Detentions of people in mental-health crises have surged in King County, with many people repeatedly cycling through the involuntary treatment system and with homeless people particularly likely to be detained again.

The county’s Involuntary Treatment Act system handled nearly 4,700 cases involving more than 3,000 people in 2017, an increase of more than 20% since 2014.  The caseload has doubled since 2007, according to the county, easily outpacing population growth.

Most people with involuntary treatment cases had interacted with the system before, and 24% had done so more than three times before, exacerbating a humanitarian problem that sometimes plays out on public streets.

Those are among the take-aways from a new report by the King County Auditor’s office.

“I would love to think that our community would be really concerned about the huge number of sick people,” King County Superior Court Judge Mary Roberts, who oversees the county’s involuntary treatment court, said in an interview last month. “It’s heart-wrenching and it’s expensive.”

People with housing instability represented 25% of all involuntary treatment cases from 2014 through 2018, and 41% of people with at least three prior cases, according to the auditor’s office report. More than 50% of people with unstable housing returned to the system within three years, compared to 36% of people with stable housing.


Black, American Indian/Alaskan Native and Native Hawaiian/Pacific Islander people are overrepresented in the system, and 50% of those people returned within three years, compared to 36% percent of white and Asian people.

The new report merged human-services data on demographics with anonymized court records to analyze for the first time who’s being detained for mental-health crises and what’s happening to those people.

The auditor’s office did the work to help King County Executive Dow Constantine, the Metropolitan King County Council and court leaders better understand how to deal with a problem that has reduced the attention paid to individual cases and has required the county to spend more taxpayer dollars.

Another report, ordered by the Constantine administration and due later this month, will look at ways to address the challenge. Court leaders are interested in launching an outpatient pilot that would allow the system to keep better tabs on people once they’ve been released.

The state’s Involuntary Treatment Act was enacted in 1974 and has been updated many times since then as the mental-health system has encountered various troubles. Faced with critical federal inspections and court rulings in recent years, the state Legislature this past spring boosted spending on treatment beds and a new psychiatric teaching hospital at the University of Washington.

When someone is experiencing a mental-health crisis and the situation is reported by a relative, neighbor, hospital, police officer or passerby, a county-employed responder and evaluator determines whether the person should be detained at a hospital for up to 72 hours. The law says people can be detained only when mental illness is making them a danger to themselves, others or property, or is making them gravely disabled.


Hospitals can seek longer periods of detention through involuntary treatment court. The cases are civil proceedings, rather than criminal, but most people are represented by public defenders. People whose cases are dismissed are more likely to return to the system, according to the auditor’s office report.

Diane Swanberg, who coordinates the county’s crisis and commitment services, knew anecdotally that people were cycling through the system but didn’t previously have data to back up that fact, she said.

“We see recidivism every single day,” she told the county council’s law and justice committee this week.

People of every income and demographic group experience mental illness and interact with and return to the involuntary treatment system, Swanberg said in an interview, but she wasn’t surprised to see recidivism associated with homelessness.

People without stable housing and people dealing with substance-abuse disorders can struggle more to make appointments and stay on medications, Swanberg said.

The area needs more low-income housing with support services and more outpatient programs with case workers who frequently reach out to clients, she said. The existing programs are maxed out, Swanberg said.

The greatest number of cases come to Swanberg’s evaluators from emergency rooms, while perhaps 30% come from the criminal-justice system, she said. In many cases, people have had misdemeanor charges dismissed because they’ve been determined incompetent to stand trial.

Staff reporter Joseph O’Sullivan contributed to this story.