Category: Mental Health

LEAD Pivots to Focus on Jail Releases, King County Outlines Behavioral Health Strategy for COVID Isolation Sites

Partitions between beds at the county’s COVID-19 isolation and recovery site in Shoreline.

1. The Public Defender Association’s Law Enforcement Assisted Diversion program, which in normal times is a program that keeps low-level offenders out of jail by providing case management and connections to services, has pivoted during the COVID epidemic to focus on people who are being let out of King County jails to prevent overcrowding and who have few social supports or legal sources of income. The Co-LEAD Program, PDA director Lisa Daugaard says, is “starting with people who were released in the wave of jail releases and are not doing very well, which is, of course, totally predictable.” The program is also accepting referrals from prosecutors, defense attorneys, and law enforcement—”people who in normal days might be subject to arrest but that is completely off the table,” Daugaard said.

With job opportunities virtually nonexistent (and work release shut down for the foreseeable future), Daugaard says property crime has risen in some areas. “For a lot of people without any means of support, what’s the option?” she says. “There’s got to be some strategy for people to take care of their basic needs when there is no way to earn money. That is the bottom line for a lot of folks.”

The Co-LEAD program, which launched this week in Burien, is providing former jail inmates with access to hotel rooms, gift cards, and crisis intervention. So far, the PDA has reserved about 25 rooms in hotels along the I-5 corridor and “we plan on scaling that up rapidly.”

If you’re wondering where LEAD is getting the money to do all this—wasn’t the mayor still withholding their 2020 funding and refusing to sign a contract until LEAD met a long list of conditions?—the answer is that the city finally signed the contract and released LEAD’s full 2020 funding in late March, after the COVID epidemic hit. “We finally executed the contract for the total amount of funding and immediately the world is different,” Daugaard says.

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2. King County is opening hundreds of hotel rooms and field hospital beds for shelter residents and for those in isolation or quarantine who have (or may have) COVID-19 and have no safe place to isolate or recover. One question that has come up both tacitly and explicitly, in Seattle and in other cities with large homeless populations, is what happens when someone needs crisis intervention or help managing their active addiction.

Both Seattle mayor Jenny Durkan and San Francisco Mayor London Breed have suggested that it would be prohibitively expensive, for example, for cities to rent out large blocks of hotel rooms for people experiencing homelessness, because they would have to be heavily staffed by care workers—workers who would need to be trained, it is implied, to intervene at a moment’s notice when homeless clients act out, attempt to destroy hotel property, or try to leave.

“It’s a scary, isolating, confusing, lengthy process, so everybody who we’ve put in these rooms has needed behavioral health care at one time or another. On day 7, after you’ve been in a hotel for that long, just human contact is important.”—King County Behavioral Health and Recovery Division director Kelli Nomura

Kelli Nomura, the director of King County’s Behavioral Health and Recovery Division, says the county has not had to ask anyone to leave any of its quarantine, isolation, and recovery centers, which, as of Sunday, will include a 140-bed field hospital in Shoreline. The county is connecting people to their existing providers when they have them, and providing behavioral health and addiction management services through its King County Integrated Care Network if they don’t.

“Everyone who’s going into these facilities is needing some level of behavioral health support,” including people who aren’t homeless, Nomura says. “It’s a scary, isolating, confusing, lengthy process, so everybody who we’ve put in these rooms has needed behavioral health care at one time or another. On day 7, after you’ve been in a hotel for that long, just human contact is important.”

Nomura says there have been instances when someone with a severe, persistent mental health disorder has had an acute episode, or when people who are actively using drugs or drinking have needed immediate help managing withdrawal symptoms. When that happens, she says, behavioral health staff either connect them by phone with their existing provider or “just step in and do that crisis intervention ourselves. … We have been deescalating, doing motivational interviewing, and you might have to go into on site” to go into a person’s room and intervene, she says.

The county is reserving beds at its isolation and quarantine site on Aurora Ave. N, which includes 23 units in modular buildings, for people who need daily methadone dosing, Nomura says, but opiate users who take Suboxone (buprenorphine) to manage their addictions can fill their prescriptions or get a new one at the other sites.

As of tomorrow, the county will have opened just over 400 units in isolation, quarantine, and recovery sites, including the 140 beds opening in Shoreline on Sunday. Department of Community and Human Services spokeswoman Sherry Hamilton says additional sites at Eastgate in Bellevue and in White Center will be ready later this month; an additional site in Seattle’s Interbay neighborhood, which was initially planned as an isolation and quarantine location, may instead be used as an expansion site for the city’s still-overcrowded shelters.

Emergency Orders, School Cancellations, and Planning for Those Who Can’t “Quarantine At Home”

 

Don’t panic, but also, sort of panic.

That was the message during a press conference on new state and local orders to contain the COVID-19 epidemic this morning, when Governor Jay Inslee and King County Executive Dow Constantine announced that all large group events are effectively canceled. Inslee’s order bans all gatherings of more than 250 people, including family gatherings, in King, Pierce, and Snohomish Counties; the county’s order, which was signed by King County Public Health officer Dr. Jeff Duchin, bans gatherings smaller than 250 people unless the organizer can guarantee that they are following every CDC recommendation to contain the spread of the virus. Later in the day, Seattle Public Schools announced it was closing schools starting tomorrow, and the Seattle Public Library board was meeting to discuss potential closures.

Meanwhile, King County Department of Community and Human Services Director Leo Flor told me that a motel in Kent purchased by the county to house patients who can’t be quarantined at home (including both people without homes to go to as well as those who share their homes with vulnerable people) just accepted its first patient, a King County residents. The county, he said, is still working out plans to redistribute people currently living in close quarters in shelters, both by locating large indoor spaces like the Seattle Center Exhibition Hall, where the Downtown Emergency Service Center shelter moved some residents on Monday, and by distributing motel vouchers to people who are not infected but are especially vulnerable to the virus.

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So what do you need to know? Here are the basics, along with a few more specific details about planning for people experiencing homelessness, who are highly vulnerable to the novel coronavirus because of preexisting health conditions, substandard living environments, and lack of access to quality health care.

• Gatherings of 250 or more people will be prohibited until at least the end of March in King, Pierce and Snohomish Counties, an order that Gov. Inslee said would likely be extended and expanded to include more parts of the state.

The goal here is to slow, not prevent, the spread of the illness so that hospitals aren’t slammed with thousands of new cases all at once. “We do not want to see an avalanche of people coming into our hospitals with limited capacity,” Inslee said.

“We recognize that isolation and quarantine are going to be difficult settings for the people in them to be in, and the ability to provide behavioral health on site or by telephone to anybody who’s in one of those facilities is one of our top priorities.” — Leo Flor, King County

Inslee emphasized that the law is “legally binding on all Washingtonians,” but said he did not anticipate having to use state police or the National Guard to enforce it. “The penalties are, you might be killing your granddad if you don’t do it,” Inslee said.

• Gatherings of fewer than 250 people are also prohibited in King County, unless the organizers abide by guidelines established by the Centers for Disease Control to prevent spread of the virus, including social distancing (the CDC recommends six feet), employee health checks, access to soap and water, and other sanitation measures. “Temporarily banning social and recreational gatherings that bring people together will help to ensure that a health crisis does not become a humanitarian disaster,” Constantine said. “Below 250, we thought people, business owners, could take measures to keep people apart,” Inslee says. However, “We do not want to see people shoulder to shoulder in bars from now on. That is just totally unacceptable.”

Duchin said the new rules would allow some flexibility for groups where maintaining six feet of distance is impossible, and Constantine added that the county will be issuing additional guidelines for “restaurants,  grocery stores, and other institutions,” and that enforcement would be complaint-based. Continue reading “Emergency Orders, School Cancellations, and Planning for Those Who Can’t “Quarantine At Home””

Involuntary Treatment Bill, Modeled on California Law, to be Resurrected Next Session

Rep. Steve O’Ban, R-28

This story originally appeared in the South Seattle Emerald.

A state senate bill aimed at taking people with severe behavioral health issues off the street and putting them into involuntary treatment is off the table for this year, but its sponsor, Tacoma Republican Steve O’Ban (R-28) says he plans to resurrect it next session, because the problem of untreated mental illness and addiction isn’t going away.

“The reason for this bill is really the parents who have these kids … who devolve into a worse and worse condition and by the nature of their condition, they don’t think they need care,” O’Ban says. Under current law, people can only be detained and put under guardianship if a court determines that they’re incapacitated by a “mental disorder” and pose an imminent threat to themselves or others.

O’Ban’s proposal would allow judges in three counties—King, Pierce, and Snohomish—to appoint executors for people who have been involuntarily held for psychiatric evaluation five or more times in a 12-month period under the state Involuntary Treatment Act. That law allows people to be held in psychiatric hospitals (or emergency rooms if no psychiatric beds are available) for up to 180 days if a judge determines that they are incapacitated by mental illness. The proposed new involuntary guardianship, or “executorship,” would last one year unless the executor filed for an extension.

The program is modeled on a similar set of bills that passed in California in 2018 and 2019, which authorized three counties—San Francisco, San Diego, and Los Angeles—to create a new “conservatorship” program for people with both severe mental illness and addiction. California state senator Scott Wiener (D-San Francisco), who sponsored both bills, says his legislation is intended to address “a very small percentage of homeless people … who are severely debilitated and not capable of accepting voluntary services.”

“One of the areas that’s been a particular concern is the lack of structure and necessary accountability for these patients who come out of involuntary treatment, or they’re in jail, where they should not be, and by the nature of their condition they don’t think they need care and they refuse the needed services.” – State Sen. Steve O’Ban (R-28)

Wiener says the new California laws create a “very narrow conservatorship to reach this small population so that we can save their lives. It is incredibly inhumane, and certainly not progressive, to allow people to die on the streets.” He estimates that the legislation would apply to as many as 100 people in San Francisco, but advocates who opposed the bill say the number is probably much smaller.

O’Ban’s bill, in contrast, would initially be limited to 10 people in each county.  Patients placed under executorship would cede most of their legal rights to a “court appointed resource officer,” or CARE officer, including the right to refuse treatment or choose their own medical providers, the right to decide where to live, and the right “to make decisions regarding social aspects of life,” according to a staff analysis of the legislation.

“One of the areas that’s been a particular concern is the lack of structure and necessary accountability for these patients who come out of involuntary treatment, or they’re in jail, where they should not be, and by the nature of their condition they don’t think they need care and they refuse the needed services,” O’Ban says.

At a hearing on the bill earlier this month, parents whose kids had died on the streets due to lack of housing and treatment testified that if the law had been in place when they were trying to get help for their children, they might still be alive today. Jerri Clark, the founder of Mothers of the Mentally Ill, told the committee that her son, who died last year at the age of 23, “cycled through hospitals that kept him just long enough that he wasn’t dangerous anymore” before releasing him.

“If you look at the big picture, we’ve completely divested from mental health care and we’ve put people out on the streets where they’re completely disintegrating… and then the only care that they’re getting is in the back of police cars.” – Jen Flory, Western Center on Law and Poverty

But critics of the legislation, including advocates for people with disabilities and people who have struggled with mental illness themselves, say that taking away people’s civil rights is inhumane and doesn’t solve the underlying issues: An acute lack of funding for treatment, housing, and intensive case management.

“We do have concerns that adding another layer of legal process to compel people into care, rather than adding new treatment or housing resources, will mainly restrict civil liberties while not actually getting to the desired outcomes,” the Department of Community and Health Services said in a statement about the bill. “Instead of adding another layer of court involvement, we think a middle of the road approach – focusing on expanding flexible, community-based intensive services and added supportive housing resources – will more effectively meet the needs of this population.”

Laura Van Tosh, a behavioral health care advocate who testified against the bill, says the fact that people are involuntarily committed again and again “points to a problem that has nothing to do with people’s mental health. How can people be committed that many times in one year and nobody has ever talked about why the system didn’t work well enough the first time?” She says the current involuntary commitment system “is like going to a restaurant and getting E. coli over and over again, and never figuring out that you should go to a different restaurant.”

California’s conservatorship law requires treatment and housing to be available before people can be placed under conservatorship, although opponents say cities may meet this requirement by simply putting people in the new program at the front of the line for scarce treatment and services. “San Francisco will not conserve people unless they have somewhere to place them,” Wiener says. “In San Francisco, we’re expanding our mental health bed capacity and our shelter bed capacity, we’re building more supportive housing, but it’s definitely a challenge.”

Similarly, O’Ban’s bill says that a county could only implement the program if there are sufficient resources, including mental health treatment and housing, to serve potential clients. The loopholes will likely be the same, if a version of O’Ban’s bill passes in the future, as those in places like San Francisco. There are always beds in Seattle for some people—the question is who gets priority.

Jen Flory, a policy analyst at the Western Center on Law and Poverty, says that by putting people in involuntary treatment and stripping them of their rights, “we’re kind of skipping from A to Z. If you look at the big picture, we’ve completely divested from mental health care and we’ve put people out on the streets where they’re completely disintegrating… and then the only care that they’re getting is in the back of police cars being brought to psych emergency [wards]. And at the end of this journey, they’re like, ‘Okay, there’s something wrong with you and we need to force this care on you.’”

David Lord, the public policy director for Disability Rights Washington, says that before the state authorizes counties to appoint guardians for people struggling with mental illness and addiction, they should actually fund the services O’Ban’s bill enumerates, which include supportive community housing, outpatient counseling and treatment, peer support services, and substance use treatment.

“If you provide services, make them available, and do it in a way that is attractive to people, they’re much more likely to accept those services than if you try to force them,” Lord says.

Neither California’s law, nor O’Ban’s proposal, specifically focuses on people experiencing homelessness. But the subtext of both bills is that they will help put people exhibiting visible symptoms of severe mental illness and addiction—shouting, acting out, and behaving in ways that make other people uncomfortable—out of sight.

In our conversation, O’Ban referred to the 100 “prolific offenders” identified in a report by former Seattle City Attorney candidate Scott Lindsay as a group that might be eligible for executorships under his proposal. And he acknowledged that while his bill is “not exclusively for those who are homeless, I think many of the people who are eligible would be” homeless.

“I can tell you that there are familiar faces, frequent flyers, people who are well-known to the law enforcement community and in emergency rooms,” O’Ban says. “If you start focusing on that population, by identifying the top 100 who are heavily utilizing all those …. you would save the system literally hundreds of thousands of dollars a year.” And “clean up” downtown streets in the process.