Trueblood - In a time when vampires have entered the mainstream, a young Louisiana waitress (Anna Paquin) sets out to prove not only can vamps and humans co-exist, they can find true love.
- Created by Alan Ball (Six Feet Under) and based on the best-selling "Sookie Stackhouse" novels by Charlaine Harris, this 7 season HBO series has been hailed as one of the best guilty-pleasure shows on TV, although, as Scott Neumyer – entertainment reporter for the Rolling Stone - so cringingly put it, by the 7th season the show had “lost its bite.”
- (oh crap, wrong True blood – I am so sorry about that. –ed)
- Aura MacArthur, Senior Project Manager, Department of Social and Health Services - macarthur@dshs.wa.gov
- What is Trueblood - When someone is picked up by the police for committing a crime, if the court or judge or defendant thinks the defendant isn’t competent to go to trial, they can order a competency evaluation. (or you can be picked up by police for simply being a person of color. My 2nd favorite bus ride of all time happened when me and my kindergartener were taking the bus to the downtown farmers market. He was just starting to read, and so read everything he could and asked a lot of questions. So, out the bus window he reads “Bail Bonds”, and asked what that meant. Being the insufferable know-it all I am, I said “well, if you do something bad and get arrested, you can pay money to not stay in jail while you wait to see the judge”. Good answer, I thought. Then, a woman on the bus bellows out “It ain’t just because you did something wrong – sometimes you get arrested just because you’re black.” Most of the bus echoed that sentiment, and then it got quiet. I thanked them for the correction, and then Henry and I got off the bus and bought some strawberries. –ed.) This is done by the Department of Social and Human Services to see if someone can participate in their own defense. If someone isn’t competent to stand trial, then competency restoration can be ordered. Restoration is also done by the Department of Social and Human Services. Those competency evaluations and restorations need to be done in a timely manner, and the State wasn’t meeting the timelines. there were long waiting lists, and not enough resources. The state was sued and lost, and rightly so.
- The state funded more resources – adding beds, adding evaluators. They thought they had the right answer for the demand, but then the demand spiked. All the bed didn’t resolve the problem. And then the state was found in contempt of court and fined (I hope the judge banged their gavel when finding them in contempt – that seems like an important part of the process. –ed). The state started paying fines of $3M-$4M per month.
- The state started having negotiations with Disability Rights Washington (https://www.disabilityrightswa.org/ ). Through hundreds of hours of negotiation, engaging lots of stakeholder discussions across the state. They came together with a 54 page summary agreement (54 is a bit of a worrisome number, because that is not the answer to ultimate question of life, the universe, and everything - even though the question to the meaning of life is “what do you get when you multiply six by nine?” –ed). Presented it to the federal court and sent it to the case members to get feedback from everyone involved – tribes, jails, nonprofits, family members, etc.
- The settlement agreement was approved. They hired the 4 of us as project managers to provide support to do everything in the 54 page agreement.
- The settlement agreement doesn’t settle the lawsuit – just the contempt of court. (so there is other work done to address the lawsuit – like the Trueblood project Greater Lakes Mental Health and Catholic Community Services have been working on. Unfortunately, the work to address the original lawsuit and the work to address the contempt of court – separate things with separate funding streams - is just all called Trueblood because it is fun to name different things the same… like one time I met these twins that were named “Fred” and “Frederick”. Um, they aren’t the same people, parents, maybe different names would not be such a bad thing. You can have them rhyme or alliterate if you want to be all cutesy, but don’t use the same name you freaks. No judgement, though… –ed).
- There are a lot of different programs and services – rolling out in phases – each phase is 2 years long
- Phase 1 – pierce region , Southwest region - Clark, Klickitat and Skamania Counties (um, those are South, not Southwest – you’re giving Cowlitz, Wahkiakum and Pacific Counties an identity complex – the region-namer may need to retake 7th grade Washington State History. –ed), and around Spokane region. Starting July 1st, and moving for 3 years.
- Phase 2 – King County – take learning from 3 regions and roll out series in King
- Phase 3 – no locations identified – the governance structure will make recommendations for phase 3.
- Many proposals are experimental – not sure if they will work as parties think they will work.
- Need to understand what all regions are currently doing successfully – want to supplement, not replace or interfere.
- If things aren’t going well, we’ll make course corrections
- Today we wanted to hear what you need and connect you with folks and help us with these conversations.
- Want to find out what is most important to you (I’m pretty sure you don’t want to know that – most times I’m unnerved when I learn what truly matters to people – you can’t put it back in a box. –ed)
- We want to build connections to the work you are doing.
- There are from 14 to 18 major projects that impact a wide variety of the system.
- Have any of you heard of the Intercept model? – the main focus of the settlement agreement was how to divert people from the criminal justice system before they get there – people who are mentally ill do not belong in jail – we need to intervene before law enforcement involvement.
- Much of the settlement agreement is around the crisis systems – housing vouchers and help find permanent housing
- Hiring more evaluators and creating more beds at Western State and Eastern State – always some need for that (uh, yeah, since Washington is 49th out of the 50 states for per capita psychiatric care beds – Missouri had 5 times as many beds per person as Washington – and they have a battleship named after them – so I’m assuming they know what they are doing. –ed)
- Creating the Forensic Navigator – a member of the court that reports to the Department of Social and Health Services – collect info so the court can provide services, including outpatient restoration services. Court has to decide who that is appropriate for. The courts will connect with behavioral health providers. They also help the different parts of the system communicate together
- There will be an intensive case management program – focused on high utilizers. Housing, case management, mental health. Helping to make sure they can navigate the system (I don’t think we can overemphasize how welcome these services will be. –ed)
- Funding for more co-responder programs - mental health staff that ride-along with law enforcement – or operate separately. It is often better to have a mental health provider respond and take someone to a mental health center.
- Crisis mental health training – help recognize someone in crisis – already available to law enforcement – but have more funding for more patrol, 911, and County/City correction officers.
- That is some of the 54 page agreement – it is very broad in scope
- Even if everything goes perfectly, it still won’t be a 100% solution to everything that is going on.
- Launching July 1st – providing support to the leads.
- Settlement agreement has stuff owned by sheriffs and police chiefs, healthcare authority, other groups. Each group has a lead that is working on the plans, and will see the outcomes from start to finish.
- Keith Lewis, Department of Social and Health Services - lewis@hca.wa.gov
- works for the Health Authority – is the lead on multiple portions of the settlement agreement (is anyone else bothered by the word “lead”. Sometimes it is a verb meaning to guide, and sometimes a noun meaning heavy metal. Whose idea was it to both spell and pronounce them the same? They have different etymologies, but somehow ended up the same. I hope the English language is embarrassed when things like this happen. –ed)
- My program is in the crisis system – co-responder system – meet in the three different regions and see what their mobile crisis team are like. We are looking where we might need to increase services. Seeing the Washington Association of Sheriffs and Police Chiefs (WASPC) – working with them to ensure their co-responder program works well– that individuals are getting the services they need. A continual loop of information.
- Our primary focus is to level off the system so it isn’t overflowing. I’m also the lead on the crisis stabilization TRUAD (not sure what this acronym means, or if I got it right. There is a reason I avoid acronyms in my notes – it is easy to be befuddled by them. –ed) program in the Pierce County area – Recovery Innovations is going great work in Fife. Some of you may know that Recovery Innovations is going to add a 16 bed unit the Spanaway/Parkland areas. For individuals from Milton and Fife – it is great, but too far from other areas of Pierce County, so police take people to the hospitals. Hospitals do good jobs, but they are busy. Individuals can end up detained in the hospital if they can’t get in the ENT (not sure if they said ENT or something else – I certainly don’t know what ENT is – I’m assuming it isn’t “Ear Nose and Throat”, a specialty for doctors. Acronyms will be the death of me. In the National Guard, whenever someone said an acronym we didn’t know, we’d say “really, another TLA” – meaning “Three Letter Acronym”. We thought we were much funnier than were actually were. I did a lot of pushups in the Guard. –ed). And go to western state. The Parkland facility is more centralized – Jodie Lear, the directory there, is ready to get involved in this work.
- Looking to add 16 beds in the Spokane Region area. Spokane wants them in their County, but want to see how to best serve all 6 counties in the area. Also need to work with Spokane tribe. Going to Spokane in July to look at the services they need there. Want to ease some of the difficulty they are having there.
- Want to enhance beds in Southwest – Clark County and such.
- We are in meetings almost every day, most of the day (join the club. –ed)
- Trueblood doesn’t address the substance use disorders – but a large percentage of the class members with mental health needs use substances to address systems. Working with partners that are there to work to address this.
- Helen – used to work at Western State – when I started, waitlist was 45 to 60 folks needing evaluation or restoration. Another ward had a waitlist of 165 (over 200 now). Often there wasn’t a forced medication order. A restoration is between 29 and 90 days – afterwards they are evaluated to determine if they should stay longer, and can ask the judge of another 90 days. In the first 90 days, they refuse medication. They complain medication and refuse and are psychotic and dangerous. I’d like our patients to come to us with a forced medication order. That is what took so long for them to get back and restored. In order to get the forced medication order, the psychologist has to petition the court. Even a patient voluntarily taking one dose resets the system. This is a huge cause of the waitlist. Any plan to have client arrive with a forced medication order? Aura – one component of the settlement agreement is technical assistance for the jails – looking at best practices and trainings and stronger relationships. Judges are hesitant to force medications, so trying to build relationships so there is more trust so judges can do the right thing.
- Sherri – Overall Impact questions - It is good to hear there will be more beds – we talk about adding 16 beds – what is that overall impact – how long are the stays – what does that impact in a year. Keith- I’m not sure how many will be served in a year. For the purpose of Trueblood – it is a situation where police need someone seen and can hold them for 12 hours for an evaluation by a mental health professional. If the Mental Health Professional says they need an extended stay, a Designated Crisis Responder can come in and do an evaluation for the 1075 and they can go to treatment facility or a community hospital. (lots of acronyms and such – not sure what 1075 means – I’m doing my best here. –ed) If an individual refuses medication if offered – we can begin the process of forced medication for the 2 week period they are there. If held over for a longer period of time, it can last for a 180 day period. The court then has to determine if the individual needs. We do need to remember that individuals have civil rights – we went a long way from locking people up away because they were a problem – we’ve moved beyond locking people away. But we haven’t gotten to where we are treating individuals properly. Individuals that hit the mental health system because of criminal activity – they are different than those with a mental health disorder. We need to be mindful we don’t lump everyone into the same basket. Mental Health needs are different from criminality – issues can happen that create stress and cause mental health challenges – that can diminish when situations change. In most cases, Mental Health Professionals determine no hospitalization is needed. In Mental Health, we operate on a 20/60/20 scale – 20% of folks will be seen again in the system. 60% you’ll never see again. That last 20%, no matter what you do, you can’t change what they do. We are working on the 20% that are tipping the system. The folks who are normally pretty healthy, they don’t need to be in a hospital for a long period of time – they just need a tune up, not a major overhaul.
- Maureen – I go back far enough that I started working with homeless people when Reagan eliminated them from the Supplemental Security Income (SSI) payment. My ears perked up when you said housing vouchers. Who is the lead for housing for Trueblood? I didn’t hear a state agency that does that. Lots of agencies could be involved with this. The stock for housing is darn near gone. Who is the housing lead and how to we interact with that part of your world. Keith – I do temporary vouchers – those who are homeless, we can do up to 14 days. The Housing and Recovery Through Peer Services (HARPS) program contact is Tiesha Kirchmen (not sure I got that right – ed.). Maureen - How will you use these housing vouchers? Keith – that is one of the things we’ve been talking to. We’ve been meeting with the Tacoma steering committee- using motels, hotel - it is only temporary. We want to connect them to HARPS – which is long term housing. The voucher program I do will go through the crisis stabilization and crisis services facility – for 14 days and then an additional 14 days. At that time, HARPS will work with them to find permanent housing. Aura – during the settlement agreement discussions, almost all conversations with Disability Rights Washington and the State had housing involved. The settlement agreement does have some housing – but it isn’t enough to fill the need in the community. The settlement agreement has the temporary vouchers controlled by the crisis centers. For folks not clinically appropriate for a hotel/motel, the HARPS teams will provide an alternative. HARPS will provide that for those people. We can coordinate to have our HARPS folks come and speak to you about this program. Maureen – if you could do a one page, bulleted. Aura - Might do a webex just about HARPS. We can coordinate connections. HARPS has a trueblood coordinater. HARPS for Trueblood works only with Trueblood members.
- Theresa – thank you for being candid that you may never catch up – you can’t close all those mental health beds and think we can catch up. Sometimes more restrictive environments are not a step in the right direction. But, many times clients get released over and over again to the community and end up dead. I’m happy you’re working with Sheriffs and jails. Can you ask they don’t’ release people before 7am. That is not OK. If they keep doing that, they need to be called out that they are not serious about mental health. This is a health issue.
- Theresa – would like to have the Court Resource Center open 24x7 – make it an urban rest stop somewhere folks can go in the middle of the night – if can’t get in the shelter or are maybe excluded from them – I want to pitch that.
- Marybeth – who makes the decision to order competency services? Aura - Judge makes decision. Prosecutor, defendant, judge – any of them can recommend the competency hearing. They will order an evaluation, it is conducted by the Department of Human and Social Services (DSHS).
- Marybeth - the folks who make the referral, do they have enough information to make a good referral. You don’t want to clog up system that is already taxed. Aura– that may be a best practice – get more training
- Questions – I’ve done ride-along with police officers – when I ride along, I never know how police will react to someone. I’ve seen police yelling at folks to calm down, others are calm and kind, and everything in between. My questions is, what sort of police training is there around mental health? Are there guarantees I’ll have consistent experiences working with Police? Aura – the criminal justice training center has lots of training for law enforcement. We want at least 25% of every police force in the region going through a 40 hour crisis intervention course that is specialized for each region. Over the next 2 years, a minimum of 25% of patrol officers in each police department will need to attend this training. Co-responder – that is a connection you want to have with the Washington Association of Sheriffs and police chiefs. Question – this isn’t mandatory? Aura – it is mandatory for that percentage. Consider reaching out to the ride along organization to provide that feedback.
- Joy - I’m glad you’re pushing something out, even if it isn’t perfect. Aura – we appreciate your attitude – we know these program won’t be perfect. If we want to be successful, we have to adapt.
- Josh – we are forming working group teams per region to have community voice. Pierce County and Spokane are different places with different needs. We have a listserv – I encourage everyone to sign up to the listserv – you’ll get updated and know about webinars and such. If you have an interested in being in a working group – please let us know through the listserv. Just e-mail to truebloodtaskforce@dshs.wa.gov. Just ask to be on the listserv or what you want to do.
- Barb – what are you doing around healthcare. Aura – there is no requirement to do outreach to Emergency Rooms. We are meeting with Emergency Room staff in Spokane – looking to provide them with info and outreach so they know how to connect to services. Barb – there is a huge issues of hospitals where nurses are beat up and abused and quitting the career – it needs to be addressed. Josh – are meeting with Catholic Health Initiative (CHI) Franciscan and reached out to Multicare – we want to make sure they have the right information to serve them. Barb – it isn’t just the main ones, it is the rural hospitals as well. Aura – I hear you, there is more work that needs to be done.
- Sherri – I suffer from mental health – early childhood trauma - I’m not going to hurt anyone. Our office is right across from Comprehensive Life Resources – what I see on Tacoma avenue and what I see on the road is frightening. What I see in the media is poorly constructed, but is also what is going one. When does visible mental health get treated by this funding – when does it become criminal and we intervene. Aura – I’m not the subject matter expert, but the crisis beds we have are available. Law enforcement if called can divert to crisis centers. Sherri – are there waitlists? Aura – not sure.
- Helen – part of mandating the ERs and such – when I was a forensic therapist social worker at Western State Hospital – we asked the patients what their symptoms looked like and what they should do – often we told them to go to the Emergency Room. It seems important that the Emergency Room staff are aware that people are coming in in this situation – they need to know what to do to respond. This is so important. Aura – just because it wasn’t in the agreement doesn’t mean it isn’t important.
- Question – What can we do to expand the parameters of this whole thing? I have a client detained over 30 times – mental health – no one wants to take her because of her aggressive background. She gets discharged to the streets all the time – with progressively worsening mental health. She is threatening harm on herself, community members, law enforcement – it is like we are waiting for harm prior to getting help for her. We need more facilities equipped to support her. Her only shelter is when law enforcement is called. That is the group the intensive case management in the agreement is designed to assist. Aura – we can share the contact information for DRW. We’ll share that contact information.
- Kelly – we really appreciate you coming here and engaging in this dialog with us.
- Josh – congratulations on the City of Destiny Award (darn straight. –ed)
- (Josh sent me some additional materials to accompany the minutes –ed.)
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