Program
The Gage Center of Forensic Excellence serves patients committed to the hospital under Revised Code of Washington Law (RCW) 10.77. These include defendants undergoing an inpatient evaluation for competency to stand trial and/or mental state at the time of the criminal offense. GCFE also provides competency restoration services and treatment to patients found not guilty by reason of insanity. The NGRI Community Program serves patients who are ready for or have already received a conditional release order by the court. Additionally, Community Program staff provide treatment and case management services to several NGRI clients living in the community after being conditionally released.
GCFE is a highly secure environment with procedures unique to that center. All patients in GCFE participate in daily active psychiatric treatment, which is ordered by a physician and individualized to patients’ particular treatment needs and reasons for admission. Group treatments, competency restoration classes, and recreational activities are offered in the Treatment and Recovery Center.
Benefits and outcomes
The goal of GCFE, like the rest of the hospital, is to promote recovery and well-being in partnership with the people we serve. However, GCFE does provide forensic evaluations to defendants who may or may not end up requiring mental health treatment. Each patient works closely with a multidisciplinary treatment team that includes staff from psychiatry, pharmacy, psychology, nursing, rehabilitation, and social Work. For GCFE patients undergoing a forensic evaluation or competency evaluation, an additional team member includes a forensic evaluator (usually psychologist or psychiatrist) who provides a formal report to the court upon completion of the patient’s evaluation or competency restoration treatment.
NGRI patients seeking conditional release or unconditional release are reviewed by the GCFE Risk Review Board. The RRB’s recommendations are sent to the Public Safety Review Panel as an initial DSHS recommendation for their review. The PSRP is an independent reviewing body that makes recommendations to DSHS and to court regarding conditional release and unconditional release. The BHHA assistant secretary reviews GCFE’s and PSRP’s recommendations to render a recommendation to the court as DSHS secretary’s designee. A judge makes the final decision as to whether and under what conditions NGRI patients may access the grounds without staff escort, go on community outings with or without staff escort, or reside in the community.
Current efforts
GCFE staff participate in the hospital’s Quality Improvement Process and are constantly striving to better meet the needs of the patients served in this center. Many GCFE patients have significant criminal and violence histories. Although the primary focus is on patient recovery, GCFE strives constantly to improve its security and safety. Ongoing improvement projects include increasing physical plant security, improving treatment planning, offering therapeutic interventions which are based on best psychiatric practices, and increasing active treatment.
Treatment and therapy
The GCFE Treatment and Recovery Center offers a wide range of group treatments, many of which are evidenced-based practices, such as cognitive behavioral therapy. Additionally, the TRC offers group therapy to increase leisure skills, vocational opportunities, and help patients better manage mental illness symptoms. Each NGRI client has a primary therapist who works one-to-one with them to lessen the risk of re-offending.
GCFE patients progress through a privilege system which offers them greater responsibility. (Unless conditionally released by a judge, GCFE patients do not leave the Gage Center unsupervised by staff.) As they advance in the GCFE privilege system, they are able to earn increased opportunities to have more personal items and greater court-approved, unsupervised walks on the WSH campus.
Community partnerships
Patients whose medical needs require additional care beyond the hospital are served in local medical hospitals and clinics. Western State Hospital works closely with the local courts and the criminal court system to provide forensic evaluations throughout Western Washington. Community Program staff also work with behavioral health service providers in every region to ensure GCFE patients receive adequate outpatient treatments and housing upon discharge.
Other information
GCFE has unique rules for a forensic setting. These include, but are not limited to, specific visitation hours and procedures, mail limitations, and restrictions on personal items allowed in the secure forensic building. Families can call and speak with their loved one’s primary therapist and/or other treatment staff if they have questions.