Our facilities include adult inpatient psychiatric facilities, an inpatient children’s psychiatric hospital, and a center for civilly committed sex offenders. In addition, our Office of Forensic Mental Health Services is responsible for managing Washington’s adult forensic mental health care system, which provides competency evaluation and restoration services. Forensic mental health services and competency restoration are for adults in the criminal court system.
The Child Study and Treatment Center is Washington's state psychiatric hospital for children and youth up to age 18. The center engages families and community teams to provide psychiatric treatment and educational services, and to plan for these young clients’ successful return to their home community.
Eastern and Western state hospitals, Olympic Heritage Behavioral Health, and the Behavioral Health and Treatment Centers provide evaluations, competency restoration and inpatient psychiatric treatment for adults with serious or long-term mental illness. These facilities deliver evidence-based and effective inpatient treatment programs, interventions and activities that promote patient and resident recovery. Our therapeutic approach is designed to empower patients and residents, instilling hope, support, self-discovery and independence.
The Special Commitment Center provides specialized mental health treatment for civilly committed sex offenders who have completed their prison sentences. Superior Courts in the county in which a person was previously convicted of a sex crime have the authority to determine if they meet the legal definition of a sexually violent predator and to civilly commit them to the SCC.
Our patients
Our adult inpatient facilities care for patients who are civilly or forensically committed. Civil patients are considered at imminent risk to themselves or others, or gravely disabled due to a mental illness.
Our civil patients include people who are civilly committed in the community and require ongoing involuntary treatment or converted from a forensic to a civil order, and habilitative mental health patients who live with both a developmental disability and a mental illness. Forensic patients enter our facilities through the criminal court system, and include patients in our competency program and in our not guilty by reason of insanity program.
- Civil Commitment Patients
A patient is civilly committed when the court agrees with a county-designated mental health professional’s clinical assessment that a person is an imminent risk to themselves or others, or they are deemed gravely disabled due to a mental illness. The criteria for civil commitment is based on at least one of these three factors. Washington state RCW 71.05 provides the legal framework for civilly committed patients in our state.
A civilly committed patient is typically held 72 hours for observation. If they continue to meet the criteria for involuntary commitment, they will remain under a commitment order for another two weeks. The court reviews our providers' recommendations to determine the patient's status.
If the court finds the patient is still a potential threat to others or themselves, the court has the authority to order involuntary treatment for 90 to 180 days for a treatment team to work with the patient to help them improve their mental health with the goal of discharging them safely back into the community.
Civil conversion patients
Civil conversion patients are people who have undergone competency restoration and were found not competent to stand trial for their criminal charges. At the time that the criminal charges are dismissed, a judge may order the person to undergo a civil commitment evaluation to determine if they meet the criteria for 90 or 180 days of involuntary treatment.
Habilitative mental health patients
habilitative mental health patients live with developmental/intellectual disabilities and mental health conditions, and have specialized treatment needs that could not be adequately addressed or supported in a community setting.
Special finding of violent felony patients
A small number of people receiving civil commitment treatment have been civilly committed following a finding that they are not competent to stand trial on a felony offense classified as violent under RCW 9.94A.030. These individuals may be subject to additional civil commitment criteria pursuant to RCW 71.05.280.
For this population, the court has determined that a behavioral health condition or developmental disability was a contributing factor to conduct associated with the criminal charge. Their civil commitment may be extended if there is evidence that the person continues to experience a behavioral health condition or developmental disability that creates a substantial likelihood of engaging in similar acts.
Before a person under this commitment is discharged to the community, the proposed discharge plan must be reviewed by the Public Safety Review Panel. The panel is an independent advisory panel that evaluates potential public safety considerations and provides written recommendations to DSHS secretary and the court. The panel's review helps inform decision-making regarding community transition planning and appropriate support for the person.
Discharge process for civil patients
Discharge planning begins upon admission and continues throughout a person’s treatment. The clinical treatment team works collaboratively with each person to assess their strengths, preferences, goals, and support needs, and to identify the services and resources that will best support a successful transition to community living. Discharge planning may include coordination with family and natural supports, managed care organizations, DSHS programs, housing providers, and community behavioral health agencies. Key focus areas include securing appropriate housing, connecting people to ongoing behavioral health and medical services, establishing health care and public benefits, and addressing other factors that support long-term stability and recovery.
When the clinical treatment team determines that a person no longer requires inpatient psychiatric treatment and can be safely served in a less restrictive setting, plans are finalized to support their transition to the community. In some cases, a person may be discharged under a conditional release, which requires compliance with court-ordered outpatient treatment conditions for the remainder of the commitment period. Courts may also order ongoing treatment and support in the community through a less restrictive order for up to one year.
- Forensic Patients - Competency Restoration
To have a fair trial, a person charged with a crime must understand nature of the legal proceedings, including the charges against them, and be able to assist their attorney in their own defense. If it appears that the person has a mental health condition that causes either or both abilities to be lacking, a judge may order a competency evaluation to inform the court about the person’s abilities to stand trial.
By law, those we serve have a constitutional right to participate in their defense. BHHA helps patients achieve competency to stand trial that meets the state law.
If an evaluator’s opinion is that a person lacks the capacity to be competent to stand trial, and the court agrees with the assessment, the court orders the person to either inpatient competency restoration in our facilities (such as the Gage Center of Forensic Excellence at Western State Hospital, Behavioral Health and Treatment Center - Steilacoom Unit or Eastern State Hospital) or outpatient competency restoration in state-contracted programs.
Patients’ restoration periods vary depending on their type of charges. If, after a restoration period, an evaluator determines that the patient still does not understand the nature of the charges against them – or cannot competently participate in their defense – another restoration period is initiated (per RCW 10.77.645).
Up to three consecutive restoration periods can be initiated to assist patients in restoring their competency. In Washington state, the maximum restoration period is up to one year for a Class A Felony. Our goal is to restore patient competency as soon as possible.
Discharge process for competency restoration patients
Patients who are restored to competency return to jail to continue with their court proceedings.
For patients who are unable to reach restorative status within the maximum restoration period, the court may find the patients incompetent and dismiss the criminal charges (RCW 10.77.405). The court may order a civil commitment evaluation or release the person into the community. Under the Involuntary Treatment Act, patients remain at our state hospitals as civil patients if they are determined to still pose a substantial danger to themselves and/or others (RCW 71.05.230).
- Forensic Patients - Not Guilty by Reason of Insanity
A person is found not guilty by reason of insanity and acquitted of the charge(s) against them when the court determines they were not able to tell right from wrong due to their mental state at the time of the offense.
These types of forensic patients typically experienced severe symptoms of mental illness at the time of the offense, which gravely impaired their capacity to perceive reality or think clearly.
For example, they might describe experiencing delusions or hallucinations that directly led them to commit the offense. If the court finds the person NGRI, the person is committed to the custody of DSHS and is usually admitted to a DSHS facility that provides treatment to those found NGRI, including Eastern State Hospital, Western State Hospital, or Maple Lane Campus – Columbia Unit or Cascade Unit. Length of inpatient commitment varies, depending on progress toward mitigating risk factors to ensure safe return to community living.
Conditional release and unconditional release processes for NGRI patients
While inpatient, review processes and a court order for conditional release that imposes specific conditions are needed in order for NGRI patients to have certain community access, specifically: unescorted grounds privileges, staff-escorted community outings, and unescorted community outings – day and overnight. For patients to be released from an inpatient NGRI program to live in the community, review processes are conducted, and a court must issue a conditional release order imposing specific conditions. Common conditions include minimum requirements for a place of residence, participating in outpatient behavioral health treatment, undergoing substance use assessments and following recommended treatment. By law, conditional release to community living requires a transition team which includes a DSHS representative who also serves as a care coordinator, a Department of Corrections representative who is a specially trained community corrections officer, and a behavioral health agency representative, unless otherwise ordered by the court.
A person acquitted NGRI may be granted an unconditional release following a review process and a court granting an order for unconditional release after determining that they no longer require DSHS and court oversight in order to remain safe in the community.
One of the required reviews for inpatient conditional release for community access privileges, conditional release to community living and unconditional release is with 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. Panel members are appointed by the governor, and their review provides an additional layer of review for consideration of greater community access for NGRI patients.
In making decisions about whether to grant court orders for inpatient conditional release for community access privileges, conditional release to community living or unconditional release, courts may consider input from the Public Safety Review Panel, defense attorneys, prosecuting attorneys, the Behavioral Health and Habilitation Administration, and other sources.
- Office of the Patient Rights Ombuds
What is the Ombuds Office?
The ombuds monitors and works to ensure compliance of the Behavioral Health and Habilitation Administration with relevant statutes, rules and policies regarding the civil rights of patients at the Behavioral Health and Treatment Centers, Child Study and Treatment Center, Eastern State Hospital, Olympic Heritage Behavioral Health, Special Commitment Center and Western State Hospital. The ombuds investigates complaints related to patients' rights and conducts independent, neutral reviews of program conformance with internal policies as they relate to patient rights. The ombuds also identifies systemic issues and makes recommendations for change or improvement.
What is the difference between the Ombuds Office and patient advocates?
The Ombuds Office is an independent and impartial reviewer of incidences and policy compliance working to ensure the protection of patient civil rights. The ombuds does not have oversight from the hospital, but rather reports to DSHS Office of the Secretary. The patient advocate is a hospital employee who works with patients to address day-to-day concerns and to ensure the patients have the most comfortable stay possible.
How do I contact the Ombuds Office?
Please note that our Ombuds only serve Washington state psychiatric patients at the Behavioral Health and Treatment Centers, Child Study and Treatment Center, Eastern State Hospital, Olympic Heritage Behavioral Health, Special Commitment Center, and Western State Hospital. If you need an ombuds for a different hospital, please contact that hospital for assistance.
You may send your written request to Ombuds Office at ombuds@dshs.wa.gov.
Contacts:
- General and CSTC: Darrin Hall, Darrin.hall@dshs.wa.gov, 253-691-5293
- ESH: Dawn Leach, dawn.leach2@dshs.wa.gov, 360-706-3904
- BHTCs (Maple Lane campus and Steilacoom Unit) and SCC: Caitlin Robertson, caitlin.robertson@dshs.wa.gov, 253-625-3983
- WSH Gage Center for Forensic Excellence, OHBH: Michelle Frasu, michelle.frasu@dshs.wa.gov, 360-819-0867
- WSH Civil Center of Excellence: Natalie Paris, Natalie.paris2@dshs.wa.gov, 360-515-6579