Suffering from paranoia and delusions, Jin Ying Kerr needed to be hospitalized for psychiatric treatment. Instead, the 74-year-old spent four months in jail, often isolated, in large part because no hospital beds were open.
Kerr believed electronic waves were stalking her. She heard the television telling her that her ex-husband — with whom she was living in Lower Queen Anne — had two daughters he’d kept secret. She even heard their voices crying out inside her mind, court records say.
One morning in March, Kerr, who is about 5 feet tall and 78 pounds, came at her ex with a large butcher knife, police records show. He threw a blanket over the blade and wrestled it out of her hand, but Kerr bit his ear and scratched his shoulder in the struggle.
“She was going to run [me] through with the knife,” he told police.
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Kerr was taken to jail and charged with second-degree assault. On April 15, a judge ordered an evaluation to determine if she was competent to face the charge.
It took 16 days for a forensic evaluator from Western State Hospital in Lakewood to interview Kerr — more than double the seven-day target set by law, court records show. Kerr wore restraints around her waist and wrists for the interview. She’d been refusing medication in the jail and was transferred to an isolated cell in the acute psychiatric wing due to “yelling, banging and emotional liability.”
The evaluator determined Kerr lacked the capacity to assist in her defense, so on June 16, a judge suspended the charge and ordered her to spend 90 days in Western State Hospital, where doctors would try to restore her to competency.
But there was no bed for Kerr at the hospital. So she remained in the jail another two months until one opened up.
Kerr’s case is not unusual. With delayed evaluations and long wait-lists for beds, severely mentally ill offenders spend months languishing in jail waiting for proper psychiatric care, often in an isolated cell for 23 hours a day.
Mental-health advocates are seeking class-action status in a federal lawsuit arguing that holding these patients in jail violates right to due process and constitutes cruel and unusual punishment. Many hope the Legislature will intervene with more funding.
Sometimes patients spend longer waiting in jail than they would serve if they were convicted of the criminal charges, said Daron Morris, deputy director of the defender association in King County. Had Kerr been convicted of the charges, she would have faced a sentence of only 30 to 90 days, Morris said.
By the time the patients finally do get to the state hospital, some have decompensated, meaning they arrive in worse mental condition than when they were arrested, said Ron Adler, CEO for Western State Hospital. “It’s heartbreaking,” he said.
For taxpayers, it’s an expensive problem. In King County, inmates housed in the acute psych unit of the jail cost an average of $391 per day — more than two and a half times the price of incarcerating a non-mentally ill person, according to the King County Department of Adult & Juvenile Detention.
Many in the system blame budget cuts to mental-health services by the Legislature, which they say have resulted in deficient psychiatric services across Washington.
Earlier this summer, the State Supreme Court banned the increasingly common practice of psychiatric boarding, in which hospitals keep mentally ill patients detained in emergency rooms when there are no long-term involuntary-treatment beds available. Mental-health officials have since been scrambling to find beds and other resources to comply with the order.
As of late August, 106 mentally ill people were in jail waiting for a bed to open at Western State Hospital, which serves the 19 counties west of the Cascades, including King County, according to the Department of Social and Health Services (DSHS), which operates the hospital.
The average wait for an offender facing a felony after being found incompetent was 69 days, according to DSHS. An offender charged with a misdemeanor waited about 30 days.
For now, it’s a problem with no end in sight.
“Everything is just stalled,” said Morris. “People who would otherwise be released to community-care options — people who aren’t facing long sentences — are just held in jail for very long periods of time with nothing being done, without adequate medical treatment, and that’s in nobody’s interest.”
In the King County Jail, offenders experiencing acute psychiatric episodes are usually housed on the seventh floor, though mentally ill people are found in the general population, as well.
Depending on their mental state, patients on floor seven are either kept alone in one of two 48-cell housing units, or in one of eight dorm-style housing units with about 20 other mentally or physically ill inmates. The jails offers medication, but doctors can’t make patients take anything other than antipsychotics if the patient refuses, other than in emergency situations.
King County offers better services than many jails in Washington, including twice-weekly visits by independently licensed therapists, said Dr. Mike Stanfill, King County psychiatric services manager for Jail Health. But jail is still no substitute for a hospital, he said.
A lack of beds and other resources for mentally ill people is not a new problem, and it’s an issue all over the country.
In 2012, the state Legislature passed a law setting new performance targets for competency evaluations of defendants in jail to be completed within seven days of a judge’s order.
But Western and Eastern State hospitals have consistently failed to meet that deadline, according to a report released by the Joint Legislative Audit and Review Committee earlier this year.
In the six-month period ending in April 2013, Western State missed the mark 87 percent of the time. Eastern State in Medical Lake in Spokane County, did even worse, failing 99 percent of the time.
Part of the problem could be high staff turnover, the report noted.
The study recognizes other factors out of DSHS’s control contribute to slowing the process, including courts, jails, attorneys and patients.
But the report also found that DSHS didn’t appear to have a strategy to fix the problem, having “not done the basic planning and analysis necessary to identify the best approach to meet the targets.” The committee also found that data was often delayed, inconsistent or inaccurate in required quarterly and annual progress reports.
Jane Beyer, DSHS assistant secretary for Behavioral Health and Service Integration Administration, said the source of the slow-moving system comes down to rising demand and a stagnant supply of resources.
From 2001 to 2012, the number of offenders referred for competency evaluations increased 82 percent to almost 3,000 per year, according to the committee’s report.
Since mental-health funding has been cut continually by the Legislature in recent years, the time mandate is often unrealistic, especially when staff have to travel long distances to see patients, said Beyer.
“I would say that seven days is, from what we’ve seen, probably one of the most aggressive statutory standards in the country,” said Beyer.
Once the patients are evaluated, there aren’t enough resources at the hospital to accommodate them, she said.
“We’re just plain out of beds,” said Beyer.
DSHS is seeking from the Legislature money to open a new ward with 30 additional restoration beds, and to hire three new forensic evaluators. The department also recently hired someone to analyze and compile data to improve the accuracy and integrity of its numbers, said Beyer.
“Despite the numbers and despite the current problems that we’re dealing with, I want you to know there’s an air of optimism,” said Adler of Western State Hospital.
Adler said he believes Western State has improved wait times for evaluations. However, DSHS so far has not completed any of its required quarterly reports for 2014, and it doesn’t expect to until mid-October.
No easy solution
Late last year, Snohomish County public defender Jason Schwarz saw the wait time endured by mentally ill patients needing beds rising again. He was running out of ideas to keep his clients from spending long stretches in jail.
The Snohomish County Jail isn’t an ideal place for someone in need of psychiatric care. The Department of Justice recently found the facility didn’t offer adequate psychiatric resources and treatment planning for mentally ill people. Those on suicide watch are placed in rubber rooms with words like “help” carved into the floor, according to a study by the advocacy group Disability Rights Watch.
These kinds of poor conditions and lacking mental-health care are common in Washington jails and can cause additional harm, according to the study. “Without adequate and mental-health treatment, individuals in jail with mental illness suffer painful symptoms and decompensate.”
Among those in need of treatment was 27-year-old Ara Badayos, who was arrested in March for slapping a police officer and found incompetent to face the third-degree assault charge. With no bed available at Western State, Badayos was placed in solitary at the jail, where she refused to take medication.
Her condition quickly grew worse. On Aug. 1, after agreeing to attend a court appearance, Badayos took off her clothes and smeared her feces on the walls when the jail staff came to collect her, said Schwarz.
Schwarz and his co-counsel, trying to get Badayos and other clients into treatment more quickly, filed countless motions with the court, and even attempted to hold DSHS in contempt for failing to move their clients. But nothing seemed to work.
“We just looked at each other and said, ‘What are we gonna do now?’ ” recalls Schwarz. “We’ve tried everything we can think of.’”
Earlier this summer, the public defender’s office sued DSHS in federal court.
The suit alleges that DSHS and administrators at Western State Hospital violated Badayos’ right to due process by holding her in the volatile jail environment, further harming her mental state. Incarcerating Badayos indefinitely without proper treatment also constitutes cruel and unusual punishment, according to the suit.
Earlier this month, Disability Rights Washington and the American Civil Liberties Union took the case over from the public defenders. They are now seeking class-action status on behalf of all mentally ill people held in Washington jails for extended periods of time.
“The problem hasn’t gone away, and it’s continued to go up,” said David Carlson, director of legal advocacy for Disability Rights Washington. “We realize now it’s going to take court intervention to get resolution here.”
Though the suit names DSHS, Schwarz said the administration is not solely to blame. The problem stems from a system flawed almost every step of the way, he said: There are not enough community resources. Police bring mentally ill people to jail instead of hospitals. Prosecutors charge people for minor crimes who are clearly suffering from mental illness.
“I think we have a fundamental breakdown of what we do to help folks with mental illness here,” he said. “Western State is just the tail end of the story.”
He and many others in the criminal-justice system believe the only long-term solution would come from legislative action.
But given all the other state’s financial woes, such as school funding, Schwarz isn’t optimistic mental health will top lawmakers’ priority list next session, he said.
“It potentially could get even worse.”
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