In 2015, a federal court ruled in Trueblood, et al. v. Washington State Department of Social Health Services (DSHS) that DSHS had been taking too long to provide competency evaluation and restoration services. In order to have a fair trial, a person charged with a crime must understand the charges against them, and be able to assist their attorney in their own defense. If either or both of these abilities seems to be lacking and it appears that the person has a mental health condition, a judge may order a competency evaluation to inform the court about the person’s abilities to stand trial. As a result of Trueblood case, the State of Washington entered into a settlement agreement to pilot new programs, offering a number of different services and approaches to change how the system works, and make sure these long delays were ended. Phase 1 of the implementation began in 2019 in 3 pilot regions: Pierce County, Southwest Washington (Clark, Skamania, and Klickitat Counties), and the Spokane region. In Southwest Washington, SWACH has played a critical convener and facilitation role for the organizations involved in the Trueblood Projects.
In Southwest Washington, many agencies have successfully implemented and continue to improve a host of supportive services. Including:
• Forensic Navigators: Office of Forensic Mental Health Services, DSHS. Navigators serve to support participants (class members) and coordinate care throughout the process.
• Outpatient Competency Restoration Program (OCRP): provided through Lifeline Connections – Works with participants to achieve the ability to participate in their own defense in a community-based setting. Has components such as: symptom management, social skills training, understanding the legal system and courtroom process, referral to behavioral health treatment, housing, and peer support
• Forensic Housing And Recovery through Peer Services (FHARPS): provided through Columbia River Mental Health Services. Helps address barriers and subsidizes housing costs (such as application fees, security deposits, initial rent costs, etc.)
• Forensic Projects for Assistance in Transition from Homelessness (FPATH): provided through Community Services Northwest/Sea Mar. Connects those at high risk of referral for competency restoration (high utilizers) to services using certified peer counselors. Will offer help getting and keeping housing, accessing health services, training on independent living skills, etc.
Not only has the successful launch of these programs helped dozens of individuals in our community get connected with the care and support they need, but lessons from these programs will inform how competency support services will be rolled out across the state.
SWACH has supported this work through coordinating cross-agency integration and technical assistance, and facilitating monthly Trueblood Collaboration Taskforce and Trueblood service provider support meetings. These meetings, facilitated by Jim Jensen, Manager of Collaboration and Learning at SWACH, provide a safe place for stakeholders and providers to discuss barriers and find collaborative solutions to better serve the clients. Providers have especially remarked how helpful the Provider Support Meetings have been, and how appreciative they are for Jim’s approach and leadership. In addition, SWACH has coordinated quarterly training to support continuous improvement of care. The most recent trainings for Trueblood stakeholders were Trauma Informed Communication in February and Motivational Interviewing for Behavioral Health Issues in May.
In an effort to better understand how people with behavioral health challenges interact with and move through the criminal justice system, SWACH partnered with the Office of Forensic Mental Health Services to support a Sequential Intercept Model Mapping Event. The Sequential Intercept Model (SIM) is a way of looking at the big picture of resource allocation and identifying gaps. It helps highlight all the off-ramps from ongoing legal issues to treatment and sustained recovery, with a goal of interrupting patterns and preventing further involvement with the criminal justice system. Over the course of two sessions, a cross-sector group from the SWACH region, including Forensic Navigators, Law Enforcement, Providers, and other stakeholders, participated in the SIM Mapping event. The group worked collaboratively to inform the mapping process, identify priorities, and create a Strategic Action Plan. While not directly related to the Trueblood projects, this work overlaps with and engages many of the same stakeholders, and provides a different perspective on how to better serve our community and guide the development of needed services. The SIM Map and Report can be seen here