control, including dramatic increases in overall referrals for competency restoration services. Over the past seven fiscal years, inpatient evaluations and competency restoration services have increased 87 percent. Further, there was a 25 percent increase in inpatient referrals in the course of a single fiscal year, from 2015 to 2016, and another 33 percent increase from fiscal year 2016 to 2017. The table below provides a number of referrals statewide and the annual percentage change from fiscal year 2013 through fiscal year 2022.

Fiscal Year chart


The chart below demonstrates the increase in referrals the department has experienced at the same time it has been adding both evaluator and bed capacity. This increase in referrals exceeds any historical peak, and greatly exceeds the previously calculated 5-8 percent expected annual rise in referrals prior to 2012.

Court Orders

The Trueblood v. DSHS lawsuit filed in 2014 challenged unconstitutional delays in competency evaluation and restoration services for people detained in jails. Generally, if a court believes a mental disability may prevent a defendant from assisting in their own defense, the criminal case is put on hold while an evaluation is completed to determine the defendant’s competency. If the defendant is found competent, they are returned to stand trial. If the person is deemed not competent, the court can order the defendant to receive services to restore competency. 

The state is ordered to provide competency evaluations within 14 days and competency restoration services within seven days of court orders and is fined by the court when those deadlines are not met. The state worked with Disability Rights Washington to develop a Contempt Settlement Agreement, which establishes a plan for providing services to persons involved in the criminal court system and for providing treatment so they are less likely to become involved in the criminal court system. This agreement is not a settlement of the Trueblood case itself, but an opportunity for DSHS to cure itself of its contempt status in federal court.

While most of the legal oversight of programs related to Trueblood comes from the Contempt Settlement Agreement, legislation also guides these programs. The court defines Trueblood class members as “all persons who are now or will be in the future, charged with a crime in the state of Washington and:

(a) who are ordered by a court to receive competency evaluation or restoration services through DSHS;

(b) who are waiting in jail for those services; and

(c) for whom DSHS receives the court order.”

Trueblood Implementation

The percentage of timely competency evaluations can be significantly increased if fewer people with mental illness enter the criminal court system. When people get the treatment they need when they need it, they are more likely to avoid becoming entwined in the criminal court system. They are also less likely to place strains on the civil inpatient system. The Contempt Settlement Agreement supports improved access to appropriate behavioral health services that are designed to dramatically reduce the number of people entering the criminal court system — enabling the state to meet the constitutional competency evaluation and restoration services timelines.

The implementation work began with the 2018 passage Substitute Senate Bill 5444. When this became law, it authorized the creation of the Forensic Navigator Program and Outpatient Competency Restoration Program. In addition to the creation of these programs, there are many others including multiple programs within the crisis system, the addition of 90 forensic beds, and the publication of the “Best Practices for Behavioral Health Services in Jail Settings” guidebook and associated trainings.

In addition to the improved services for class members as a result of implementation efforts made by DSHS, the Washington State Health Care Authority, and the Criminal Justice Training Commission, more than $100 million in contempt fines have been held in abeyance by the court as of June 30, 2021.

The Trueblood Contempt Settlement Agreement includes the following plan for phasing in programs and services:

  • Pierce, Southwest and Spokane regions (July 1, 2019-June 30, 2021)
  • King region (July 1, 2021-30, 2023)
  • Thurston, Mason, and Salish regions (July 1, 2023-June 30, 2025)


Work is underway by DSHS, the Washington State Health Care Authority, and the Criminal Justice Training Commission to ensure a smooth implementation of Trueblood-required programs in King County, which is the focus of Phase 2. Trueblood-required programs are recommended to be implemented in Thurston, Mason, and the Salish Region (Kitsap, Jefferson, and Clallam counties) as part of Phase 3.

For more information about implementation, or to be added to the Trueblood listserv to receive updates and information, email