Legislature prioritizes investments and policy changes to state’s behavioral health system

The legislature continues to prioritize investments and policy changes to the state’s behavioral health systems.

In terms of budget, both the House and Senate proposed budgets make substantial investments in both community behavioral health supports, as well as forensic competency restoration investments.

Senate:

• $69 million to continue implementation of the Trueblood Settlement Agreement
• $719 million for state forensic, civil, and behavioral health facilities
• $141 million for community-based mental health facilities
• Additional funding for operational expenses of community behavioral health facilities expected to become operational soon.

House:

• $91.5 million to continue implementation of the Trueblood Settlement Agreement
• $669 million for state forensic, civil, and behavioral health facilities
• $224 million for community-based mental health facilities
• Additional funding for operational expenses of community behavioral health facilities expected to become operational soon.

In addition to budgetary action, the legislature is engaging in behavioral health policy. A potentially significant bill for some jurisdictions pertaining to forensic mental and behavioral health is SB 5440 regarding competency restoration services. Last week, the bill experienced a major revision with the adoption of an amendment, which would include only a select list of misdemeanors eligible for competency restoration. AWC is concerned about the potential ramifications of this and is asking the legislature to return to the previous standard of including all misdemeanors.

For cities, the most critical components of the amendment are in Section 8, 9, and 10, beginning on page 22:

• Section 10 amends the per se definition of a “serious offense” in RCW 10.77.092 to include only the following misdemeanors: (1) gross misdemeanors with domestic violence; (2) gross misdemeanors with a sexual motivation allegation; and (3) DUI and physical control. All other misdemeanors and gross misdemeanors would be excluded from the per se definition of a serious offense, and thus would be unlikely eligible for competency restoration. The case would be dismissed.
• If an individual meets the charge and compelling state interest test to be eligible for competency restoration and has had two or more competency evaluations in the preceding two years, a forensic navigator would be required to meet with the defendant and provide a diversion program recommendation. The prosecutor could agree to the proposed diversion and dismiss the case, or even if the prosecutor does not agree to diversion, the defense may move for dismissal without prejudice and refer the defendant to the services recommended in the diversion program. The court would be required to grant the defense’s motion if there is a preponderance of the evidence that the defendant agrees to the services suggested and can safely receive the services in the community.

Finding a solution to the competency backlog wasn’t the only behavioral health topic on legislators’ minds last week. The House and Senate also each heard bills that would enhance behavioral health resources in Washington:

The Senate Ways & Means Committee heard HB 1134, creating additional supports for the current 988 behavioral health crisis response and suicide prevention system. The bill focuses on the question of “who to call” when an individual needs crisis behavioral health support for themselves or someone else. This bill establishes liability protection for several entities and personnel for activities related to the dispatching decisions of the hotline and the transfer of calls between 911 and 988. The bill also creates an endorsement for 988 rapid response crisis teams that meet standards and a grant program to support them. AWC supports expansion of the 988-line to provide cities with a more robust service for their residents.

Meanwhile, the House Appropriations Committee heard SB 5120, establishing 23-hour crisis relief centers, a new category of credentialed behavioral health facilities in Washington state. In contrast to HB 1134, this bill focuses on “where to go” when someone is in behavioral health crisis. 23-hour crisis relief centers would be open 24 hours per day, seven days a week and accept anyone in a behavioral health crisis who walks in the door, are brought in by first responders, or are referred through the 988 behavioral health crisis system. With very limited exceptions, all law enforcement referrals would need to be accepted. Centers would provide services and coordinate care, limiting patient stays to less than 24 hours in most cases. The bill would also eliminate triage facilities as a behavioral health category and convert those existing triage facilities into crisis stabilization units. AWC supports this important first step to expanding crisis behavioral health treatment services.