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Record number of defendants with mental illness 'decompensating' in Washington jails

More people than ever before with mental illness are waiting in Washington jails for court-ordered treatment. Research shows this causes their illnesses to worsen.

SPOKANE, Wash — Decades of research show that people with serious mental illness who are jailed, especially in solitary confinement, experience steep declines in their mental health. But in the state of Washington, the time spent behind bars for people who are mentally ill and waiting for court-ordered treatment is at an all-time high.  

“It pisses me off,” said 34-year-old Josh Stuller of Spokane, who spent more than a year in solitary confinement in the Chelan County Jail in Wenatchee in 2015 and 2016. 

“My message to (the state) is to get your act together and take it seriously because if you let people languish in the conditions of county jails for (long periods of time), I would consider that a crime against humanity," said Stuller.

Washington is experiencing the biggest backlog in state history of mentally ill defendants sitting in jails, waiting for required services to restore what’s called “competency.” That means giving defendants the help they need to understand the charges against them and to participate in their defense.

In October 2021, approximately 350 defendants deemed incompetent to stand trial were waiting for a bed at Western State Hospital in Lakewood or Eastern State Hospital outside of Spokane. In October 2022, the number was about 850 people, a 142% increase in one year, state records show. The numbers include people waiting both in and out of county jails.  

“(Jail) is the worst place to be for a person who has a serious mental illness,” said Lisa Dailey, executive director of the Washington DC-based Treatment Advocacy Center. “It can really cause irreversible brain damage. And the longer that a person spends in untreated psychosis the harder it is for them to return to the same level of functioning once they’re receiving treatment again.”

The state agency charged with providing services to mentally ill defendants, the Department of Social and Health Services (DSHS) has been in “contempt” of a 2015 federal court order since July 2016. The order stems from a 2014 class action lawsuit, known as Trueblood. In the case, federal Judge Marsha Pechman ruled DSHS is violating the civil rights of defendants waiting in jail for services. She ordered that mentally ill defendants get a bed at a state psychiatric hospital within seven days. Currently some people are waiting seven months.

“We’re doing everything possible to get them out of that situation as quickly as possible,” said Dr. Thomas Kinlen, director of the DSHS Office of Forensic Mental Health Services. “We don’t want them in jail. That’s not what we view as the treatment that they need.”

Researchers have long found the jail environment has adverse impacts on the mental health of people with serious mental illnesses such as schizophrenia and bipolar disorder.

A 2013 United Nations report on the Standard Minimum Rules for the Treatment of Prisoners concluded solitary confinement if used “for any reason based on discrimination,” amounts to “torture.” The expert panel also said solitary confinement should be “explicitly prohibited” for “persons with psychosocial disabilities.”

Advocates say the delays are unconstitutional because people with an illness have the right to medical care and shouldn't be treated differently, such as being put in solitary confinement, because of a disability.

"For people who are mentally ill, the longer they're in isolation oftentimes the more entrenched their mental illness becomes. So people are decompensating. They end up in self-harming behaviors. Sometimes it can lead to death by suicide," said ACLU of Washington Legal Director La Rond Baker. "It's a very, very frightening situation."

Stuller, of Spokane, landed in jail after police found threatening writings and a list of names in his Wenatchee apartment in October 2015. Prosecutors charged him with attempted murder. Court records show he waited a month in solitary confinement for a mental health evaluation from DSHS. When an evaluator found him competent to stand trial he served another year in the concrete cell the size of a parking stall, 23 hours a day.

Stuller has a form of schizophrenia and said he didn’t understand the charges against him and didn't remember writing the threats. Jail memos from a mental health counselor detailed his mental health decline.

“(Josh) hears negative hallucinations, a group of very mean people are always talking (to him). This is 24-7,” wrote Chelan County Regional Justice Center Mental Health Manager Leslie Carlson. “They tell him in a descriptive way that his parents are dead ... (and he sees) spiders and cockroaches (in his cell).”

“I was hearing voices saying ‘We’re going to kill you. This is the end of your life. We’ll let you know when and how we’re going to kill you,’” Stuller said. “If you’ve ever felt that level of human suffering that I’ve felt, I don’t believe that any human being deserves to feel that way."

Stuller said he now has PTSD from the experience in the Chelan County jail, on top of his other diagnosis.  

“It was a very steep decline,” Stuller said. “It added an additional diagnosis onto what I already had. And what I had is nothing I would wish on anybody. I’m still angry and I’m really trying to forgive but since I still continue to live with the after affects, I’m very bitter about it.”

Massive increase in demand

DSHS officials said the biggest challenge to moving people into Western and Eastern State hospitals is the dramatic increase in demand. The number of people in jail ordered to receive in-hospital services jumped from 996 people in 2015 to 2397 people in 2022. That’s an increase of 141%.

“We knew ahead of time that services would be increasing over time. We knew that. But can you predict? Can you look into a crystal ball and know exactly what’s going to happen? No,” said DSHS Chief Medical Officer Dr. Brian Waiblinger. “Ideally, they would be in the community. They would be with their family, their friends, they wouldn’t be involved in the criminal justice system. The ultimate goal is to prevent them from having that interaction, to begin with.”

DSHS has several construction projects underway to create more bed space and resources, including a 58-bed facility on the grounds of Western State Hospital scheduled to open within months. These beds are designated for people charged with a crime who need competency evaluations or restoration services.

“It’s a very difficult time right now,” Waiblinger said. “(But) I am very hopeful that we can turn this around. I think we need to do something about creating more community resources.”

Josh Stuller was found not guilty by reason of insanity in 2016. He was ordered to Eastern State Hospital for treatment. Within three months there receiving appropriate help, he said he was out of psychosis. 

Today, Stuller is a new father and is engaged to be married. He’s also an advocate for stronger public policy surrounding the treatment and de-criminalization of people with mental illness.

“(Keeping people in jail), it’s barbaric. It’s 2022, not 1922,” Stuller said. “Quit making excuses. There are human lives at stake here.”

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