Examining
the
Tools in the Toolbox
A Review of Community Supervision of
Dangerous Mentally Ill Offenders
As conducted by a multi-disciplinary team convened by
King County Prosecuting Attorney, Daniel T. Satterberg, and
Department of Corrections Secretary, Eldon Vail

"I only have the tools in my toolbox, and the tools I have aren't necessarily
the right ones." - Thomas McJilton, Community Corrections Officer, to the
Seattle Post-Intelligencer, March 26, 2008

Prosecuting Attorney’s Office

The efforts of this workgroup are dedicated to the memory of

Shannon Harps
April 3, 1976-December 31, 2007

Shannon Harps was born on April 3, 1976, in Mentor,
Ohio. She loved the outdoors and spent much of her
life helping to preserve nature.
Shannon graduated from Miami University in Oxford,
Ohio, in 1998. During college, she spent a summer
working near Crater Lake National Park in Oregon.
This experience sparked a strong desire in Shannon to
move to the Pacific Northwest should she ever have
the opportunity. Shannon obtained a Masters Degree
in Environmental Education from Lesley College, in
Massachusetts, in 2000.

photo by Dave Schiefelbein

Shannon was able to combine her passion for the
environment with her career when she started working
for the Sierra Club in June, 2000. She spent her first
three years working for the Sierra Club in Ohio.

In 2003, a Sierra Club position opened up in Seattle, and Shannon was selected for it.
Her new position involved long hours trying to bring together activists and volunteers
from across the state in a campaign to reduce greenhouse gases. Shannon was described
by her co-workers as a special person who cared both about the environment and
engaging with people.
In Shannon's spare time she enjoyed biking, running, and hiking. She had studied in
Europe, backpacked in Alaska, and was planning a trip to South America. Shannon
Harps was 31-years old at the time of her death. In her all-too-short life, Shannon clearly
gave more than she received.

Some of the factual information in this section came from a memorial published in The Cleveland Plains
Dealer on January 13, 2008.

i

Tools in the Toolbox: Table of Contents
Dedication ......................................................................................................................

i

Executive Summary ...................................................................................................... vi
Caveats ........................................................................................................................... ix
Timelines ........................................................................................................................ x
Introduction: Genesis - How and why this report came to be .....................................

1

Part I: Preliminary Information - Two key components of the criminal
justice and mental health treatment systems ......................................................

5

A: Dangerous Mentally Ill Offenders ................................................................
B: Civil mental health commitment system (The Involuntary
Treatment Act) ..............................................................................................

5
8

Part II: The Available Tools - How a CCO can remove a defendant
from the street ..................................................................................................... 10
A:
B:
C:
D:

Arrest for violation of supervision conditions ..............................................
Arrest for new crime .....................................................................................
Voluntary hospitalization ..............................................................................
Involuntary civil mental health commitment ................................................

10
10
10
10

Part III: Looking Backward - A review of how "the system" interacted
with James Williams ........................................................................................... 11
A: Williams' Arrival in Washington State and conviction for
Assault in the First Degree ............................................................................
B: Williams' behavior while in prison and attempts at treatment ......................
C: Designation of Williams as a Dangerous Mental Ill Offender .....................
D: Williams' post-prison supervision and treatment ..........................................

11
12
13
14

Part IV: Even While We Worked - The September 2, 2008, shooting in
Skagit County ...................................................................................................... 17
Part V: Observations Revealed - Points of consideration for further action .............. 21

ii

Part VI: Looking Forward - Concepts for Possible Reform ....................................... 25
A: System Capacity ............................................................................................
B: Cross-system communication and cooperation ............................................
1. Remove communication barriers ............................................................
2. Improve the knowledge base of law enforcement agencies
and officers ..............................................................................................
3. Create an accessible database .................................................................
4. Create or enhance multi-agency teams ...................................................
C: Changes to the ITA system - In-Patient ........................................................
1. Expand or clarify existing grounds for detention – general ....................
2. Expand or clarify existing grounds for detention - 90 and
180-day petitions .....................................................................................
3. Improve the use of known information in ITA proceedings ...................
D: Changes to the ITA system - Out-Patient .....................................................
1. Enhance and expand the ability to order mandatory outpatient treatment ......................................................................................
E: Changes to the ITA system - DMIO specific ................................................
F: Changes to the criminal justice system .........................................................
1. Enhance criminal mental health courts ...................................................
2. Improve competency statutes ..................................................................
3. Alter existing NGRI statutes ...................................................................
4. Create a "Guilty, But Mentally Ill" finding ............................................
5. Change to "Determinate-Plus" sentencing in certain cases ....................
6. Increase post-supervision sanctions ........................................................
G: Hybrid options - civil commitment/criminal justice .....................................
1. Pre-charging - create Jail Diversion Programs .......................................
2. Create separate civil commitment systems for those with
violent convictions ..................................................................................
3. Create a system to classify the dangerousness of violent
offenders .................................................................................................
H: DMIO program concepts for reform .............................................................
1. Change the program name ......................................................................
2. Ensure that the existing program works as designed ..............................
3. Expand the existing program ..................................................................
4. Ensure that known information about a DMIO is
provided to DMHPs ................................................................................
5. Expand CCO options for removing DMIOs from the streets .................
6. Get DMIOs into the most intensive/appropriate out-patient
programs .................................................................................................
I: Funding concerns ..........................................................................................
J: Miscellaneous ...............................................................................................

26
26
26
27
27
28
28
28
28
29
29
29
30
30
30
30
31
31
31
31
32
32
32
32
33
33
33
33
33
34
34
34
35

Conclusion: A Call to Action ....................................................................................... 36

iii

APPENDIX A - Submissions from Workgroup Members and Discussion
Summary ............................................................................................................. 37
1. Summary of session discussions on three subjects .......................................
a. Eliminating roadblocks to communication .............................................
b. Providing DMHPs with information on DMIOs in advance ..................
c. DMIOs and Mental Health Advanced Directives ...................................
2. Memorandum from Michael Finkle, Seattle City Attorney's
Office ............................................................................................................
3. Letter from Dr. David Lovell, University of Washington
Professor .......................................................................................................
4. Letter from Dr. Christos Dagadakis, Attending Psychiatrist,
Harborview Medical Center ..........................................................................
5. Memorandum from The Honorable Mary Lou Dickerson,
Washington State House of Representatives ................................................
6. Letter from David Hocraffer, The Public Defender of King
County ...........................................................................................................
7. Letter from Sarah Coats and Shelley Williams, Office of the
Washington State Attorney General .............................................................
8. Joint letter from Eldon Vail, Department of Corrections, and
Robin Arnold-Williams, Department of Social and Health
Services .........................................................................................................
9. Submission from the King County Prosecuting Attorney's
Office ............................................................................................................
10. Memorandum from Captain Scott Strathy, King County
Sheriff's Office ..............................................................................................
11. E-mail from Jo-Ellen Watson, King County Crisis and
Commitment Services ...................................................................................
12. E-mail from Trish Blanchard and Declan Wynne, Sound Mental
Health, and Jo-Ellen Watson and Michael Leake,
King County Crisis and Commitment Services ............................................

38
38
39
40
41
45
48
50
56
62
71
74
82
88
92

APPENDIX B - Glossary and Acronyms ....................................................................... 95
APPENDIX C - Legal Standards Related to Mental Illness ...........................................100
APPENDIX D - Involuntary Civil Mental Health Commitment (ITA)
Caseflow in King County ....................................................................................104

iv

APPENDIX E - A Primer of Mental Health System Components .................................106
A: Civil Mental Health Systems ........................................................................107
1. The Involuntary Treatment Act and civil mental health
court ........................................................................................................107
a. The interface between criminal competency and civil
commitment ............................................................................................109
2. Designated Mental Health Professionals ................................................109
3. The Regional Support Network and out-patient services
Providers .................................................................................................110
a. Sound Mental Health's CIAP program for DMIOs ..........................111
B: Criminal Justice and the Mentally Ill - Pre-Adjudication .............................111
1. The criminal courts and the basics of prosecution ..................................111
a. Superior Court ...................................................................................112
b. District and Municipal Courts ...........................................................112
2. Specialty criminal mental health courts for misdemeanors ....................113
3. Mental health services in the King County Jail ......................................114
4. Defendants not competent to stand trial due to mental illness ................116
C. Criminal Justice and the Mentally Ill - Post Adjudication ............................118
1. The Department of Corrections and the prison system ...........................118
2. The Department of Corrections and community supervision .................121
3. Dangerous Mentally Ill Offenders ..........................................................122
4. DOC's Special Needs Unit in King County ............................................123
5. Defendants found Not Guilty by Reason of Insanity ..............................124
APPENDIX F - The Charging Documents Filed in State v. James Anthony
Williams ..............................................................................................................127
APPENDIX G - Recent Media Articles on DOC's Special Needs Unit in
King County ........................................................................................................134

v

Executive Summary
On December 31, 2007, a young woman named Shannon Harps was stabbed to death in
Seattle. The person charged with her murder is James Anthony Williams. Williams has
a history of prior violence (shooting a stranger in 1995) and a history of severe mental
illness. He was also under supervision by the Department of Corrections (DOC) at the
time of Ms. Harps' murder. Shortly after Williams was charged, King County
Prosecuting Attorney Dan Satterberg and Department of Corrections Secretary Eldon
Vail convened a workgroup to review Williams' interactions with the criminal justice and
mental health treatment systems. This report is the product of the workgroup's efforts.
Williams was not an offender who "flew under the radar." While imprisoned after the
1995 shooting, DOC identified him as mentally ill, very resistant to treatment, and likely
to be dangerous. By the time he was released from prison, he had been designated as a
"Dangerous Mentally Ill Offender" (DMIO). DMIO is not just a designation, but also a
program which allows for additional monies (about $10,000 a year for five years) to be
used to provide services and support for offenders designated as DMIOs as long as they
engage in out-patient treatment.
After prison, Williams lived in Seattle. As a DMIO living in King County, Williams was
monitored by DOC Community Corrections Officers (CCOs) who specialize in working
with mentally ill persons. He was also enrolled in a special mental health treatment
program run by Sound Mental Health (SMH), a private mental health treatment agency.
Through SMH's program, which could access the additional $10,000 in state monies,
Williams received stable housing and medications. Williams averaged multiple contacts
per week with his CCO, his out-patient treatment providers, or both. Once a week, his
case was reviewed by a joint meeting of SMH, CCOs, Seattle Police Officers, and others.
After his prison release in March, 2006, Williams lived in the community for eleven
months without major incident. However, from February 15, 2007, until Ms. Harps’
murder on December 31st, he totaled only 38 more days in the community. On February
15th, his CCO arrested him for violating conditions of his supervision. He spent about
three weeks in jail. Nine days after his release, he threatened to shoot his CCO and SMH
staff and was arrested again. This incident led to criminal charges, additional jail time,
and a related four month civil mental health commitment at Western State Hospital
(WSH). Nineteen days after his release from WSH, he was arrested for threatening a
housemate. He stayed in jail for three months. He also lost his housing.
On December 21st, just before his release from jail for threatening the roommate, he was
evaluated by Designated Mental Health Professionals (DMHPs) for possible civil
commitment for mental health treatment. The DMHPs decided he did not meet grounds
for detention.
In the 10 days between Williams’ release from jail on December 21st and Shannon Harp's
murder on December 31st, his CCO or SMH case manager saw him at least four times,
including several hours before the stabbing. Although the CCO was concerned about
Williams, Williams had not violated his supervision conditions or committed a new
vi

crime, so Williams could not be arrested. He had not done or said anything warranting a
new referral to the DMHPs, so he was not evaluated for a civil mental health
commitment. Without a mechanism to detain Williams on December 31st, his CCO had
no choice but to let Williams go back to the streets.
This workgroup has reviewed Williams' interactions with the criminal justice and mental
health systems since the 1995 shooting, including his participation in the DMIO program.
The workgroup was a forum for discussion and ideas, and did not try to create consensus
for specific proposals. Workgroup members who interact directly with offenders or the
mentally ill discussed what hindered them in fulfilling their duties in the most effective
manner. Members discussed the most appropriate treatment settings for mentally ill
offenders and expressed their concerns that civil rights should not be infringed based
upon mental illness only. As a result of discussions, the workgroup identified 16 points
that must be considered as lawmakers look to reform the system. In addition to the 16
points of consideration, the workgroup identified 76 specific concepts for possible
reform.
The workgroup was a forum for ideas, and did not seek consensus on which reform
concepts should be implemented. However, the members of the workgroup agreed that it
is imperative to address the capacity of the mental health system (both in-patient and outpatient treatment) when any proposal is examined.
Although 76 concepts for reform were identified, the workgroup's discussions centered
primarily on three areas: removing mentally ill offenders off the street when they become
a risk to others, the quality of the DMIO program, and communication between agencies
and systems.
Taking mentally ill offenders off the street
In reviewing Williams' history, the workgroup learned that if an offender is deteriorating
or not following supervision conditions, a CCO has only four tools to take the offender
off the street. Two of those tools, arrest for a new crime or arrest for violation of
supervision conditions, will get the offender off the street quickly, but do not directly
provide for mental health treatment. The third tool, civil commitment for in-patient
mental health treatment, leads to treatment, but is often not available because of strict
criteria related to risk which must be met before detention will occur. The final tool,
voluntary hospitalization, is not realistic for offenders resistant to treatment. What is
lacking is a way to get violent offenders who are decompensating or showing other signs
of risk off the streets quickly and into a treatment situation which will be long enough
and secure enough for their treatment needs and the risk presented. This new tool could
be part of the criminal justice system, the mental health system, or a hybrid of both.
The DMIO Program
The workgroup learned that the DMIO program has achieved positive results. Two
WSIPP studies indicate that the program has had success in getting DMIOs into treatment
sooner and more often, reducing felony recidivism, and creating an overall systemic
savings of $1.24 for every dollar spent on the program. However, full statewide funding
vii

has not been provided in recent years and is threatened with budget cuts. Furthermore,
many DMIOs live in counties in which Regional Support Networks (RSNs) and mental
health providers will not contract with the Mental Health Division of DSHS to provide
services to DMIOs, due in part to liability concerns.
Communication
The workgroup learned that communication across systems is a general problem that
professionals face every day. Many professionals are prohibited from communicating
with others because of confidentiality laws such as HIPAA. Sometimes it is just the
perception of the coverage of confidentiality laws which inhibits communication.
However, even if the communication roadblocks were lessened, there is no general
database where information about the dangerous mentally ill person is kept, and the
professionals in one system cannot easily access the information in another.
The workgroup agreed that there is no obvious answer on how to improve public safety,
protect civil rights, and get offenders into effective treatment at minimal costs. However,
one major purpose of the workgroup was to identify the questions needing answers and
the points to consider for positive reform to occur. It was also a forum for proposing
concepts of reform, knowing that consensus would be elusive at this stage. Whatever
proposals policy makers or lawmakers choose to pursue further, they must weigh the
increase in public safety against the monetary cost of new or expanded programs, and
must continue to consider the liberty costs to those detained. This paper is a beginning of
the conversation over reform, not the end.

viii

Caveats
Caveat 1:
James Anthony Williams is charged in King County with Murder in the First Degree,
with a Deadly Weapon sentencing enhancement. Isaac Zamora is charged in Skagit
County with six counts of Aggravated Murder and fourteen counts of other felony crimes.
They are presumed innocent of those charges until proven guilty. They are also
presumed competent to face these charges until proven otherwise.
Caveat 2:
The focus of the workgroup and this report is on systems. While the workgroup has not
seen obvious individual error on the part of the professionals working with James
Williams, we do not intend to preclude the possibility that other parties may expose error
via other internal review or appropriate litigation.
Caveat 3:
While legislative staff have been present and have been part of the discussion during
workgroup meetings, no specific proposals have been endorsed by elected officials. We
want to thank the staff for their involvement and ability to bring their perspective to the
discussion, but we must acknowledge that they are, and must remain, neutral on specific
proposals, as their job is to support the elected lawmakers in the State House and Senate.

ix

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xi

INTRODUCTION
Tools in the Toolbox: Genesis
How and why this report came to be
On December 31, 2007, Shannon Harps was brutally murdered near her apartment in the
Capitol Hill neighborhood of Seattle. On January 29, 2008, the King County Prosecuting
Attorney's Office charged James Anthony Williams with Murder in the First Degree, with
a Deadly Weapon sentencing enhancement. Williams' culpability, if any, in causing
Shannon Harps' death will be determined through the criminal justice system.
Irrespective of Williams' guilt or innocence of the crime charged, James Williams is a
person with a violent criminal history and who suffers from symptoms of a major mental
illness. He also was engaged in the out-patient mental health treatment system, was
civilly committed for in-patient mental health treatment, and was under the strictest
supervision available in the criminal justice system. In the past 13 years, including 11
years in prison and two years in the community, Williams interacted with a wide gamut
of professionals from many of the organizations and systems that focus on mental illness,
on criminal justice, or on both. These organizations and systems include the Department
of Corrections, the criminal justice system, the civil involuntary mental health
commitment system, and the out-patient mental health treatment system. All of these
systems had much the same goals: to keep the community safe, to keep Williams safe,
and to get Williams to accept mental health treatment.
Upon filing the murder charge stemming from the slaying of Shannon Harps, the King
County Prosecuting Attorney's Office, together with the Department of Corrections,
convened a workgroup to review how Williams interacted with these professionals, and,
perhaps more importantly for the workgroup, how the systems interacted with each other.
This workgroup consisted of medical professionals, university professors, legislators, law
enforcement, prosecuting attorneys, defense attorneys, legislative staff, community
mental health providers, Community Corrections Officers, advocates for the mentally ill,
and others. During the course of the review of Ms. Harps' murder, another incident
occurred in Skagit County in which six people, including Sheriff's Deputy Anne Jackson,
were killed. The charged suspect in that shooting, Isaac Zamora, was also under DOC
supervision and reportedly had a mental illness. This workgroup heard about the
differences in DOC's risk assessments of James Williams and Isaac Zamora, the base of
knowledge DOC had on each offender, and the different levels of supervision for each
offender.
The workgroup was a forum for review of facts, for identification of issues, and for
genesis of possible solutions. The presentations and discussions during workgroup
meetings revealed a timeline of the events from Williams' sentencing in 1995 until his
arrest in January, 2008. The presentations and discussions also came to focus on some
specific points for consideration - clear questions or observations of systemic issues. The
discussion often centered on proposed solutions to those issues.
This report examines the systems that Williams interacted with and attempts to ask
whether improvements in those systems and their interactions might offer more to both
1

the public and to other offenders like Williams. This report does not contain final
answers. The workgroup did not seek a consensus and did not take votes on
recommendations. Rather, it presents ideas to policy makers at the state and local levels
for further consideration and debate. The murder of Shannon Harps and the tragedy in
Skagit County created this opportunity, and obligation, to review the interplay of our
systems, and to consider all options for reform.
Here are the workgroup participants:

Dan Satterberg

Eldon Vail

King County Prosecuting Attorney

Secretary
Washington State Department of Corrections

Craig Adams

Jim Adams

Deputy Prosecuting Attorney
Pierce County Prosecuting Attorney's Office

National Alliance on Mental Illness

The Honorable Ida Ballasiotes (retired)

Senior Counsel
Democratic Caucus Staff
Washington State House of Representatives

Jane Beyer

Washington State House of Representatives

Kevin Black

Trish Blanchard

Staff Counsel
Human Services and Corrections Committee
Washington State Senate

Chief Clinical Officer
Sound Mental Health

Sarah (Sally) Coats

Dr. Christos Dagadakis, M.D.

Assistant Attorney General
Section Chief, Mental Health Section
Washington State Attorney General’s Office

Medical Director
Crisis Intervention Service
Harborview Medical Center

Karen Daniels

Anne Deacon

Assistant Secretary for Community Corrections
Washington State Department of Corrections

Division Manager
Snohomish County Human Services

The Honorable Mary Lou Dickerson

Sergeant Liz Eddy

Washington State House of Representatives

Seattle Police Department

Erin Ehlert

Officer Scott Enright

Assistant Chief Criminal Deputy
King County Prosecuting Attorney’s Office

Seattle Police Department

Mike Finkle

Russ Goedde

Assistant City Attorney
Seattle City Attorney’s Office

Assistant Director, Operations
King County Office of the Public Defender

2

Ian Goodhew

John Gower

Deputy Chief of Staff
King County Prosecuting Attorney’s Office

Caucus Attorney
Washington State House of Representatives

Rashi Gupta

David Hackett

Policy Director
Human Services, Housing & ACHS Coordinator
Washington State Association of Counties

Senior Deputy Prosecuting Attorney
King County Prosecuting Attorney’s Office

Dr. Murray Hart, M.D.

V. David Hocraffer

Manager-Inpatient Forensic Evaluation Program
Center for Forensic Services
Western State Hospital

King County Public Defender
King County Office of the Public Defender

The Honorable Christopher Hurst

Richard Kellogg

Washington State House of Representatives

Director
DSHS Mental Health Division

John Lane

Richard Lichtenstadter

David Lord

Dr. David Lovell, Ph.D.

Governor's Policy Office

Felony Supervisor
The Defender Agency

Director of Public Policy
Disability Rights Washington

Research Associate Professor
Psychosocial and Community Health
University of Washington

Leesa Manion

Tom McBride

Chief of Staff
King County Prosecuting Attorney’s Office

Executive Secretary
Washington Association of Prosecuting Attorneys

Thomas McJilton

Linda Merelle

Community Corrections Officer
Washington State Department of Corrections

Staff Counsel
Human Services Committee
Washington State House of Representatives

Bonnie Muccilli

The Honorable Al O’Brien

Field Administrator
Washington State Department of Corrections

Washington State House of Representatives

Laura Petregal

Betty Pine

Deputy Prosecuting Attorney
King County Prosecuting Attorney’s Office

Manager
King County Jail Health Services

Dr. Richard Ries, M.D.

Ethan Rogers

Professor of Psychiatry
Director, Division of Addictions
University of Washington

Senior Deputy Prosecuting Attorney
King County Prosecuting Attorney’s Office

Bernie Ryan

Amnon Shoenfeld

Policy Counsel
Washington State Senate

Director
King County Mental Health, Chemical Abuse and
Dependency Services Division

3

The Honorable Julie Spector

David Stewart

Judge
King County Superior Court

Human Services Director
Pierce County Corrections

Cheryl Strange

Captain Scott Strathy

Deputy Secretary
Washington State Department of Corrections

King County Sheriff’s Office

Dr. Eric Trupin, Ph.D.

Jo-Ellen Watson, Ph.D.

Professor and Vice-Chair
Department of Psychiatry and
Behavioral Sciences
University of Washington School of Medicine

Coordinator
Crisis and Commitment Services
King County Mental Health, Chemical Abuse and
Dependency Services Division

Shelley Williams

David Weston

Chief
Mental Health Services
DSHS Mental Health Division

Assistant Attorney General
Washington State Attorney General’s Office

Declan Wynne

Program Manager
Mentally Ill Offender Department
Sound Mental Health

4

PART I
Tools in the Toolbox: Preliminary Information
Two key components of the criminal justice and mental health
treatment systems
On January 19, 1995, James Anthony Williams shot a stranger at a bus stop in Seattle.
Seattle Police arrested Williams soon thereafter. He spent the next eleven years in jail or
prison. On January 16, 2008, Williams was arrested for failing to follow court-imposed
conditions related to the 1995 shooting. In the thirteen years between the two arrests,
Williams interacted with numerous people working for the criminal justice and mental
health treatment systems.
This review of Williams' contacts with the criminal justice and mental health treatment
systems, and the professionals who try to carry out the systems' goals, will start with a
brief overview of two components of those systems: (1) the Dangerous Mentally Ill
Offender designation and program, which applies to certain offenders upon their release
from prison, and (2) the civil mental health involuntary commitment system, through
which persons with mental illness may be forced to do treatment if they present a risk to
themselves or others. Appendix E contains full descriptions of these and many other
components of the criminal justice and civil mental health treatment systems as a
resource the reader of this report can refer to as needed.
A. Dangerous Mentally Ill Offenders
Most persons with mental illness are law abiding and have very little, if any, contact with
the criminal justice system, except perhaps as victims. Still, a very small number of
persons with mental illness do commit crimes of extreme violence. When this occurs, the
system must be able to address the individual's criminal behavior and their mental illness.
The system must treat the individual and also protect the public. One major approach
used in Washington State is to identify, while they are in prison, offenders who have
mental illness and present a likelihood of future violence, and then to engage those
offenders in intense mental health services as they leave incarceration and re-enter the
community. The offenders so identified are designated as Dangerously Mentally Ill
Offenders (DMIOs). The unique and intensive program designed to engage a DMIO in
services is the Community Integration Assistance Program (CIAP).1
Depending on exactly how their symptoms impacted their actions, mentally ill persons
who commit criminal acts of extreme violence may be found either guilty of the crime or
Not Guilty by Reason of Insanity.2 Those found guilty will be sentenced by a judge just
like any other convicted defendant. The judge's sentence will have two components: (1)
incarceration time, usually in the state prison system, and (2) a period of supervision in
1

The term "Dangerous Mentally Ill Offender" is the term used in the Revised Code of Washington.
"Community Integration Assistance Program" is what the Mental Health Division of DSHS calls the
program for DMIOs. The terms are sometimes used interchangeably. CIAP is also what some out-patient
mental health provider agencies call their specific program of case management and other services they
directly provide to DMIOs.
2
The implications of a Not Guilty by Reason of Insanity finding are described in Appendix E.

5

the community which starts upon the offender's release from prison and during which the
offender must follow certain conditions. The state prison system is run by the
Washington State Department of Corrections (DOC). The professionals assigned to
monitor offenders3 on community supervision work for DOC and are known as
Community Corrections Officers (CCOs). If a person does have a mental illness, one of
the imposed conditions of supervision may be to follow mental health treatment
recommendations. However, the mere imposition of mental health treatment as a
condition of supervision is often not enough to prompt an offender to actually engage in
treatment, especially for the most severely mentally ill.
The goal of the DMIO designation and associated program is to mitigate the likelihood of
further violent acts by offenders with mental illness, for whom normal DOC community
supervision may not be effective. The process to identify an offender as a DMIO starts
during the last 12 months of the offender's period of incarceration. Per RCW 72.09.370,
DOC identifies incarcerated offenders who are reasonably believed to be dangerous to
themselves or others and have a mental disorder. Well in advance of the offender's
scheduled release date, the offender is referred to the "DMIO Committee," a board of
professionals consisting of members from DOC, DSHS, Regional Support Networks,
community mental health and chemical dependency providers and others. If determined
by the committee to meet the criteria for DMIO designation, the offender is then
designated as a Dangerous Mentally Ill Offender.
An offender designated as a DMIO receives additional scrutiny by DOC once released.
However, the offender is also offered additional mental health treatment and support
services through the Mental Health Division of Washington State's Department of Social
and Health Services (DSHS). The Mental Health Division (MHD) contracts with
regional agencies known as Regional Support Networks (RSNs) and with communitybased mental health treatment providers to provide the DMIO related services.
Unfortunately, there are areas of Washington State where no RSN or provider is willing
to contract to provide DMIO services, due to liability concerns. In these areas, an
offender designated as DMIO will not be provided the enhanced DMIO services.
As noted, the primary goal of the DMIO program is to increase public safety. The main
strategy of the DMIO program is to have DOC and DSHS work closely with community
mental health providers to get DMIOs into housing and into community-based mental
health treatment soon after their release. If the DMIO participates in treatment, the
treatment provider has access to about $10,000 per year (for the first five years after
release) to help the DMIO receive necessary treatment, housing, or other services. This
$10,000 is provided by DSHS, and is in addition to any funding from other potential
sources, such as Social Security.
Presumably, additional attention and resources will lead to the DMIO being more
psychiatrically stable, reducing recidivism and creating overall savings for the system.
Early studies of the DMIO program indicate some success, including a lower felony
recidivism rate, earlier entry into mental health treatment, and a savings (through lower
3

"Offender" is the term most CCOs use in referring to those they supervise, and that will be the term
primarily used in this paper.

6

incarcerations costs, prosecution costs, etc.) of $1.24 for every $1.00 spent on the
program.
The legislation creating the DMIO designation and related program created different
charges for DOC and DSHS with regard to whether a DMIO's participation in treatment
is mandatory or voluntary. Under certain circumstances, DOC or a judge can order an
offender to comply with treatment. If participation in mental health treatment is imposed
as a condition of supervision, the offender’s participation is considered mandatory by
DOC because a CCO can arrest a DMIO who has not participated in treatment.
However, once the period of DOC community supervision has ended, the DMIO's
continued participation in the enhanced program only occurs if the DMIO voluntarily
agrees to do so.4 DSHS has no inherent authority to mandate that a DMIO participate in
treatment.5
In King County, DMIOs are supervised in the community by DOC's Special Needs Unit.
This group of eight Community Correction Officers has smaller caseloads -- 25 to 30
defendants, rather than the approximate 40 defendants most CCOs supervise. There are
approximately 45 DMIOs in King County supervised by the Special Needs Unit. The
rest of the unit's caseload is made up of other offenders with mental health issues, such as
those offenders found Not Guilty by Reason of Insanity (NGRI). Most Special Needs
Unit CCOs have mental health backgrounds. They generally see each DMIO once or
twice a week, and may see them more often if the condition of the DMIO seems to
warrant it. Each CCO is often quite familiar with the DMIOs on the other CCOs'
caseloads, and this fosters more of a team approach by the Special Needs Unit. For
instance, when one CCO is checking in on a DMIO and is in an area where another CCO
also has a DMIO, the CCO will check-up on both DMIOs if possible.
In King County, the Special Needs Unit CCOs keep in close contact with their DMIOs'
out-patient mental health treatment providers. The out-patient treatment providers are the
professionals who manage an offender's mental health treatment plan, including
attempting to make sure that the offender is prescribed and takes medication as
appropriate. Out-patient treatment providers are not considered part of the criminal
justice system.
For most DMIOs in King County who engage in treatment, mental health case
management is provided by Sound Mental Health (SMH), a private agency which
provides a wide variety of out-patient mental health services. SMH has a program
designed specifically for DMIOs, called the Community Integration Assistance Program.
Besides communicating about any particular offender for which there is heightened
concern, the CCOs and SMH meet once a week to review the status of all DMIOs. This
meeting is also attended by other agencies, including the Seattle Police Department
(SPD), housing representatives, and chemical dependency treatment providers. There are
4

It is important to note that in some cases, the criminal sentence does not include any period of community
supervision. In these cases, DOC involvement with the DMIO ends once the DMIO is released from
incarceration.
5
Participation can again become "mandatory" if another court, such as the ITA court discussed in the next
section, obtains jurisdiction over the DMIO and orders participation in mental health treatment as part of its
proceedings.

7

about 60 DMIOs in King County engaged in the CIAP program, including many who are
not on active DOC supervision.6
B. Civil mental health commitment system (The Involuntary Treatment Act)
Once an individual convicted of a violent crime has completed their time of incarceration,
if the individual also has a major mental illness, they may come into contact with the civil
mental health commitment system. The involuntary treatment part of the civil mental
health system attempts to protect the public and the mentally ill when risk can be
identified but before serious harm occurs. It also provides a mechanism to treat mentally
ill criminal defendants who are incompetent to stand trial.
Every state has a system for involuntary detaining and treating persons who are
dangerous to themselves or others because of mental illness. In most cases, commitment
can occur before a crime has been committed. Furthermore, the goal of the commitment
is treatment, not punishment. Therefore, these proceedings are considered civil in nature.
In Washington State, the current civil involuntary treatment system was created by
legislation known as the Involuntary Treatment Act (ITA).
Even though no crime is charged, involuntary hospitalization via the ITA is considered a
major imposition on a person's liberty. Therefore, many appropriate due process
considerations are in place to make sure involuntary detention and treatment is warranted,
even for someone previously convicted of a violent crime who clearly has a mental
disorder. These considerations include a right to counsel and a right to contest the
commitment in front of a judicial officer, or, at times, a jury.
Because commitment is an imposition on a person's liberty, the grounds for ITA
detention are limited, and the standards for approving detention are high. A person can
only be placed involuntarily in a hospital if, due to the mental disorder, the person
presents a likelihood of intentional serious physical harm to themselves or others, if they
have caused substantial damage to another's property, or if they cannot provide for their
essential needs of health and safety.7 If the basis for commitment is "danger to others,”
the risk must be substantial, the potential harm must be serious, the risk must be specific
to individuals rather than general in nature, and the person must have engaged in a
"recent overt act." The patient's well-being is as much a priority of the ITA system as
public safety is.
6

The total number of DMIOs currently living in King County is not known, because once a DMIO is no
longer supervised by DOC and is not engaged in the CIAP program (either by choice or because the five
years of enhanced services have concluded), the DMIO's whereabouts are not tracked. Some may be
engaged in mental health treatment, even through an RSN, but since this treatment is not connected to the
criminal justice system, it is not tracked by DOC or DSHS.
7
Courts usually require that the risk must be a near term risk, rather than one where the harm is unlikely to
occur for some time, if at all. Many people refer to this as the risk needing to be "imminent," using the
term "imminent" in a general sense. However, "imminent" has a specific legal definition in the ITA
statutes that bears solely on whether the individual can be put immediately into a treatment facility on a
DMHP's own authority or whether the DMHP must obtain judicial authorization first. If judicial
authorization is obtained, the detention can occur even though the situation does not fit the legal definition
of "imminent." Legally, therefore, the danger need not be "imminent" for detention to occur.

8

Furthermore, the design of the ITA system is to minimize the period of in-patient
treatment. With some exceptions, only after a person has been in the local hospital for 72
hours and then 14 days can a local hospital seek hospitalization for 90 days and transfer
to a state hospital. After that, a patient can be involuntarily detained for longer periods of
time at a state hospital, but only if the case is reviewed every 180 days and the grounds
upon which the detention is based can be proven to still exist each time it is reviewed. A
person cannot be hospitalized merely because they would benefit from the
hospitalization, and must be released once the immediate mental health crisis is resolved
and out-patient treatment appears to have a legitimate chance of being successful.
Most ITA cases begin with a referral to local officials known as Designated Mental
Health Professionals (DMHPs). The DMHPs gather what information they can about a
person referred to them, including talking to available witnesses. They also attempt to
directly talk to and evaluate the person. If the DMHPs decide the person meets grounds
for detention and needs hospitalization, they detain the person for up to 72 hours and send
them to a local in-patient psychiatric treatment facility, known officially as an Evaluation
and Treatment Facility (E&T). If the E&T decides the person needs longer-term
treatment, they file a petition with the Superior Court requesting 14 additional days of inpatient treatment. A hearing can occur over the need for additional treatment and both
the E&T and the patient will be represented by attorneys. Further petitions (first for 90days of treatment, and then for 180-days) can be filed based on the perceived risk and
treatment needs of the patient. At each stage after the first 72 hours, the detained person
has a right to contest the detention and force the treating facility to prove to a judicial
officer (or sometimes to a jury) the grounds for detention.8
If the referral to the ITA system is in conjunction with a criminal case being dismissed
because the defendant is not competent to stand trial, the initial request for treatment
under the ITA can be for 180 days if the charged crime was a felony and 90 days if the
charged crime was a serious misdemeanor. In King County, the defendant may go
directly from jail to Western State Hospital, which decides whether to initiate the ITA
proceeding.

8

See Appendix D for a flowchart of the adult ITA system in King County.

9

PART II
Tools in the Toolbox: The Available Tools
How a CCO can remove a defendant from the street
If a Community Corrections Officer believes an offender they are supervising has
become dangerous and needs to be removed from the community, that CCO has four, and
only four, "tools" to remove the person from the community. These tools are available
whether or not the offender is designated a DMIO. There are no additional tools
available for taking a DMIO off the street, other than these four.
A.

Arrest for violation of supervision conditions

First, if an offender has violated a condition of the offender's supervision, the CCO can
arrest the offender, put the offender in jail, and file a violation report. However, the
maximum amount of time an offender can serve is 60 days per violation, and the offender
may receive no mental health treatment or may refuse available treatment while in jail.
B.

Arrest for new crime

Second, if an offender's misconduct rises to the level of a new crime, a law enforcement
agency can be contacted and the offender can be arrested and charged. However, the
length of detention due to the new charge and the services provided while in jail depends
upon many factors, including the nature of the charge, whether an offender can make
bail, and the offender's willingness to cooperate with treatment while incarcerated.
C.

Voluntary hospitalization

Third, the CCO can encourage the offender to enter into a psychiatric hospital
voluntarily. However, most hospitals will not accept DMIOs as voluntary patients,
because the DMIOs' past history indicates that they are so resistant to treatment that they
will not be successful as good-faith voluntary patients. Furthermore, any voluntary
patient can request to leave the hospital at any time, making it an impractical option for
the CCO in all but the rarest of circumstances.
D.

Involuntary civil mental health commitment

As the fourth option, a CCO can refer an offender for involuntary mental health
commitment under the Involuntary Treatment Act (ITA). However, the grounds for ITA
detention are limited, and the standards for approving detention are high. If the potential
ground for commitment is "danger to others,” the risk must be substantial and near term,
the potential harm must be serious, the risk must be specific to individuals rather than
general in nature, and the person must have engaged in a "recent overt act." The design
of the ITA system is to minimize the period of in-patient treatment, and the offender
would have the right to contest the commitment in front of judicial officers fairly
frequently. In short, for a CCO looking to take an offender off the street, the ITA system
is only a hit-or-miss option, and can only rarely be considered a long-term solution.
10

PART III
Tools in the Toolbox: Looking Backward
A review of how "the system" interacted with James Williams
Caveat: James Anthony Williams is charged with Murder in the First Degree, with a
Deadly Weapon sentencing enhancement. He is presumed innocent of those charges
until proven guilty. He is also presumed competent to face these charges until proven
otherwise.
James Anthony Williams was born in Arkansas on March 17, 1959. His mother died
when he was eight, and he never knew his father. After his mother died, he was raised by
other members of his family, mostly maternal grandparents, but his living situation never
stabilized. His formal education ended in Grade 5, although he would later earn a GED
while in prison. His first hospitalization for mental health issues occurred in Arkansas
when he was 12 years old. By age 19, the Social Security Administration determined that
he was eligible for SSI income due to his mental disability.
Williams' first commitment to a prison system occurred in Arkansas in 1976 at age 17 for
a burglary and theft crime. Between 1976 and 1994, he migrated through Arkansas,
Texas, Florida, and Oklahoma, and committed at least four crimes ranging from
misdemeanor assault to felony forgery. He was assessed or hospitalized psychiatrically
several times. He was diagnosed with a major mental disorder and with a personality
disorder. Major mental disorders can often be treated with medications. Medications are
less likely to successfully address the major symptoms of personality disorders.
Williams was often prescribed psychiatric medication but very rarely took the
medications on his own. He also felt the need to have a weapon on him because he
foresaw a need to use it in self-defense. He also had a persistent feeling of animosity
towards women.
A.

Arrival in Washington State and conviction for Assault in the First Degree

Williams arrived in Washington State in the first part of 1994. In March, he committed a
misdemeanor assault in Kittitas County. By January, 1995, he had made his way to
Seattle.
On January 19, 1995, Williams was at a bus stop in downtown Seattle. He singled out a
complete stranger. He began harassing the stranger, asking the stranger whether he was
"scared of a gun" and indicating that he had one. Williams then pulled out a .44 caliber
handgun from his backpack. William pointed the gun at the stranger, and asked the
stranger in slang terms whether the stranger wanted Williams to shoot. Williams then
shot the stranger in the hand. The victim fled and Williams shot at him two more times.
Williams also fled but was soon caught and confessed.

11

The King County Prosecuting Attorney's Office charged and tried the defendant on a
charge of Assault in the First Degree, with a Deadly Weapon Sentencing Enhancement.
Prior to trial, he was twice sent to Western State Hospital for competency evaluations.
The evaluator at Western State Hospital determined that Williams was able to assist his
attorney in his own defense and understand the nature of the charges against him and that,
therefore, Williams was competent to stand trial. A Superior Court jury found Williams
guilty as charged on September 1, 1995. The defendant's standard range was 105 to 135
months. This range included time added on because of the use of the deadly weapon. On
October 20, 1995, the trial court judge sentenced Williams to 135 months of confinement
(the top end of the standard range), to be followed by two years of supervision in the
community by the Department of Corrections. As conditions of supervision, the judge
ordered that the defendant obtain a mental health evaluation and follow all treatment
recommendations, and that he complete anger management counseling.
In most cases, defendants are released prior to the expiration of their sentence due to
good behavior while in prison, with the remainder of the potential confinement time
added to the two years of community supervision. Based on the law at the time he was
sentenced, Williams could have been released 20.25 months early (15% of 135 months) if
he behaved appropriately in prison. However, Williams' behavior in prison was so bad
that he earned less than two months off his incarceration time.
B.

Williams' behavior while in prison and attempts at treatment

Williams entered the Washington State prison system in October, 1995. His first stop
was at the assessment center at the DOC facility in Shelton. He began violating prison
rules even before the assessment process was finished. Within a week, he ended up in
23-hours-per-day confinement because of rule infractions. This type of confinement is
called segregation. While Williams did not spend his entire prison term in segregation,
Williams spent most of his sentence apart from the rest of the prison population as he
committed close to 250 rule infractions during his imprisonment. Williams was
considered a very violent and intense prisoner and would repeatedly make very detailed
and graphic threats to prison staff which accounted for many of the infractions.
During his imprisonment, he stayed at many DOC facilities. His first transfer for mental
health reasons was to the mental health program at McNeil Island. He stayed in that
program for two months. This did not lead to long term psychiatric stability.
DOC later moved Williams to the Special Offender Unit9 in the DOC facility in Monroe.
This is the most intensive mental health program within DOC. DOC sought and obtained
approval to place Williams on an involuntary medication regimen. Once on medications,
the symptoms of his mental disorder improved. However, DOC's authority to administer
medications involuntarily is limited, and Williams reached the level of functioning at
which involuntary medication could not be continued. Once involuntary medication
stopped, Williams refused to take medications voluntarily.

9

This is different from the "Special Needs Unit" consisting of CCOs supervising out-of-custody defendants
in King County.

12

Williams' continued refusal to take his medications voluntarily created a clear pattern
during his years in DOC. Once he was off his medications, he would decompensate.
Initial symptoms of the decompensation were an increase in pressured speech, an
increased level of agitation, and increased perseveration and delusions. He would then
commit rule infractions, often by threatening or assaulting others, leading to his being
placed in 23-hours-per-day confinement. This would lead to another order allowing
medications to be administered involuntarily. Once on medications, some of his
symptoms improved, eventually leading to the next iteration of the pattern. During
periods of better behavior, he would be moved out of the Special Offender Unit or even
out of the Monroe facility.
As noted earlier, Williams could have earned up 20.25 months of time off for good
behavior (known as earned early release). However, Williams' overall behavior in prison
was so bad that he earned only minimal time off, and ended up serving over 133 of the
entire 135 month prison sentence in the various DOC prison facilities.
C.

Designation of Williams as a Dangerous Mental Ill Offender

In July, 2004, the end of Williams' maximum court-ordered prison sentence was less than
two years away, and with it, DOC's authority to keep the defendant in a locked facility.
Once the sentence was complete, DOC had no option but to release Williams back into
the community. In an effort to prepare Williams for the transition, DOC again placed
him in the Special Offender Unit at Monroe.
Another round of involuntary medication improved Williams' symptoms. This particular
combination of medications appeared to have the best overall effect. Williams' behavior
and socialization ability reached its highest plateau of his DOC stay. Williams' rate of
committing infractions lessened, but did not cease. Even at his increased level of
functioning, Williams had a delusional fear of electricity and electric shock to the extent
that DOC was deterred from putting him in a general population setting because he feared
being in a cell which contained an electrical outlet. Eating with other inmates was a big
step for him socially. He expressed nervousness about the upcoming release into the
community. He showed symptoms of depression, a condition that had not been prevalent
earlier. DOC worked with Williams on an 11-step "Progressive Re-Entry Program" and
started to talk with him about his release.
Beyond treatment attempts while Williams was still in prison, DOC prepared for
Williams' release into the community by referring him for designation as a Dangerous
Mentally Ill Offender. A committee that reviews such requests agreed that Williams
should be designated as a DMIO. In the last few months of his incarceration, Williams
was persuaded to sign Releases of Information and to work with Sound Mental Health,
the mental health treatment agency in King County which has a program specifically for
DMIOs. Once SMH was on board, they arranged for Williams to live at Berkey House
upon release from prison. Berkey House is clean and sober housing for the mentally ill.
DOC also assigned the Community Corrections Officers of the Special Needs Unit in
King County to supervise Williams after his release.
13

D.

Williams' post-prison supervision and treatment

Williams was released from prison on March 8, 2006. Either his CCO and/or his SMH
case manager would meet with him almost every day of the work week. Sometimes the
visits were at Williams' residence; sometimes Williams went to the SMH or DOC office.
Later, appointments would even occur at designated street corners or near police stations
as concerns about Williams' behavior grew. An on-site manager of Berkey House would
report on how Williams behaved during the weekend. There was a weekly meeting
between CCOs and SMH staff, where all DMIO offenders were discussed. The meeting
would be attended by others, including Seattle Police Officers assigned to a special unit
who often deal with the mentally ill.
For a month and a half after his release from DOC, Williams maintained appropriate
behavior in the community. When he was not at SMH offices doing mental health
treatment such as group therapy sessions, he spent most of his time in Berkey House
watching television. His first official sanction for violating the conditions of his
supervision occurred in June, 2006, when he self-reported that he had missed treatment
groups the previous week. He was verbally reprimanded for the violation. Throughout
the rest of 2006 and into early 2007, he received three more sanctions for not following
supervision conditions: once for missing treatment groups, once for missing medications
(which he resumed the next day), and once for using marijuana. His sanctions were a
verbal reprimand, a requirement to attend more groups, and a requirement to report to the
DOC office three times a week for a month for urinalysis.
On February 15, 2007, his CCO believed Williams had stopped taking his medication.
The CCO also felt Williams was deteriorating and that Williams should not be on the
street. The CCO arrested Williams for violating his supervision conditions. This was
Williams' first time behind bars since his release from prison. A Superior Court judge
sanctioned him with 15 days in jail for the violation. He was released from jail on March
7th.
On March 16, 2007, while in the SMH office, Williams made threatening remarks to
others, including a threat to shoot his CCO and all the case workers at his assigned SMH
office. He was also failing to take his medication. CCOs arrested Williams immediately.
Williams would remain in a locked facility (jail or Western State Hospital) from March
16 until September 3, 2007.
Williams' actions on March 16th would result in both sanctions for violating his
supervision and new criminal charges. For violating his supervision by not taking
medication, a Superior Court judge imposed 60 days in jail as a sanction. This was the
maximum amount of time the judge could impose.
While the defendant was sitting in jail on the sanction, the Seattle City Attorney's Office
filed misdemeanor Harassment charges for the March 16th threats towards the CCO and

14

others. On April 21st, having never left jail, Williams was arraigned on the new charge.
Bail was set at $100,000, a very high figure for a misdemeanor. 10
Seattle Municipal Court had jurisdiction over the misdemeanor case. Williams' case was
referred to the Mental Health Court of Seattle Municipal Court. This is a criminal court.
It is oriented towards getting its participants into mental health treatment. However, by
April 24th, Williams' competency to stand trial became an issue. On May 1st, and because
Williams was not competent to stand trial, the Municipal Court judge was required by
statute to dismiss the criminal case. As permitted by statute, the court then sent Williams
to Western State Hospital for possible civil mental health commitment under the
Involuntary Treatment Act.
Western State Hospital sought civil mental health commitment through the Involuntary
Treatment Act. They succeeded in their request and Williams was officially civilly
committed soon after his arrival in early May, 2007. The initial commitment was for 90
days of in-patient treatment. Williams would stay in in-patient treatment at Western State
Hospital until September 3, 2007. Confidentiality laws protect Williams’ right to privacy
as an ITA patient, so WSH cannot disclose the reasons for Williams’ discharge, including
whether WSH thought discharge was appropriate or whether the grounds for further
detention could no longer be proved at an ITA hearing.
CCOs of the Special Needs Unit began working with social workers at Western State
Hospital soon after the civil commitment started, knowing that he would eventually have
to be released. The assigned CCO worked with Western State Hospital social workers
for approximately a month to prepare Williams for release. When the release came on
September 3rd, CCOs picked the defendant up from WSH and drove him to see his case
manager at SMH, and then drove him home to Berkey House.
Less than three weeks later, on September 22nd, Williams threatened another resident of
Berkey House. Seattle Police arrested him. At the time of the arrest, the defendant was
armed with a knife. He told the police that it was for self defense.
This time, the defendant would remain in jail from September 22 until December 21,
2007.
Once again, Williams' actions would result in both sanctions for violating his supervision
on the 1995 Assault 1 conviction and in new criminal charges. Almost immediately, the
Seattle City Attorney's office filed misdemeanor Harassment charges in Seattle
Municipal Court. For violating his supervision by not following mental health treatment
recommendations, a Superior Court judge would later impose 60 days in jail as a
sanction. This was the maximum amount of time the judge could impose.
10

In Washington State, any crime where the maximum punishment is greater than one year of confinement
is classified as a felony. Non-felony crimes (i.e., where the maximum sentence is one year or less) are
classified as either misdemeanors, where the maximum punishment is no more than 90 days, or gross
misdemeanors, where the maximum punishment is at least 90 days but no more than one year. In this
report, the term "misdemeanor" will refer to both misdemeanors and gross misdemeanors unless
specifically noted. Harassment is a gross misdemeanor with a maximum punishment of one year in jail.

15

The misdemeanor charge was referred to the same criminal Mental Health Court of
Seattle Municipal Court. This treatment-oriented court requires voluntary participation
on the part of a defendant. Williams opted not to participate and his case was transferred
back to regular Municipal Court. Williams' competency to stand trial was also raised
again. However, this time the court found Williams competent to stand trial.
On December 18th, Williams pleaded guilty to one count of misdemeanor Harassment.
He was sentenced to 120 days with credit for time served. He was also referred to the
Designated Mental Health Professionals of King County (DMHPs) to see whether he
should be civilly committed because of risks to himself or others caused by his mental
disorders.
DMHPs met with the defendant on December 21st, his last day in jail. The DMHPs did
not detain the defendant for civil commitment. Strong confidentiality statutes protect the
rights of those detained or being considered for detention for civil mental health
commitment under the Involuntary Treatment Act. As they would be for any person
referred to them for civil commitment, DMHPs are prohibited by statute from discussing
Williams' case.
Because of his threats, Williams had been evicted from Berkey House. After his release
on December 21st, Williams was homeless, staying nights at a homeless shelter. There
were six working days between December 21st and December 31st. The CCOs and SMH
staff saw Williams at least four of those days and had extensive discussions about him at
a meeting on a fifth day. His CCO saw him on December 31st. Williams' presentation
that day was not much different than in previous days. There was now always a level of
concern the CCOs had about him, and much of the effort of the CCOs went into making
sure Williams took his medication. However, between December 21st and December
31st, Williams had not made any threats or menacing gestures, nor engaged in any
suicidal or homicidal ideation. He therefore neither had done nor said anything which
would have warranted a referral for civil mental health commitment. Between December
21st and December 31st, he had not committed a new crime and was compliant with his
conditions of supervision. His CCO therefore had no authority to arrest him.
On December 31, 2007, hours after the meeting with DOC, Shannon Harps was stabbed
to death on Capitol Hill.
DOC and SMH found housing for Williams at the Curben Hotel, which is considered
housing of last resort. Williams missed a DOC appointment on January 10, 2008. On
January 16th, DOC officers arrested Williams for supervision violations. These violations
were never adjudicated because on February 5, 2008, the King County Prosecuting
Attorney's Office filed murder charges against Williams for the death of Shannon Harps.

16

PART IV
Tools in the Toolbox: Even While We Worked
The September 2, 2008, shooting in Skagit County
Caveats:
Isaac Zamora is charged in Skagit County with six counts of Aggravated Murder and
fourteen counts of other felony crimes. He is presumed innocent of those charges and
competent to face them.
The workgroup received information about the Skagit County tragedy from DOC's
perspective, via a presentation and submission. Accounts of the perception of others in
this section come from media reports.
While this workgroup met over several months to examine the systems and tools that
professionals use to treat and supervise mentally ill offenders in the community, another
tragic incident occurred in Skagit County, Washington. On September 2, 2008, six
people were killed, including Sheriff's Deputy Anne Jackson, and four more were injured
in a single shooting rampage. The charged suspect, Isaac Zamora, was also a convicted
felon, and while never in prison, was under Department of Corrections supervision, with
probable mental health issues. Similar themes are present in both cases, but significant
differences also exist. While this incident occurred near the end of the workgroup's
sessions, the workgroup did have at least a discussion and partial review of this incident.
As of this writing, DOC had not completed a full internal review of their interaction with
Zamora, and information regarding this incident is not as available or complete as in the
Williams review. 11 However, Zamora's rampage merits discussion as part of this
workgroup's examination of how the criminal justice system interacts with the mentally
ill. It merits discussion because, like Williams, Zamora was under DOC supervision and
appears to be seriously mentally ill. Unlike Williams, however, the DSHS/DOC system
never identified Zamora as a potential candidate for the Dangerous Mentally Ill Offender
program. Zamora was, in fact, not eligible for the DMIO program since he had never
been to prison. In many respects, Zamora more accurately represents the type of offender
the system must deal with every day. Both offenders moved through the same system,
albeit each receiving a different level of scrutiny and supervision.
Prior to his most recent arrest, Zamora had 25 misdemeanor convictions for offenses
including Theft, Obstruction of a Law Enforcement Officer, Malicious Mischief,
Violation of a No-Contact Order and drug offenses. He had three felony level
convictions including Theft in the Second Degree, Malicious Mischief in the Second
Degree and Violation of the Uniform Controlled Substances Act--Possession of Cocaine.
From the public's perspective, it is clear that Zamora has an alarming number of criminal
convictions. However, Zamora's criminal history is similar to numerous others in prison
11

Information about Isaac Zamora and his handling by DOC comes from the DOC offender file summary
and from the presentations of Eldon Vail and Cheryl Strange at the workgroup meeting on September 22,
2008.

17

or on DOC supervision, and therefore unremarkable for that particular population.
Unlike Williams, Zamora's potential for extreme violence is not revealed by the nature of
his prior convictions because his criminal history does not include any assault convictions
and certainly does not include a conviction for a felony-level violent offense.
As a result of Zamora's latest felony conviction for VUCSA in May 2008, the court
sentenced Zamora to six months in jail, and 12 months of supervision in the community
by DOC. As conditions of supervision, the sentencing judge ordered Zamora to
participate in a mental health evaluation and a substance abuse evaluation and to follow
all recommended treatment.
DOC identifies the level of risk each offender under their control presents to the public.
Zamora was sentenced at a time when DOC was transitioning from one risk assessment
tool to another. Zamora was assessed using both tools. While still in custody, DOC
completed an intake on Zamora using the older tool, called the Level of Service
Inventory Tool (LSI). Using this tool, DOC assessed Zamora as having a LSI score of
39, which resulted in a Risk Management Level B (RMB) classification. This is the
second highest risk category (out of four).
DOC contracts with some county jail facilities to house inmates. Zamora therefore did
his jail time in Okanogan County. Contract facilities like Okanogan are not used for
severely mentally ill inmates, as these facilities will not accept persons with major mental
illnesses or significant behavior problems. What can be inferred from this is that Zamora
was not presenting with symptoms of mental illness while incarcerated, or the Okanogan
jail would have requested that he be moved.
Zamora was released from jail in early August, but was quickly arrested for an
outstanding warrant. He was released again on August 6, 2008. It appears the assigned
CCO learned of his release on Friday, August 8, 2008, and left a message for Zamora
telling him to report by the end of the day. Zamora did not report on Friday, but did
report to the DOC office by 11:00 am on Monday, August 11th. Zamora was directed to
report again the following day to meet directly with his assigned CCO. On August 12,
2008, Zamora reported as directed and spoke with his CCO. Zamora indicated that he
was living with his parents and attempting to get help from DSHS. The CCO asked
Zamora whether he was working with the local jail transition services in attempting to set
up a mental health appointment and Zamora said, "I will do everything on my own. I
don't need them." Zamora said he would not go to Compass Health (an out-patient
mental health treatment agency) "because they take care of all the white trash there." He
talked about relocating to Bellingham. The CCO reminded Zamora he could not move
without approval and that he was to continue to report the first and the third Wednesday
of each month.
On August 13, 2008, DOC reclassified Zamora using the newly adopted Static Risk
Assessment. This assessment attempts to rank offenders using unchanging factors such
as gender and criminal history. Using this new assessment tool, Zamora scored out as

18

High Risk - Non-violent. According to DOC's new tool, this assessment means that
Zamora was evaluated as having a high risk to re-offend in a non-violent crime.12
On August 20, 2008, Zamora again reported to his CCO. He had not yet obtained a
mental health or substance abuse evaluation. Despite his earlier negative statements
regarding mental health treatment, he stated that he was still working with DSHS to
obtain assistance and funding. He reported that he had an orientation set for the
following week. He also indicated that his parents had kicked him out and he would be
staying at a local shelter. Zamora also submitted a urinalysis sample, which tested
negative for any controlled substance. Zamora's CCO indicated that he reported one
more time after August 20, 2008. She entered lengthy notes about this contact into the
computer records of DOC, but they were apparently lost when the new computer system
went down. The CCO reported that Zamora had reported to her and indicated that he was
back living on his parent's property. Zamora's next scheduled report date was September
3rd. Zamora never reported because on September 2, 2008, and less than a month after
DOC community supervision began, he was arrested for allegedly killing six people and
injuring four others in a Skagit County shooting rampage.
As noted above, Zamora appeared to DOC to be a typical supervisee, and nothing from
his behavior in jail raised itself as a reason to be particularly concerned about his
potential for extreme violence. His risk assessments had classified as presenting some
risk, and the mental health examination requirement gave notice that there were probable
mental health issues, but his CCO and other DOC staff had not seen worrisome
symptoms of mental illness. There was no court-set deadline for obtaining the mental
health evaluation. His progress towards obtaining the evaluation was typical, especially
as he also had to arrange for the funding of the evaluation.
DOC's perception, based on the information they had first-hand and from the Okanogan
jail, was in stark contrast to the perception of family and local law enforcement. Media
reports indicate that Zamora had a clear and well-known history of mental illness.13
Zamora as an individual and his symptoms of apparent mental illness were known to the
12

An offender's classification is used to determine some mandatory supervision targets, such as the number
and type of monthly contacts between an offender and the CCO. Since the Skagit County shooting, all
offenders who had been classified using the new static risk assessment tool were electronically rescored
after DOC was informed by the Washington State Institute for Public Policy (WSIPP) of calculation errors.
The formula received from WSIPP upon which the DOC computer application was initially constructed
was in error. The new scoring went into effect on October 20, 2008. The result of this rescoring changed
Zamora’s classification from High Risk - Non-violent to High Risk - Violent. Regarding Zamora's actual
supervision, the contacts the CCO made with Zamora in the office (since he was homeless) met the
mandatory contacts guidelines for a High Risk - Violent risk level classification.
13

The workgroup did not hear from law enforcement or mental health officials from Skagit County.
Information regarding police and family knowledge of Zamora's apparent mental illness comes from two
Seattle Times articles: O'Hagan, Maureen and Berens, Michael. "Shooting-rampage Suspect Described as
Deeply Troubled." Seattle Times. 4 Sept. 2008 <http://seattletimes.nwsource.com/html/localnews/
2008158190_webzamora04m.html>; and Whitely, Peyton. "Skagit County Murder Spree Suspect: 'I Kill
for God.'" Seattle Times. 6 Sept. 2008 <http://seattletimes.nwsource.com/html/localnews/2008162802_
shootings06m.html>.

19

Skagit County's Sheriff's Department and specifically to Deputy Anne Jackson, who was
killed in the rampage.
The family, friends and neighbors of Isaac Zamora have said that he was in need of
psychiatric treatment for years. Family and neighbors reported that Zamora had shown
increasing signs of mental illness over the years, including suicide attempts,
hallucinations, overt threats and property damage. Zamora's mother reported that despite
the family's urging, he would not agree to on-going mental health treatment. At one
point, in 2003, Zamora's mother and his girlfriend took him to a Whatcom County
hospital saying they feared for their safety. At that time, he was held for a few weeks.
Upon release he told his girlfriend he wanted to go back. However, the hospital declined
to re-admit him for further treatment. Later, Zamora was admitted to another hospital
and during that stay, he bit a hospital employee who was restraining him. The next day,
he was discharged. Zamora's mother told reporters that over the years the family tried
everything they could think of to get him into treatment and nothing worked.
However, none of the information or concerns of the police and family reached DOC
before the shooting, to alert DOC that Zamora had this level of potential violence.
Zamora had been in the community for less than a month before the shooting, and his
community supervision was therefore still in its early stage. DOC believes its local
CCOs in Skagit County have a good relationship with the Sheriff's Department, but
Zamora had not yet been discussed between the two agencies. There is no central
database where DOC can look up what police or mental health agencies know about an
individual. Zamora's mental health treatment had been spread across more than one
county, so even if DOC had access to what was done in Skagit County, they may not
have had access to what was known in Whatcom County. DOC will typically contact
family members as part of supervision, but it had not yet occurred in the short time (in
DOC's view) Zamora had been on their supervision.

20

PART V
Tools in the Toolbox: Observations Revealed
Points of consideration for further action
Caveat:
The focus of the workgroup and this report is on systems. While the workgroup has not
seen obvious individual error on the part of the professionals working with James
Williams, we are not intending to preclude the possibility that other parties may expose
error via other internal review or appropriate litigation.
On December 31, 2007, Williams' CCO appeared to be out of "tools" to take Williams off
of the street. Williams had not committed a recent crime. He was compliant with his
conditions of supervision. He was too resistant to treatment to be a good-faith voluntary
patient at a psychiatric hospital. He did not make any threats or menacing gestures, nor
engage in any suicidal or homicidal ideation, so he had neither done nor said anything on
which his CCO could have based a referral for hospitalization under the Involuntary
Treatment Act.
The review of how a DMIO such as Williams could appear to be dangerous and yet had
to be left in the community led the workgroup to discussions of how the criminal justice
and mental health systems interact with each other, including their ability to
communicate with each other. Some of the discussion was directly related to events
during the Williams' timeline; much of the discussion turned to broader issues,
experiences, and concerns. Certain themes came to the fore, even if no clear answer also
became apparent.
What follows are specific points to consider when a policy maker contemplates any
systemic reform in this area. These are the questions and observations that became the
focal points of the workgroup's attention.
Consideration point (1):
How can the capacity of the mental health treatment system, including both in-patient and
out-patient treatment, be adjusted or expanded to better fit the treatment needs of persons
who have mental illness, especially for the very small segment of the population who
have mental illness and also have the potential to become extremely violent?
Consideration point (2):
What legal, policy, and technological roadblocks prevent the professionals who work
with persons with mental illness from communicating with each other? How can the
roadblocks be removed? These professionals include police, prosecutors, mental health
treatment providers, Designated Mental Health Professionals (DMHPs), Community
Correction Officers (CCOs), and the criminal and civil courts.
21

Consideration point (3):
Is there a way to expand an existing centralized database, or create a new one, so that any
professional (including law enforcement, CCOs, DMHPs, or treatment providers)
needing to interact with a person with mental illness and a history of violence can learn
about the illness and history prior to the interaction?
Consideration point (4):
Some offenders who (A) have committed a violent crime and (B) have a mental illness
are classified as Dangerous Mentally Ill Offenders (DMIO) as they are being released
from prison. Which treatment or support services are most effective in reducing
recidivism by DMIOs (e.g., FACT teams - Forensic Assertive Community Treatment
teams, expanded use of Less Restrictive Alternatives, outpatient civil mental health
commitment, or housing programs)?
Consideration point (5):
If a DMIO is living in the community and either decompensates or otherwise becomes
dangerous:
Is the civil involuntary mental health treatment system, known as the ITA
system, appropriate for DMIOs?
Are initial 72-hour or 14-day involuntary treatment periods, which are
available in the ITA system, of any use for ITA cases involving DMIOs?
Are the local in-patient treatment facilities safe and secure enough to
handle a DMIO (both for the patient and for others)? As an example, King County has
only 14 beds available for the most acute patients, where the staffing is highest and the
ability to prevent a person from acting out physically is greatest. Those beds are often
full, meaning DMIOs must either be sent to other ITA beds or be left boarding in a
hospital emergency room.
If the DMIO's behavior does not meet standards for ITA commitment,
how can other professionals intervene to prevent harm to the offender or others?
Consideration point (6):
Are the practices of Designated Mental Health Professionals, who have the authority to
detain people under ITA law, consistent on a statewide basis, assuming the same
circumstances and facts are presented to a DMHP; or are there variances by county or
region? If there are variances by county or region, are there statutory or professional
revisions that can address the variations in outcomes?

22

Consideration point (7):
Are the practices and standards of Evaluation and Treatment facilities, prosecutors, and
defense attorneys, and the interpretation of ITA law by the judiciary, consistent across the
state? If not, are there ways to make them less divergent?
Consideration point (8):
Should there be less strict standards under which a person can be ordered to do
mandatory out-patient mental health treatment? If so, what should be the ramification if
the person does not follow the order? Is it an infringement on civil rights if the
ramification is involuntary in-patient treatment?
Consideration point (9):
Which system is best equipped to deal with a DMIO who becomes dangerous or
decompensates: the Department of Corrections, the ITA system, or a third system yet to
be created?
Consideration point (10):
Do CCOs need more options (tools) in order to supervise DMIOs? What tools can be
created to take DMIOs off the street when they exhibit signs of dangerousness or
decompensation, but have not violated their supervision conditions or met ITA criteria?
What other agencies could also benefit from having more options?
Consideration point (11):
What interventions are appropriate for offenders with mental disorders who present a
threat to public safety, but have not been designated as a DMIO?
Consideration point (12):
The DMIO programs appear to have succeeded in creating a cooperative atmosphere
between DSHS, Regional Support Networks, local mental health providers, and DOC.
What steps can be taken to shore up or improve the DMIO program? How can counties
which are reluctant to provide services to DMIO for fear of liability be made or enticed to
provide those services?
Consideration point (13):
Should prosecutors have more charging options when mental illness is a contributing
factor in the commission of a violent crime? If so, to what crimes should the expanded
options be available? What are the types of concerns, due process or otherwise, that can
be raised by giving prosecutors more options?

23

Consideration point (14):
Should judges have more sentencing options when mental illness is a contributing factor
in the commission of a violent crime? If so, to what crimes should the expanded options
be available?
Consideration point (15):
What is the best way to evaluate the costs and benefits of a lifelong supervision,
commitment, or incarceration approach to segments of the DMIO population, as reflected
in such suggestions as creating a "Guilty, but Mentally Ill" finding in criminal cases, an
SVP-style civil commitment analog, or a "determinate plus" sentencing scheme for
offenders who are violent and mentally ill?
Consideration point (16):
If, in connection with a conviction for a violent offense, additional mechanisms are
created allowing for involuntary in-patient mental health treatment for those who become
or remain a risk to public safety, should the in-patient treatment be under the auspices of
DOC or of DSHS? Should any new resources made available for additional out-patient
treatment or support (such as housing) be controlled by DOC or by others?

24

PART VI
Tools in the Toolbox: Looking Forward
Concepts for Possible Reform
The Community Correction Officers and mental health professionals working with
Williams appeared to have tried all viable options for improving Williams' behavior and
keeping the community safe. By December 31st, there was much concern about
Williams' potential for violence, but he remained in the community. However, as of
December 31st, no tool in the toolbox, from the violations process, to a new criminal
prosecution, to the ITA commitment process, to voluntary hospitalization, could be used
to either remove Williams from the streets or to improve his behavior.
As expressed in the previous section, there are discernable issues to explore concerning
the criminal justice system, the mental health treatment system (including involuntary
commitment), and the way the two systems interact. Many specific ideas were brought
out during workgroup discussions. Many members of this workgroup have submitted
their concepts and other observations in writing. Those submissions are attached as
Appendix A. Appendix A also includes a summary of three concepts which were
discussed extensively during workgroup meetings, but have not appeared in the
submissions of the workgroup members.
This section contains 76 concepts for possible reform drawn from the discussions and
submissions. No votes were taken on recommendations, and a consensus was not
sought. Rather, we offer these ideas to policy makers at the state and local level for
further consideration and debate. Whatever concepts are pursued further, the increase in
public safety must be weighed against the monetary cost of new or expanded programs
and the liberty and privacy costs to those detained who present as dangerous but who
would not actually be violent.
Caveat: While legislative staff have been present and have been part of the discussion
during workgroup meetings, no specific proposals have been endorsed by elected
officials. We want to thank the staff for their involvement and ability to bring their
perspective to the discussion, but we must acknowledge that they are, and must remain,
neutral on specific proposals, as their job is to support the elected lawmakers in the State
House and Senate.

25

Concepts for Reform
System Capacity
1. Increase the capacity of the facilities that care for the mentally ill, as it is important to
acknowledge that current in-patient and out-patient resources are not sufficient, and
that any reform will likely result in more persons utilizing both in-patient and outpatient care. These facilities include the state hospitals run by DSHS (both forensic
and civil beds), the treatment centers within DOC, and facilities working with
Regional Support Networks (including local ITA Evaluation and Treatment facilities
and providers who work with persons under court orders to do out-patient treatment).
(From discussion in several workgroup meetings; submission of Jo-Ellen Watson)
2. Re-evaluate what is the appropriate number of in-patient wards which should be
operating at Eastern and Western State Hospitals, including whether wards currently
scheduled to be closed at Eastern and Western State Hospitals should remain open.
(From discussion in 10/7/08 workgroup meeting)
3. Investigate whether it would be cost-effective (through reduction of demand for inpatient treatment) to expand either out-patient resources (including housing
resources), the number of Program of Assertive Community Treatment (PACT)
teams, and/or the placement resources for dementia patients. (From discussion in
10/7/08 workgroup meeting)

Cross-system communication and cooperation
Remove communication barriers
4. Remove regulatory and agency-policy barriers to the sharing of information across
agencies who are involved in mental health crisis prevention and intervention. Some
barriers are based on law and regulations, others are based on the perception of law
and regulation. A workgroup approach may be needed to identify specific problems
and the exact type of fix needed (e.g., education as to what laws and policies actually
prohibit, change in regulatory policy, or change in statute). (DOC/DSHS submission,
eighth bullet point)
5. Encourage law enforcement personnel to make inquiries into mental health history
and symptoms, and not to assume that privacy laws will prevent the information from
being provided. (Captain Scott Strathy submission, bullet point #2)
6. When information sharing is allowed, require that information be transmitted quickly
from agency to agency when it is regarding a person in crisis. (From discussion in
10/7/08 workgroup meeting)
7. Allow civil mental health courts, prosecutors, and defense attorneys to communicate
information to criminal mental health courts, prosecutors, and defense attorneys.
(From discussion in 3/19/08 workgroup meeting)

26

8. Allow law enforcement, prosecutors and criminal courts to obtain information
concerning civil mental health commitments for use in determining bail, and in
making decisions concerning filing of charges and release of defendants in violent
offenses. (PAO submission, point #8)
9. Expand the ability of the state hospitals to notify the prosecutors of felony charges
that the person so prosecuted will be leaving the state hospital. (Coats/Williams
submission, point #2)

Improve the knowledge base of law enforcement agencies and officers
10. Increase training for police officers in working with persons with mental illness,
including how to identify those who are decompensating and to whom that
information should be shared, and what type of information is and is not protected by
privacy laws. (Captain Scott Strathy submission, bullet points # 2 and 4; From
discussion in 10/7/08 workgroup meeting)
11. Create means and protocols for police to formally assess the risk posed by persons
who have mental health issues and who have made recent violent threats. This could
be done through the training of commissioned law enforcement personnel in the use
of risk assessment tools. It could also be done by members of the behavioral science
community working for or in conjunction with police. (Captain Scott Strathy
submission, bullet point #1)
12. Encourage further information sharing between law enforcement agencies, including
by out-of-state agencies who know of individuals with high risk potential moving to
Washington State. (Captain Scott Strathy submission, bullet point #3)
13. Examine current police interagency cooperative agreements for gaps in information
sharing regarding persons who present a high risk of potential violence. (Captain
Scott Strathy submission, bullet point #3)

Create an accessible database
14. Develop a database, or adjust a currently existing database, to cover persons with
prior convictions for violent felonies and with mental illness. The database should
include a synopsis of past acts of violence and other relevant information. It should
be accessible to any professional (DMHP, DOC CCO, police officer, mental health
provider) who may be involved in crisis intervention. (Dr. Dagadakis submission,
point #7; Captain Scott Strathy submission, bullet point #2; Discussion in 9/22/08
workgroup meeting)
15. Create lists of specific risk factors for potentially violent individuals such as DMIOs,
and then make sure that all potential crisis responders have access to those lists so
they can compare a person's current presentation to past times when they have
actually acted violently. (From discussion in 4/30/08 workgroup meeting)

27

Create or enhance multi-agency teams
16. Establish interagency staffing to identify "high alert" cases, followed by
communicating the gathered information to DMHPs. The information would include
packets containing descriptions of past acts, behavior while in prison, and known
criminal convictions. (Dr. Lovell submission, 2nd page, 1st bullet point; DOC/DSHS
submission, seventh bullet point; Discussion in 4/30/08 workgroup meeting)
17. Create multi-agency teams, which include DMHPs, law enforcement, CCOs, and outpatient providers to pro-actively monitor and intercede with persons with mental
illness who have a history of violence or dangerousness ("high-alert" cases). Multiagency teams exist, but they generally do not include DMHPs. (Dr. Lovell
submission, 2nd page, second bullet point; Dr. Dagadakis submission, point #5; Mike
Finkle submission, point B-1-a.; DOC/DSHS submission, seventh bullet point)
18. Include a mental health professional, such as a nurse (but not necessarily a DMHP),
in multi-agency teams. (From discussion in 4/2/08 workgroup meeting)
19. Develop a Rapid Response Team in King County, consisting of one representative
from CCS, SMH-CIAP, DOC-Special Offenders Unit, and Seattle CIT, in order to
staff specific and emerging situations with this particular sub-population of offenders.
The purpose of the team would be to develop a cross-system crisis plan evaluating the
needed response and determining which system best meets the community's and
offender's needs: Civil Commitment, Criminal Justice (if a new crime committed), or
revocation of community supervision. If successful and resources are available, the
project could be expanded to other high-risk populations. (CCS/SMH submission,
point #5)

Changes to the ITA system - In-Patient
Expand or clarify existing grounds for detention - general
20. Expand the definition of "likelihood of serious harm" to clarify what constitutes a
"violent act." (DOC/DSHS submission, fourth bullet point)
21. Expand the definition of "likelihood of serious harm" to include other readily
identifiable risk factors. (DOC/DSHS submission, fourth bullet point)
22. If a risk classification system exists, make it easier (almost automatic) to civilly
commit a person who has been assigned a high violence risk level. (Dr. Dagadakis
submission, point #2)
23. Work to standardize how ITA law is implemented statewide by DMHPs, E&T's,
prosecutors, and the courts. (From discussion in 10/7/08 workgroup meeting)

Expand or clarify existing grounds for detention - 90 and 180-day petitions
24. In addition to all current grounds, allow ITA detentions for 90 days of treatment to be
based on threats made by a person before the person's hospitalization, if the person
continues to present a likelihood of serious harm due to a mental order.
(Coats/Williams submission, point #1)
28

25. After a felony charge is dismissed due to the lack of competency of a defendant to
stand trial, allow a subsequent ITA petition for 180 days of in-patient treatment to be
based on any 180-day petition ground, not just on grounds related to the likelihood of
felony acts being repeated. (Coats/Williams submission, point #2)
26. Change the wording of the ground for 180-day petition related to felonies from "acts
constituting a felony" to "acts that threatened, attempted, or inflicted physical harm
upon the person of another or substantial damage upon the property of others."
(Coats/Williams submission, point #2)

Improve the use of known information in ITA proceedings
27. Amplify and specify that certain evidence is relevant to a determination of whether
ITA grounds for detention exist, including correctional records, community mental
health records, and hospital records. (Dr. Lovell submission, 2nd page, third bullet
point)
28. Clarify that in making a decision as to whether ITA grounds for detention exist, the
examiner can use established past patterns of behavior to determine what is likely to
occur if there is no intervention. (Dr. Lovell submission, 2nd page, fourth bullet point)
29. In initial ITA detentions, direct DMHPs and the courts to consider evidence of a
person's past involvement in the criminal justice system, including past competency
determinations, past ITA commitments, and past patterns of decompensation. (Rep.
Dickerson submission, ITA point #1; DOC/DSHS submission, second bullet point)
30. Make it easier to obtain admissible copies of criminal history or mental health
treatment records for use in evaluating the need for 72 hours of mental health
evaluation and treatment. (Rep. Dickerson submission, ITA point #2)
31. Make it easier for a judge to consider the facts leading to an earlier ITA detention
when deciding issues in a current ITA proceeding. (From discussion in 4/30/08
workgroup meeting)

Changes to the ITA system - Out-Patient
Enhance and expand the ability to order mandatory out-patient treatment
32. Consider authorizing involuntary out-patient treatment using broader standards than
standards used to authorize involuntary in-patient treatment. Initial steps could
include either a pilot program (including an evaluation component) or development of
a stakeholder workgroup to explore the viability of an involuntary out-patient
program. (Rep. Dickerson submission, ITA point #3; DOC/DSHS submission, first
bullet point)
33. Extend the length of ITA Less Restrictive Orders. For example, extend the length of
all L.R.O.'s to 180 days, even if the in-patient hospitalization time for revocation of
the L.R.O. doesn't change. (From discussion in 4/30/08 workgroup meeting)
34. If a person with a prior conviction for a violent felony is detained for at least 14 days,
make any follow up Less Restrictive Order have a lifetime duration. The patient
could ask for termination of the L.R.O. after ten years. A violation of the L.R.O.
would result in a 180 day commitment. (Dr. Dagadakis submission, points #3,4,6)
29

35. If a person civilly detained has a prior conviction or has been found Not Guilty by
Reason of Insanity for a violent offense, allow an ITA court to impose an L.R.O. with
at least a 180 day duration. A violation of the L.R.O. would result in a 180 day
commitment. (PAO submission, point #9)
36. Clarify that the criteria for revocation of a L.R.O. of a person assigned a high
violence risk level is non-compliance with the L.R.O., not only whether any other
ITA criteria are met. (Dr. Dagadakis submission, point #9)

Changes to the ITA system - DMIO specific
37. Eliminate short-term civil commitments (e.g. 14-day and possibly 90-day
commitments) for DMIOs who need civil commitment. (From discussion in 6/25/08
workgroup meeting)
38. Do not send DMIOs to local E&T's upon initial civil commitment detentions. Send
DMIOs to facilities better able to handle a DMIO's level of potential violence
(probably state hospitals, with immediate priority admission provisions). (From
discussion in 6/25/08 workgroup meeting)
39. Create an out-patient civil commitment program for DMIOs over whom DOC
supervision has elapsed. The threshold for commitment would be lower than the
present ITA commitment standards for non-offending citizens. (PAO submission,
point #3)

Changes to the criminal justice system
Enhance criminal mental health courts
40. Expand criminal mental health court to include certain felonies (not just
misdemeanors reduced from felonies). (Mike Finkle submission, point B-1-c.)
41. Have one regional criminal mental health court which accepts cases from all
jurisdictions in that region, including all felony and misdemeanors. (From discussion
in 6/25/08 workgroup meeting)

Improve competency statutes
42. Require a competency evaluation at the end of any in-patient civil commitment for
any person whose civil commitment started after a violent felony charge was
dismissed due to the lack of competency of the person. (From discussion in 3/19/08
workgroup meeting; PAO submission, point #6)
43. In violent felony cases where a state hospital has restored the competency of a
defendant, give the courts clear discretion to have the defendant held at the state
hospital pending trial, to prevent decompensation in local jails. (From PAO
submission, point #6)

30

Alter existing NGRI statutes
44. Expand the definition of insane in NGRI pleas to the definition of insane used in the
Model Penal Code § 4.01 (1) - "A person is not responsible for criminal conduct if at
the time of such conduct as a result of mental disease or defect he lacks substantial
capacity either to appreciate the criminality [wrongfulness] of his conduct or to
conform his conduct to the requirements of law." (David Hocraffer submission, page
4)
45. For any person found NGRI for a violent offense, impose a lifetime L.R.O. upon
release from in-patient treatment. (Dr. Dagadakis submission, point #8)

Create a "Guilty, But Mentally Ill" finding
46. Create a "Guilty, But Mentally Ill" finding in criminal cases, to allow for certain
defendants, in appropriate cases, to be held accountable for their acts but also allow
for the initiation and continuation of mental health treatment to reduce the likelihood
of future violent acts. (PAO submission, point #7)
47. As part of creating a Guilty, But Mentally Ill finding in criminal cases, expand the
definition of insanity or GBMI to include a volitional impairment component. (Mike
Finkle submission, point B-1-d.)

Change to "Determinate-Plus" sentencing in certain cases
48. Authorize the use of "Determinate-Plus" sentencing for violent offenders who are
mentally ill. Determinate-Plus sentencing would be used as a sentencing
enhancement when the initiating conditions, including a future dangerousness
provision, are charged and proved. As part of this system, an offender's engagement
in mental health treatment while in prison would be one of the factors considered
when release is at issue. (PAO submission, point #4)
49. Create a system to classify the risk of violence for persons subject to DeterminatePlus sentencing, to be determined at time of release into the community. (PAO
submission, point #4)

Increase post-supervision sanctions
50. Make the sanctions for violation of supervision conditions longer than 60 days to
ensure violent offenders are off the street longer. (From discussion in 4/30/08
workgroup meeting)

31

Hybrid options - civil commitment/criminal justice
Pre-charging - create Jail Diversion Programs
51. Create a jail diversion program for persons with mental illness that is post-booking
but pre-charging. Criteria allowing entry into the program could include whether the
person has a history of at least two prior cases dismissed due to lack of competency
(where the person was not detained after dismissal), the nature of the charge, or the
person's criminal history. (Mike Finkle submission, point B-1-b.)
52. Encourage more communities throughout the state to create jail diversion programs
and facilities. (From discussion in 10/7/08 workgroup meeting)

Create separate civil commitment systems for those with violent convictions
53. Create a system with the ability to quickly hospitalize decompensating offenders,
similar to the current NGRI supervision system, for a broad category of violent
offenders who are mentally ill. (From discussion in several workgroup meetings)
54. Create a separate civil commitment track for those under DOC supervision, where the
grounds for commitment, the length of in-patient treatment, and the facility where the
in-patient treatment occurs can be bettered tailored to the detained person's history of
actual violent acts. (PAO submission, point #2)
55. Create a civil commitment model for violent or dangerous mentally ill offenders
similar to SVP-type commitment, to address the likelihood that DMIOs will need
longer terms of in-patient and court-ordered out-patient treatment. (PAO submission,
point #5)
56. Create secure facilities for persons with mental illness who are not amenable to
treatment and who continually commit criminal acts jeopardizing public safety.
(From discussion in several workgroup meetings)

Create a system to classify the dangerousness of violent offenders
57. Create a classification system to assign a violence risk level to persons with mental
illness who have a history of violent acts. The assigned risk level can be used in a
variety of circumstances. The designation would be made by a workgroup
representing a cross-section of the criminal justice and mental health systems. (Dr.
Dagadakis submission, point #1; Discussion in 5/15/08 workgroup meeting)

32

DMIO program concepts for reform
Change the program name
58. Rename the DMIO program, probably to the Community Integration Assistance
Program, as some private providers of services, such as housing, do not provide
services to persons tagged as "Dangerous." (Rep. Dickerson submission, DMIO point
#1)

Ensure that the existing program works as designed
59. Ensure that key stakeholders remain aware that there does not need to be a correlation
between the predicate crime and mental illness in order for an offender to be
designated a DMIO. (CCS/SMH submission, point #1)
60. Ensure that documentation of crimes and mental health evaluations are received by
the DMIO statewide selection committee prior to their DMIO determinations.
(CCS/SMH submission, point #2)
61. Require that referrals to RSNs and out-patient mental health treatment agencies occur
at least three to five months prior to a DMIO's earliest possible release date so that
there is adequate pre-release assessment and engagement in services of the DMIO.
(CCS/SMH submission, point #3)
62. Work to ensure there is access to services for DMIOs statewide, possible by requiring
RSNs to contract as a DMIO service provider as a condition of their Medicaid
contract with the state. (Rep. Dickerson submission, DMIO point #4)

Expand the existing program
63. Expand the group of high-risk offenders eligible for the DMIO model of pre-release
engagement, interagency cooperation, and enhanced social service support.
(DOC/DSHS submission, fifth bullet point)

Ensure that known information about a DMIO is provided to DMHPs
64. Require that any pre-release assessment of a DMIO is provided to the DMHPs where
the DMIO will reside. This assessment should include a psychological profile,
behaviors exhibited while in prison, and a complete description and dates of each
previous offense. (CCS/SMH submission, point #4)

33

Expand CCO options for removing DMIOs from the streets
65. Authorize CCOs to remove DMIOs from the streets upon decompensation or other
signs the public is at risk, even if no new crime or supervision violation has occurred.
(PAO submission, point #1)
66. Authorize CCOs to place a DMIO into a secure treatment facility rather than jail
when the DMIO has authority to remove them from the street. This could be a
facility run by DOC. (PAO submission, point #1)

Get DMIOs into the most intensive/appropriate out-patient programs
67. Encourage DMIOs to execute Mental Health Advance Directives. In conjunction
with this, whether providers are currently willing to honor directions in MHADs
should also be explored. (Rep. Dickerson submission, DMIO point #5, second bullet
point)
68. Provide greater flexibility in the use of DMIO funding. An example would be
authorizing DSHS to transfer funds to DOC if additional supervision is an appropriate
service for a particular DMIO. (Rep. Dickerson submission, DMIO point #3, third
bullet point)
69. Require that DMIOs be evaluated for eligibility for PACT programs and give DMIOs
who qualify priority to receive PACT services. (Rep. Dickerson submission, DMIO
point #5, first bullet point)
70. Develop a Forensic Assertive Community Treatment program for offenders under
correctional supervision which is closely modeled on the PACT team program.
(DOC/DSHS submission, sixth bullet point)

Funding concerns
71. Give violent offenders who are mentally ill but who do not qualify for Medicaid a
non-Medicaid funding tier. (Dr. Dagadakis submission, point #10)
72. Backfill the existing funding shortfall of the DMIO program. (Rep. Dickerson
submission, DMIO point #2)
73. Increase DMIO contractor rates. Means of increasing the rate could include a
biennial inflationary adjustment or creating a geographic adjuster based on local
housing costs. (Rep. Dickerson submission, DMIO point #3, first and second bullet
points)

34

Miscellaneous
74. Modify the initial placement and evaluation processes in the case of high-risk
offenders under correctional supervision to ensure a full review of all circumstances.
(DOC/DSHS submission, third bullet point)
75. Increase the ability for medications to be administered involuntarily in local jails.
(From discussion in 6/25/08 workgroup meeting)
76. Create a community awareness campaign to educate the public on who to call when
they see a person in an apparent mental health crisis. (From discussion in 10/7/08
workgroup meeting)

35

CONCLUSION
Tools in the Toolbox: A Call to Action
Professionals within the civil and criminal systems work hard and often succeed in
preventing harm due to mental illness. It is impossible to know how many violent acts
are actually prevented daily because of the efforts and frequent interventions of
Community Corrections Officers, DMHPs, mental health professionals, and the police.
Their efforts should be praised and applauded.
Those working within the systems also remain cognizant of the rights of individuals and
balance those rights with the need to protect public safety. Despite the professionals'
best efforts, persons with mental illness are unpredictable and will, at times, inflict
serious harm or even death. Yet, and although such a risk is always present despite the
systems' best efforts, there is no such thing as an "acceptable murder." The tragedy that
befell Shannon Harps is also a call to examine the tools given to those charged with
preventing future tragedies.
James Williams was mentally ill. He presented a risk to others, even though no one could
say exactly when or against whom he would act. The professionals dealing with
Williams knew the risk he presented, and used their available tools to try to prevent it
from coming to fruition. Nevertheless, the available tools were not enough. The
indications, at this point, are that James Williams' presence on Capitol Hill on the
evening of December 31, 2007, was due to the limits of the system, not by the lack of
diligence or effort of the professionals working within it.
Therefore, the available tools must be sharpened, and new tools created. The mission of
this workgroup has been to explore and suggest areas where the tools can be improved,
and with it, public safety. It is now up to those hearing these suggestions to further
explore them, come up with their own ideas, and implement those which are feasible.

36

APPENDIX A
Submissions from Workgroup Members
and Discussion Summary
1.

Summary of session discussions on three subjects: ............................................
a.
Eliminating roadblocks to communication .............................................
b.
Providing DMHPs with information on DMIOs in advance ..................
c.
DMIOs and Mental Health Advanced Directives ...................................

2.

Memorandum from Michael Finkle, Seattle City Attorney's Office .................. 41

3.

Letter from Dr. David Lovell, University of Washington Professor .................. 45

4.

Letter from Dr. Christos Dagadakis, Attending Psychiatrist,
Harborview Medical Center ................................................................................ 48

5.

Memorandum from The Honorable Mary Lou Dickerson,
Washington State House of Representatives ...................................................... 50

6.

Letter from David Hocraffer, The Public Defender of King County ................. 56

7.

Letter from Sarah Coats and Shelley Williams, Office of the
Attorney General ................................................................................................. 62

8.

Joint letter from Eldon Vail, Department of Corrections, and Robin
Arnold-Williams, Department of Social and Health Services ............................ 71

9.

Submission from the King County Prosecuting Attorney's Office ..................... 74

10.

Memorandum from Captain Scott Strathy, King County Sheriff's
Office .................................................................................................................. 82

11.

E-mail from Jo-Ellen Watson, King County Crisis and
Commitment Services ......................................................................................... 88

12.

E-mail from Trish Blanchard and Declan Wynne, Sound
MentalHealth, and Jo-Ellen Watson and Michael Leake, King
County Crisis and Commitment Services ........................................................... 92

37

38
38
39
40

Appendix A-1
Summary of session discussions on three subjects
a. Eliminating roadblocks to communication:
At some point in every workgroup meeting, the discussion turned to communications,
often focusing on communication between agencies and systems, and where
professionals in the mental health and criminal justice fields have come up against
roadblocks in communicating with each other.
Here are some situations workgroup members have noted (either in workgroup sessions
or via e-mail) where attempts to get information have been stymied, at least in King
County:
1.
Some persons with mental health issues find themselves charged with a
misdemeanor crime and under the jurisdiction of a criminal mental health court. If that
person is also civilly detained under the ITA, the ITA confidentiality statute, RCW
71.05.390, limits what professionals in the ITA system can tell those in criminal mental
health court. This includes prosecutor to prosecutor, even if they work in the same office.
2.
Sometimes the information concerning the prior violent history of a person being
evaluated by a DMHP can only be found by examining the criminal history of the person.
However, DMHPs do not have the authority or the technological capability to check
criminal history. Furthermore, proof of criminal history in court, including the facts of a
particular prior offense, may be difficult to substantively provide to the court because of
evidentiary rules and the short timeline from detention until the first hearing.
3.
Some out-patient mental health treatment agencies who are seeking extensions of
ITA court orders for out-patient treatments are reluctant to provide access to and copies
of the patient's records to the ITA prosecutors (who are representing the agency in court)
and defense attorneys because of concerns over violating HIPAA.
4.
DMHPs and King County prosecutors have had difficulty accessing mental health
information DOC has on former prison inmates. Some of the information is archived
with DOC, and DOC may also consider the information as protected from disclosure
under HIPAA. These issues may even be preventing the offender's CCO from accessing
the same information.
5.
Law enforcement officers have been prevented from serving No Contact Orders
on persons in E&T's, even when the officer already knows the person is a patient,
because the E&T will only allow the officer on the unit if the patient agrees to be served.
6.
Hospitals (non-E&T's) boarding patients have refused to provide a copy of their
chart to evaluators and prosecutors for court preparation purposes without a specific court
38

signed subpoena. This has occurred despite the fact that the evaluator and prosecutor are
representing the hospital's interests and a mental health professional from the hospital has
signed the petition requesting an extension of involuntary in-patient treatment, and
despite exceptions in ITA confidentiality laws. These hospitals will forward the exact
same information to an E&T once the bed is available, where there is no issue as to how
the information will be used for court preparation.
7.
A person who is a DMIO, or who has previously been found NGRI, or who is
currently on DOC supervision, may present themselves (or otherwise end up) at a
hospital emergency room with mental illness symptoms. The emergency rooms, even
psychiatric emergency rooms, have no way to directly find out that person's status and
history of violence.
8.
Because an emergency room may not know a person is on DOC supervision, the
CCO will not learn of the offender's emergency room visit and potential increased risk to
others.

b.

Providing DMHPs with information on DMIOs in advance:

One common theme for improving public safety is to make sure that all of the
professionals who may come in contact with a DMIO are aware of the DMIO's history
and are prepared to react to it. For instance, DMHPs are often called to evaluate a
DMIO. However, they currently have about the same amount of information for a DMIO
as they do for any other person referred to them for evaluation.
This means that when the DMHP is called to do an evaluation of the DMIO they may
lack the historical perspective on the DMIO's dangerousness and may only be looking at
a snapshot of the DMIO's current behavior.
To assist the DMHPs, DOC at release could prepare packets of information regarding a
DMIO's dangerousness and responsiveness to treatment. These packets would be given
to DMHPs upon the DMIO's release from prison. The police and supervision CCOs
could update this information as warranted. Then, when a DMHP is called upon to
evaluate a DMIO, the historical information will be at hand. This would save the DMHP
from having to scramble for the information, or do without it, during the short time frame
they have to make their detention decisions.
At its most efficient, this communication could include a list of symptoms present during
previous decompensations leading to violence. It could be made available to any
professional who may have contact with the DMIO, not just DMHPs. Any professional
aware of this list would have a better ability to compare the DMIO's current presentation
to their historical risk symptoms and a better ability to gauge their current likelihood of
acting out in a violent manner.

39

c.

DMIOs and Mental Health Advanced Directives:

Currently, any person can sign what is known as a Mental Health Advanced Directive. In
a MHAD, a person, while in a compensated state, indicates what type of mental health
treatment they are willing to undergo should they decompensate. A valid MHAD can
lead to mental health treatment in situations where the person is either not consenting or
unable to give direction. MHADs were authorized by the legislature in 2003. As
currently structured, it is possible for a person to revoke their MHAD fairly easily, even
as their mental health deteriorates.
MHADs may be a viable tool to help CCOs and other professionals work with DMIOs
after their release from prison. The key is to restrict the ability of a DMIO to revoke their
MHAD. The process for encouraging DMIOs to enter into treatment and obtain the extra
funding available to DMIOs begins at least three months before the DMIO's release date.
Ideally, and as part of these discussions, the DMIO would also be urged to enter into a
MHAD and to agree to make the MHAD non-revocable. Mandating an MHAD would
not be required so as not to make the MHAD a reason for a DMIO to reject treatment.
However, the current laws governing MHADs could be altered in minor ways to make
clear that a DMIO's non-revocation clause would be followed in more situations than
other MHADs.

40

Appendix A-2
Memorandum from
Michael Finkle
Seattle City Attorney's Office

41

SEATTLE CITY ATTORNEY
THOMAS A. CARR

MEMORANDUM
TO:

Leesa Manion

FROM:

Mike Finkle

SUBJECT:

April 30 Meeting of DMIO Work Group

DATE:

April 4, 2008

Since I won’t be able to attend the next meeting, I’m sending you some of my thoughts in
advance. Hopefully they will be of some use to the DMIO Work Group as a whole.
A.

Overall impressions:

1.
To steal a phrase from financial advisors, nickels and dimes can add up very
quickly. There are a number of things we can do that have a small but definite impact. The
more small-but-feasible ideas we come up with that can be implemented relatively quickly,
the less we need to depend on finding one or two grand, brilliant recommendations.
2..
We should begin to look for ways for the mental health side and the criminal
justice side to partner up, rather than work separately in our own “silos” on our own
solutions. One example that came up at the meeting is to assign as patrol partners a law
enforcement officer, someone from a community provider, and a DMHP.
3.
We need to keep in mind the relatively non-aggressive, non-assaultive
mentally ill as well as the fewer but highly dangerous DMIOs. The former can turn into the
latter if left untreated.
4.
Everyone whether mentally ill of not, has their own maximum level of
functioning. We can’t increase a mentally ill person’s level of functioning beyond what
they are capable of as a result of their illness. We therefore need to have strategies for both
ends of the spectrum: those whose level of functioning cannot be raised from dangerous to
non-dangerous, as well as those whose level of functioning can be raised with housing,
treatment, etc.

42

B.
Specific Impressions, some of which were voiced at the meeting and some of which
were discussed at an earlier County-based work group:
1.
On the criminal justice side, implement solutions at all stages of the game, from
arrest through trial. Each solution will provide some benefit; all solutions together will
provide greater benefit. Here are some examples:
a.
Pre-arrest stage or pre-booking stage: Partnering a police or sheriff officer
with someone from Sound Mental Health and a DMHP is something that strikes me as
feasible and effective for a particular portion of the mentally ill who come into contact with
the criminal justice system. That could include people like James Anthony Williams, who
pose a severe public safety risk on the one hand, and mentally ill who, if left untreated
and/or homeless could become the next James Anthony Williams.
b.
Post-booking, but pre-charging diversion: There were some long-ago
discussions about this one. Essentially, it would be designed to divert potential criminal
defendants from jail to services. One way to screen for appropriateness is to use a bright
line selection tool. For example, it could be limited to defendants who have been found
incompetent and were not detained by the DMHP on two consecutive court cases. As an
added safety precaution, we could always add limits as to potential charge and as to prior
criminal history. That would focus the diversion resources squarely on those who could
benefit from it most. It would also reduce jail usage, and would reduce the risk that a highly
dangerous mentally ill offender would be diverted.
c.
Post-charging but pre-trial (case disposition). Both Seattle and King County
have mental health courts at the misdemeanor level. They function differently because their
demographics are different, but they each provide access to housing and services to those
who couldn’t otherwise do without, in a manner tailored to their particular circumstances.
One area to explore is expanding the mental health court concept to felonies. The SRA
creates difficulties in the sense that it ties the court’s hands: a defendant who has a particular
standard range would not necessarily be able to receive an “opt-in” reduced sentence that
went below the standard range. What I have in mind is a Superior Court mental health court
that takes on felonies, as opposed to a District or Municipal Court MHC that takes felony
drop-downs.
There is a two-step legislative solution to this issue. Step one is to create a pilot project that
receives funding to create a felony-level mental health court in the state, with certain
mandatory criteria. King County would be a visible and logical choice. Step two is to
include in that legislative package a provision that expressly authorizes diversionary-type
dispositions in felony matters. It could be drafted either as form of diversion or as or as a
mitigating factor in calculating a defendant’s standard range.

43

d.
Post-charging, resolved by trial. Now is a good time to re-examine how our
insanity/diminished capacity statutes interact and whether they do what we want or need
them to do.
Currently, we use the M'Naughten test, which limits insanity to cognitive impairment, and
we have the judicially created diminished capacity defense. An insanity acquittal can result
in commitment to Western (or Eastern) State Hospital; a diminished capacity acquittal does
not result in any form of mental health commitment.
One suggestion was to adopt a “guilty but mentally ill” statute. While the pool of
defendants who could potentially assert a GBMI defense is small compared to the pool of
mentally ill defendants who opt in to MHC on a regular basis, the level of potential danger
to self or others posed by the pool of potential GBMI defendants ,is much higher for the
GBMI-eligible defendants than for MHC defendants.
It may also be worth looking at amending the insanity statute away from the more limited
M'Naughten test to apply to volitional as well as cognitive impairment. That would open
the insanity/GBMI options to a larger group of mentally ill defendants.

44

Appendix A-3
Letter from
Dr. David Lovell, Ph.D.
University of Washington Professor

45

April 30, 2008
TO:

Dan Satterberg
King County Prosecuting Attorney

FROM: David Lovell
RE:

Shannon Harps Workgroup

While our discussion has revealed systemic issues in the interface between criminal
justice and mental health systems, I’m assuming that this group does not want to take on
all of the issues (e.g., NGRI statute, competency restoration, sentencing). Keeping our
focus on interventions to cope with the issues in the murder of Shannon Harps, I’d like to
suggest two premises:
•

The tragic murder of Shannon Harps on New Year’s Eve was a rare event: among
persons with mental illness, among persons with mental illness who have been to
prison, and among persons with mental illness sent to prison for violent offenses.

•

It is nevertheless the responsibility of corrections, community mental health agencies,
and civil commitment authorities, working together, to prevent such tragedies
whenever there is substantial reason to fear a tragic outcome.

From these premises it follows that our approach to supervision, detention, and
confinement must be narrowly tailored to the individual circumstances and patterns of a
dangerous person living in the community. Status as a violent offender or as a DMIO
participant provides altogether too broad a brush.
A narrowly-tailored third form of civil commitment, analogous to 71.09, is also not
workable. In addition to its expense, the process would be far too cumbersome to permit
a nimble response to changing circumstances. Mr. Williams was less dangerous when he
was released than he was after a year in the community, when his compliance began to
waiver and especially when he lost his housing and treatment compliance could no longer
be monitored. Furthermore, we have it on good authority that there are several other
exceptional people under supervision who are equally scary but are not transitioning from
prison. Since they lack the criminal history relevant to a 71.09-style commitment, they
would be missed by this alternative.
If we rule out a third form of civil commitment as well as policy interventions based on
criminal status, we are left with the Involuntary Treatment Act. After discussion with
colleagues, I see two suggestions worth pursuing, in the spirit of not biting off more than
we can chew:
46

1. Develop specialized “best practices” protocols for the rare cases that are a focus of
concern among police, corrections, and community mental health staff. These
practices would include the following:
•

Interagency staffing identifies “high alert” cases and communicates information
about them to designated mental health professionals, so that a review of
detention or commitment does not need to begin from a blank slate.

•

Delegate one of the DMHP team to join the interagency team managing “high
alert” cases.

Such an approach might establish, for example, that the ability of a person like Mr.
Williams to maintain a coherent and reasonable presentation during a single interview
is part of a pattern of decompensation and relapse into paranoia and violence.
2. Without changing the criteria for detention of civil commitment in the ITA, add
language with the following objectives:
•

amplify and specify the evidence relevant to a determination: correctional
records, community mental health records, hospital records.

•

Clarify that the decision examines the nexus between the presumptive detainee’s
current condition and history to address not only what is happening now but what
is likely to happen, based on established patterns, in the absence of intervention.

47

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University of Washington School of Nursing | Seattle, Washington, 98195-7263 | 206-543-6960, Fax 206-685-9551

48

Appendix A-4
Letter from
Dr. Christos Dagadakis, M.D.
Harborview Medical Center

49

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Appendix A-5
Memorandum from
The Honorable Mary Lou Dickerson
Washington State House of Representatives

51

June 6, 2008
MEMORANDUM
To:

Ethan Rogers

From:

Rep. Mary Lou Dickerson

Re:

Proposals for inclusion in Prosecutor Satterberg’s DMIO Task Force report

At the May meeting of Prosecutor Satterberg’s DMIO Task Force, task force members were
invited to submit proposals for inclusion in the task force’s final report, a draft of which will be
discussed at the June 25th meeting of the TF. This memorandum reflects some background
information and options that I would respectfully request be included in Prosecutor Satterberg’s
report of the task force’s deliberations.
The DMIO program:
Currently, 523 offenders have been identified /designated through the DOC/DSHS process as
DMIO. However, of these 550 offenders, only 212 are actually receiving services. Among those
not receiving services:
Approximately 1/3 live in a county that does not have a DMIO program contractor;
Approximately 1/3 live in a county with a DMIO program contractor, but have chosen
not to participate in services through the program.
o Based upon a statement made by the DOC CCO at the last meeting, we would
think that the offenders in this group who are under active DOC supervision are
at least required to participate in mental health treatment as a condition of their
supervision. However, the DMIO program provides funding and services in
addition to mental health treatment, most notably, housing support.
Approximately 1/3 are in prison, jail, inpatient psychiatric or some other institutional
setting.
For those offenders served through the program, WSIPPs evaluations have been favorable. Their
most recent report, issued in February 2008, using a 3 year follow-up period, found that the
program:
Has a positive return of $1.24 for every dollar spent.
Reduces overall felony recidivism rates by 37%, i.e. comparison group recidivism rate of
43%, versus a DMIO recidivism rate of 27%.
Does not significantly reduce new misdemeanor offenses, and has not demonstrated a
significantly significant reduction in new violent felonies, i.e. comparison group 30 new
violent felonies, versus DMIO group 24 new violent felonies.

52

Options:
1. Amend the DMIO statute to rename the program. DSHS and DOC no longer refer to the
program as the DMIO program. They call it the “Community Integration Assistance
Program”.
2. As an initial step to support the program, backfill the existing funding shortfall. In the
past couple of years, the program has been underfunded with respect to the ability to
serve all offenders who want to participate in counties with DMIO program contractors
for the full five years of the program.
o This initial backfill step would be about $800,000 to $1m for the ’09- ’11
biennium. The DMIO budget of $1.43m for SFY 2007 was overspent by
approximately $426,000 to serve the 229 active DMIO participants.
3. DMIO contractor rates have not increased since the program’s inception in 1999. In the
context of the funding discussion, the legislature also could consider:
o Increasing the DMIO program rates through a vendor rate increase, or by
requiring biennial inflationary adjustment of the rate.
o The majority of DMIO funds are used to secure appropriate housing for DMIO
participants. Given the variability in housing costs across the state, the
legislature could use a geographic adjuster for the rates, analogous to the
adjusters currently used for residential long-term care services. [NOTE: A report
on the adjusters currently used for these services will be submitted to the
legislature in June 2008.]
o Provide greater flexibility in the use of DMIO funding. For example, authorize
DSHS to transfer funds to DOC to the extent that additional DOC supervision
might be the appropriate service for a particular DMIO program participant.
4. Provide access to DMIO services on a statewide basis:
o Currently, there are no DMIO contractors in the following counties/RSN service
areas, i.e. the RSN does not contract, nor do any direct services providers in the
county:
Chelan – Douglas RSN
Clark County RSN
Grays Harbor RSN
Greater Columbia RSN, in Klickitat, Benton, Franklin, Walla Walla,
Columbia, Whitman, Garfield, Asotin
Peninsula RSN, in Jefferson
North Central RSN, in Okanogan, Grant, Lincoln, Adams, Ferry,
Stevens, Pend Oreille
Spokane RSN
o In the following counties, RSN’s have refused to contract, but direct service
providers have agreed to cover some or all of the RSN service area:
Greater Columbia RSN:
• Central WA Comprehensive MH serves Yakima, Kittitas and
Skamania counties
North Sound RSN:
• Associated Provider Network/Compass serves the entire RSN
service area

53

Peninsula RSN:
• Kitsap MH Services serves Kitsap County
• Peninsula Community MH Center serves Clallam County
Thurston-Mason RSN:
• Behavioral Health Resources serves the entire RSN service area.
o

o

As of August 2007, 83% of active DMIO participants had been found eligible for
Medicaid. Given the severity of their mental illness, it is likely that the vast
majority of these individuals would meet the RSN access to care standards. In
other words, whether there is an active DMIO program or not in a particular
county, the likelihood is that these individuals are eligible to receive services
through the RSN.
The DMIO program provides additional funding for services to these
individuals, and has been proven to reduce recidivism rates.
In effect, it can reduce risk, rather than increase risk, for RSN’s
participating in the program.
Consider whether RSN’s should be required to contract as a DMIO service
provider as a condition of their Medicaid contract with the state. Note that
current law already provides immunity from liability for simple negligence to
RSN’s and treatment providers serving DMIO participants.

5. Incorporate the following actions into DMIO pre-release discharge planning:
o Require that DMIO participants be evaluated to determine their need for PACT
(Program for Assertive Community Treatment) services. To the extent that such
services would be appropriate, give DMIO participants priority to receive PACT
services through the RSN.
o Encourage DMIO program participants to execute a mental health advance
directive [MHAD] under chapter 71.32 RCW prior to release. The advance
directive provides an opportunity for the individual to clearly express treatment
preferences should they become incapacitated, and build a better relationship
with the treatment provider. To the extent that a treatment provider is able and
willing to honor an advance directive, there might be an opportunity to intervene
when a DMIO participant has decompensated to the incapacity standard in the
advance directive, but may not yet meet the ITA commitment standard.
Concerns have been expressed regarding treatment providers’ willingness to
honor directions in MHAD’s, so this issue should be more fully explored.
The Involuntary Treatment Act [ITA]:
1. At the initial decision to detain for 72 hour evaluation and treatment, direct the DMHP
and court to consider evidence of the individual’s past involvement in the criminal
justice system, including competency determinations under chapter 10.77, past
involuntary commitments, or past patterns of decompensation:
o The current ITA statute specifies instances in which the DMHP or the court can
consider an individual’s past violent acts or treatment history. At the 14 and 90
day commitment hearings, the court must give great weight to certain
information regarding an individual’s prior criminal acts and/or treatment history.
The statute explicitly provides that this information cannot be the sole basis for a
decision to commit. RCW 71.05.245; RCW 71.05.285.

54

o

The current statute also directs a DMHP, when conducting an evaluation under
the ITA, to consider all reasonably available records and information regarding
prior evaluations under chapter 10.77 RCW, the individual’s history of violent
acts, prior determinations of incompetency or insanity under chapter 10.77 RCW,
and prior ITA commitments. RCW 71.05.212. The law is unclear regarding the
extent to which this information can be relied by the DMHP in reaching his/her
decision.

2. Address concerns about difficulty in accessing criminal and mental health treatment
history information, and in obtaining admissible copies of criminal history or treatment
records on a timely basis in the context of evaluating the need for a 72 period of
evaluation and treatment.
3. Consider authorizing involuntary outpatient commitment using a standard broader than
that applicable to involuntary inpatient commitment:
A number of states, including Minnesota, New York and Texas, have enacted statutes
that allow the court to order involuntary outpatient treatment. In Minnesota, for example,
the outpatient commitment standard allows the court to base its decision upon the fact
that an individual has had repeated recent hospitalizations, is exhibiting symptoms similar
to those that preceded prior hospitalizations and will, without treatment, likely deteriorate
to the point of meeting the criteria for involuntary inpatient treatment.
Under current law in Washington State, the court must consider whether a “less
restrictive alternative” would be appropriate as an alternative to inpatient treatment.
However, an individual must be found to meet the ITA standard for inpatient treatment,
i.e. likelihood of serious harm or gravely disabled. The states noted above use a legal
standard for involuntary outpatient civil commitment that is different, and somewhat
broader, than the standard for involuntary inpatient treatment.
This is a very controversial proposal, as it results in restraints upon individual rights. In
addition, to the extent that involuntary outpatient commitment results in court ordered
intensive treatment, increased mental health service costs, and additional court costs
could result.
A 2001 Rand Institute review of the literature did not find compelling evidence to support
the use of involuntary outpatient treatment. They were unable to determine whether the
involuntary treatment or the intensive services that accompanied involuntary treatment,
produced the positive outcomes that have been found in some studies. The MacArthur
Foundation is now funding an effort to explore more fully the use of mandated
community treatment. Washington state’s DMIO program, by its design, provides
intensive services to program participants.

55

Options:
1. Authorize a limited pilot program to test the effectiveness of involuntary
outpatient treatment in WA State. Any pilot implementation would include an
evaluation component.
o
o

o

Geographical pilot program: For example, in New York State, the
program was implemented for a pilot period only in New York City.
Utilize this option only in the DMIO program: The primary concern
with this pilot option is that it would bring potential deprivation of rights
into the program, which could significantly diminish individuals’
willingness to participate in the program.
Allow the program to be implemented statewide, but sunset the program
to allow it to operate only for 3 or 5 years.

2. Develop a stakeholder workgroup to explore the viability of, and need for, and
involuntary outpatient commitment option in Washington State.

56

Appendix A-6
Letter from
David Hocraffer
The Public Defender of King County

57

tQ
King County
Office of the Public Defender
Department of
Community and Human Services
Walthew Building, Fourth Floor
123 Third Avenue South
Seattle, WA 98104

206-296-7662
TTY Relay 711

Fax 206-296-0587

June 11,2008

Daniel T. Satterberg
King County Prosecuting Attorney
King County Courthouse, W554
516 Third Avenue
Seattle, WA 98104
RE:

Dangerous Mentally III Offender (DMIO) Work Group

Dear Mr. Satterberg:
This letter is to provide input on the efforts of the DMIO work group. At the onset, it should be
noted, that these comments are being provided without the benefit of reviewing a draft of King
County Prosecuting Attorney's Office proposals. As such, the comments will be of a more
general nature, than specific comments on any proposed statutory language.
The DMIO Work Group spent considerable time reviewing the circumstances surrounding
pending murder charges against James A. Williams. This individual's background was reviewed
in light of current practices and procedures involving persons designated Dangerous Mentally III
Offenders, and persons under the jurisdiction of King County Superior Court pursuant to the
Involuntary Treatment Act.
The work group was provided recommendations from various sources. Included in those
recommendations were outlined proposals for new sentencing legislation, changes to the "not
guilty by reason of insanity" defense, and modifications to the Involuntary Treatment Act (ITA)
legislation and procedures.

@
RECYCLED

rAP[;R

58

Daniel T. Satterberg
June 11, 2008
Page 2

I.

"Determinant Plus" Sentencing Enhancement
The King County Prosecutor's Office provided an outline of proposed legislation to
modify sentencing statutes to provide for a "determinant plus" sentencing enhancement.
This proposal is based on the determinant plus sentencing for sex offenders. For various
reasons, such extension of this concept as proposed is seriously flawed.
A.

Blakely Requirements
Sex offenses with "determinant plus" sentences are sentenced based on conviction
for a specific offense. Unlike sex offenses, in order to employ "determinant plus"
sentencing for non-sex offense felonies committed by persons who would be
classified as "dangerous mentally ill offenders" (DMIO), such persons would be
convicted for offenses that others, not described as DMIO, who are likewise
convicted of such charges, would not be subject to a "determinant plus"
sentencing. This means two different persons convicted of th~ same offense .
would be subject to different sentencing schemes.
The distinguishing factor would be that additional findings of fact would have to
be made by a jury as to an enhancement factor relating to DMIO. The requirement
for such enhancement factors to be found by a jury was determined by the U.s.
Supreme Court in Blakely v. Washington, 542 U.S. 296 (2004).
This requires a legislative determination that specific factors are enhancements
which increase the sentence for DMIO defendants. Although conceptually easy to
consider, this is extremely difficult, if not impossible, to set out in adequate
statutory language.

B.

Overbreadth
Any statutory language which sets out the enhancement factors for DMIO
"determinant plus" sentencing will have to be narrow and precise. There is
substantial risk that any language employed will be overbroad, i.e. including many
individuals within its reach for whom the sentencing scheme was not intended.
Given that mental illness is presumably part of the enhancement, it will be almost
impossible to avoid such overbroad application. Given the likelihood of coexisting disorders and professional disagreements as to appropriate diagnoses, this
risk is compounded.

59

Daniel T. Satterberg
June 11,2008
Page 3

C.

Criminalizing Mental Illness
Given the Blakely requirements of additional findings of enhancement factors, the
DMIO factors will of necessity include a requirement that a jury find some degree
or diagnosis of mental illness. Such inclusion of mental illness in a sentencing
scheme to increase length and severity of sentences amounts to criminalization of
mental illness.
The nature of sentences contemplated, e.g. Department of Corrections (DOC)
incarceration, indicates that this is not a treatment or hospitalization scheme.
To the extent that a jury is able to find beyond a reasonable doubt that a mental
illness impacted a defendant's conduct sufficiently to qualify for such an enhanced
sentencing scheme, then that defendant likely would or should be found not guilty
by reason of insanity by the same jury.

D.

Use and Abuse of Enhancements
Given the prevalence of some degree of mental illness within the defendants
facing felony offenses, consideration must be made as to how the existence of
such enhancements would be used by prosecutors.
It is a common practice for prosecutors to threaten to add current statutory
enhancements to serious felonies, in the event that a defendant declines a pretrial
offer to plead guilty, and rather proceeds to trial. It is to be presumed that this
practice would continue, but expanded to include the DMIO enhancements. The
effect will be that some individuals with mental illness will plead guilty and accept
DOC sentences in order to avoid the risk ofDMIO enhancement findings at trial.
Less incentive will exist for prosecutors to consider mitigating impacts of mental
illness on defendant's conduct, and indeed, some defendants will avoid disclosure
of mental illness out of concern for increased punishment by DMIO
enhancements.

In any event, such use or abuse, of the existence of a DMIO enhancement
sentencing scheme, would be inconsistent with societal goals of treating, not
punishing, mentally ill individuals, as well as reserving the most serious criminal
sanctions for strictly criminal conduct.

60

Daniel T. Satterberg
June 11, 2008
Page 4

II.

Not Guilty by Reason of Insanity / Guilty but for Mental Disease or Defect
The work group was provided a brief description and comparison of Washington's not
guilty by reason of insanity defense with other states' defenses of this nature.
Washington employs a restrictive application of the McNaghton Rule for detennination of
the defense of not guilty by reason of insanity.
A number of other states employ more expanded defenses, including a Model Penal Code
defense, which requires a finding of that at the time of the offense, the defendant suffered
from a mental disease or defect, and by reason of such mental disease or defect was
unable to appreciate the criminality of his conduct, or to confinn his conduct to the
dictates of the law. Some states employ this as a "guilty but insane" or "guilty but for
mental disease or defect" (GBI). See e.g. Oregon Revised Statutes 161.295 - 161.309,
161.313 - 161.400. For example in Oregon, GBI is an affirmative defense, in which the
result of a finding by a jury is not a conviction for a crime, but instead results in
hospitalization and jurisdiction by a Psychiatric Security Review Board, which determine
release, and conditions of release.
The outline of the "detenninant plus" scheme provided to the work group included a
proposal to use a "guilty but mentally ill" finding by a jury, where this amounts to a
conviction when mental illness exists, but is not quite enough to qualify for a not guilty
by reason of insanity. When combined with the narrow definition of Not Guilty by
Reason of Insanity (NGI) in Washington, the use of the guilty but mentally ill designation
as outlined to the work group would amount to convictions for a large number of persons.
This will happen as a practiced practical effect of compromise jury verdicts. It will also
result from there being no vehicle by which the jury can consider circumstances in which,
although a defendant may have appreciated the criminality of their cqnduct, were
otherwise unable to confirm their conduct to the dictates of the law. As outlined in
certain sections, this still criminalizes mental illness, and substitutes incarceration for
treatment.
A better solution is to consider expanding the Washington definition of insanity for NGI
purposes to include the Model Penal Code test. The potential would be that more
mentally ill defendants would be able to qualify for NGI, and appropriate treatment and
hospitalization.
Concerns involving the problematic intersection of the ITA and the insanity defense could
be addressed by some variation of proposals such as put forth by Dr. Dagadakis and

61

Daniel T. Satterberg
June 11, 2008
Page 5

Dr. Lovell, in order to more practically address continuing treatment needs ofthose
determined to be.NGI. Such proposals can likewise address DMIO individuals.
Although more modest in approach, these proposals do not run the risks of harm that a
"Determinant Plus" sentencing scheme, as outlined, run.

III.

Conclusion
The James A. Williams case involved extreme tragedy. However, the old saying "hard
cases make bad law" is very applicable to this situation. The history and circumstances
giving rise to the events involved in that specific case have a number of factors. Using
this tragic event to create overbroad sentencing schemes that criminalize and penalize
mentally ill individuals due to their mental illness only serves to compound the tragedy.
A much more cautious approach is urged. Examination of the various proposals to
modify application and requirements of the ITA statutes and procedures, especially as
they relate to mentally ill individuals with a documented history of violent conduct, is a
more prudent course of action.

Please contact me bye-mail at david.hocraffer@kingcounty.gov, or by phone at 206-296-7741,
should you wish to discuss this further.

cc:

Jackie MacLean, Director, Department of Community and Human Services

62

Appendix A-7
Letter from
Sarah Coats and Shelley Williams
Office of the Washington State Attorney General

63

Rob McKenna

ATTORNEY GENERAL OF WASHINGTON
7141 Cleanwater Dr SW· PO Box 40124 • Olympia WA 98504-0124

June 24, 2008

Dan Satterberg
King County Prosecuting Attorney
W554 King County Courthouse
516 Third Avenue
Seattle, WA 98104

RE:

Proposed Changes to the Involuntary Commitment Law

Dear Mr. Satterberg:
We proposed changes to RCW 71.05.280, .290, and .320 for inclusion in the 2009 AGO
legislative package. We believe that these proposed changes address situations in which a
dangerous but mentally ill person could be civilly-committed but for technicalities in the current
statute. We received permission Hunter Goodman, Director of Governmental Affairs in the
AGO, to share our proposal with this workgroup. These changes pertain to cases in which a
person is found incompetent to stand trial for either misdemeanor or felony charges, and is
referred by the criminal court for civil commitment.
As noted in theDraft White Paper, civil commitments after a person is found incompetent to
stand trial for misdemeanor or felony charges differ from other civil commitments. A typical
civil commitment process begins with a detention for up to 72 hours for observation and
evaluation, followed by a 14-day commitment, then a 90-day commitment, and then successive
180-day commitments. When a person is referred directly for civil commitment after
misdemeanor charges are dismissed due to incompetency to stand trial, however, the State may
directly file a petition for 90 days. When a person is referred directly for civil commitment after
felony charges are dismissed due to incompetency to stand trial, the State may directly file a
petition for 180 days. If a person is mentally ill and dangerous, the public will benefit from the
ability to detain the person for a longer period of time for treatment.
1.
RCW 71.05.280(2). When misdemeanor charges are dismissed because the
defendant is incompetent to stand trial and the defendant is referred for a 90-day commitment,
the State can petition under any or all of the following grounds:
•

The person is "gravely disabled" - in other words, the person is unable to take care of
his/her own needs of health and safety (RCW 71.05.280(4)).

64

ATTORNEY GENERAL OF WASHINGTON
Dan Satterberg
June 24, 2008
Page 2

•
•

During the current detention, the person threatened, attempted, or inflicted physical
harm on another or substantial damage to the property of another person, and as a
result of mental disorder presents a likelihood of serious harm (RCW 71.05.280(1».
The person was taken into custody as a result of conduct in which s/he attempted or
inflicted physical harm upon the person of another or himself or herself, or substantial
damage to the property of another person, and continues to present, as a result of
mental disorder, a likelihood of serious harm (RCW 71.05.280(2».

As noted above, one can be committed for making threats while in custody, but not if the threats
were the reason the person was taken into custody. Thus, if a person whose misdemeanor
charges were dismissed due to incompetency had been (1) taken into custody for threatening
behavior that did not rise to the level of "attempting" or "inflicting" physical harm on another or
substantial damage to property, and (2) does not meet any other civil commitment grounds such
as grave disability, that person cannot be committed.
The need to add the word "threatened" to RCW 71.05.280(2) is illustrated by a case we handled
in which Mr. C, a mentally-ill person who believed he has a "license to kill" from the United
Nations, carried many weapons (including a grenade launcher) in his car. A jury refused to
civilly commit Mr. C because his threatening behavior did not meet the elements ofRCW
71.05.280(2). While Mr. C was stopped at a stoplight, he held a gun pointed up while staring at
the driver in the next lane. The driver felt threatened and called the police. When the police
took Mr. C into custody, they found a complete weapons arsenal in his car. Mr. C had legal
permits for all ofthe weapons (including the grenade launcher).
Because Mr. C could take care of his basic needs and because he was not a behavior problem in
the hospital, DSHS sought to commit Mr. C based on the ground that he was taken into custody
as a result of conduct in which he attempted or inflicted physical harm upon the person of
another. Because RCW 71.05.280(2) limits the conduct to "attempted or inflicted physical
harm" instead of "threatened, attempted or inflicted physical harm," the jury found that Mr. C did
not meet the elements for commitment, as brandishing a gun is a "threat," not an "attempt," to
inflict harm.
2.
RCW 71.05.280(3) and RCW 71.05.290(3). As noted above, when a person is
referred directly for civil commitment after felony charges are dismissed due to incompetency to
stand trial, the State may directly file a petition for one hundred and eighty days. RCW
71.05.290(3). Unlike the misdemeanor cases, the State cannot petition on any ground to obtain
the longer commitment in a felony case; rather, the State must establish the following ground to
obtain a 180-day commitment:
(3) Such person has been determined to be incompetent and criminal charges have been
dismissed pursuant to RCW 10.77.086 (4), and has committed acts constituting a felony,
and as a result of a mental disorder, presents a substantial likelihood of repeating similar
acts....
RCW 71.05.280(3).

65

ATTORNEY GENERAL OF WASHINGTON
Dan Satterberg
June 24, 2008
Page 3

This limitation presents several problems. First, establishing the RCW 71.05.280(3) ground
requires that the State prove that the person committed "acts constituting a felony" by clear,
cogent and convincing evidence. If witnesses refuse to cooperate or the evidence is otherwise
lacking, we cannot civilly commit this person for 180-days, even if the person is gravellydisabled or meets one of the other grounds for civil commitment.
Moreover, there are cases in which we can prove the "acts constituting a felony," but we cannot
prove that, "as a result ofa mental disorder, [the person] presents a substantial likelihood of
repeating similar acts." In other words, the person may suffer from a mental disorder and be in
need of commitment, and may even be dangerous; but did not commit the "acts constituting a
felony" as a result of a mental disorder. Again, we cannot civilly commit this person for 180days even if the person is gravelly-disabled or meets one ofthe other grounds for civil
commitment. Therefore, we propose deleting the phrase "under RCW 71.05.280(3)" in
RCW 71.05.290(3) to allow the State to petition on any ground for a 180-day detention.
We also propose amending RCW 71.05.280(3) to change "acts constituting a felony" to "acts
that threatened, attempted, or inflicted physical harm upon the person of another, or substantial
damage upon the property of others" for a couple of reasons. First, the proposed language is
consistent with other commitment grounds (i.e., RCW 71.05.280(1) and proposed RCW
71.05.280(2)) that focus on public safety. Second, while civil commitments are civil
proceedings, some trial courts have said that the phrase "acts constituting a felony" casts doubt
on whether the proceedings are civil or criminal. Some courts have ruled that such statutory
language imports the full panoply of constitutional protections for criminal trials, which is
unduly burdensome for civil commitment hearings.
We also propose changes to expand prosecutor notification when a felony defendant who has
been referred for civil commitment leaves the state hospital. Current law only provides for
prosecutor notification when the detained person leaves the hospital if that person has first been
committed under RCW 71.05.280(3). Providing this notification without statutory authorization
if the evaluators determine that the detained person does not meet civil commitment criteria and
must be released may violate HIPAA and the confidentiality provisions ofRCW 71.05.390 and
.630. Our proposed changes to RCW 71.05.280(3) require prosecutor notification in these
situations, as well as prosecutor notification if an 180-day civil commitment is sought on other
grounds pursuant to our proposed changes to RCW 71.05.290(3). This expanded prosecutor
notification would give the prosecutors the opportunity to re-file charges and take the person into
custody if the prosecutor chooses to do so, and would be more consistent with RCW
71.05.235(2), which provides for a type of notification when a petition is not filed after serious
misdemeanor charges are dismissed due to incompetency and the defendant is referred for civil
commitment.

66

ATTORNEY GENERAL OF WASHINGTON
Dan Satterberg
June 24, 2008
Page 4

3.
RCW 71.05.320. The proposed changes to RCW 71.05.320 are simply to make
this section consistent with our proposed changes to RCW 71.05.280 and .290.
We welcome any comments and suggestions that you and the workgroup may have.
Thank you.

::;~9~
SARAHJ. COATS
SHELLEY A. WILLIAMS
Assistant Attorneys General
SJClbtc
Enclosure

67

RCW 71.05.280

Additional confmement -

Grounds.

At the expiration of the fourteen-day period of intensive treatment, a person may be confined for
further treatment pursuant to RCW 71.05.320 if:
(1) Such person after having been taken into custody for evaluation and treatment has
threatened, attempted, or inflicted: (a) Physical harm upon the person of another or himself or
herself, or substantial damage upon the property of another, and (b) as a result of mental disorder
presents a likelihood of serious harm; or
(2) Such person was taken into custody as a result of conduct in which he or she
threatened, attempted or inflicted physical harm upon the person of another or himself or herself,
or substantial damage upon the property of others, and continues to present, as a result of mental
disorder, a likelihood of serious harm; or
(3) Such person has been determined to be incompetent and criminal charges have been
dismissed pursuant to RCW 10.77.086(4), and has committed acts «eonstituting a felony» that
threatened, attempted, or inflicted physical harm upon the person of another, or substantial
damage upon the property of others, and as a result of a mental disorder, presents a su13stantial
In any pfoeeeeing pUfSl:lant to this su13seetion
likelihood of serious harm fej3eating similar aets
it shall not 13e neeessary to sho'll intent, willfulaess, Of state ormine as an element oHhe erime»;
or

«.

(4) Such person is gravely disabled.
RCW 71.05.290

Petition for additional confmement -

Affidavit.

(1) At any time during a person's fourteen-day intensive treatment period, the
professional person in charge of a treatment facility or his or her professional designee or the
designated mental health professional may petition the superior court for an order requiring such
person to undergo an additional period of treatment. Such petition must be based on one or more
of the grounds set forth in RCW 71.05.280.

(2) The petition shall summarize the facts which support the need for further confinement
and shall be supported by affidavits signed by two examining physicians, or by one examining
physician and examining mental health professional. The affidavits shall describe in detail the
behavior of the detained person which supports the petition and shall explain what, if any, less
restrictive treatments which are alternatives to detention are available to such person, and shall
state the willingness of the affiant to testify to such facts in subsequent judicial proceedings
under this chapter.

68

(3) If a person has been determined to be incompetent pursuant to RCW 10.77.086(4),
then the professional person in charge of the treatment facility or his or her professional designee
or the designated mental health professional may directly file a petition for one hundred eightyday treatment (( lifider RC\V 71.05.280(3)). No petition for initial detention or fourteen day
detention is required before such a petition may be filed. If the professional person responsible
for deciding whether to file a petition decides not to file a petition. or ifhe or she files a petition
that does not include the grounds set forth in RCW 71.05.280(3), that professional person or his
or her designee shall notify the prosecuting attorney of the county in which the criminal charges
against the detained person were dismissed at least three days before the detained person is
released. if such notice has been reguested in writing.

RCW 71.05.320
Remand for additional treatment - Duration - Developmentally
disabled - Grounds - Hearing.
.
(1) If the court or jury finds that grounds set forth in RCW 71.05.280 have been proven
and that the best interests of the person or others will not be served by a less restrictive treatment
which is an alternative to detention, the court shall remand him or her to the custody of the
department or to a facility certified for ninety-day treatment by the department for a further
period of intensive treatment not to exceed ninety days from the date ofjudgment: PROVIDED,
That;
(a) If ((the gralifies set ferth ifi RON 71.05.280(3) are the basis afeammitmeat» the
detained person has been determined to be incompetent pursuant to RCW 10.77.086(4), then the
period of treatment may be up to but not exceed one hundred eighty-days from the date of
judgment in a facility certified for one hundred eighty-day treatment by the department.
(b) If the committed person has a developmental disability and has been determined
incompetent pursuant to RCW 10.77.086(4), and the best interests of the person or others will
not be served by a less-restrictive treatment which is an alternative to detention, the court shall
remand him or her to the custody of the department or to a facility certified for one hundred
eighty-day treatment by the department. When appropriate and subject to available funds,
treatment and training of such persons must be provided in a program specifically reserved for
the treatment and training of persons with developmental disabilities. A person so committed
shall receive habilitation services pursuant to an individualized service plan specifically
developed to treat the behavior which was the subject of the criminal proceedings. The treatment
program shall be administered by developmental disabilities professionals and others trained
specifically in the needs of persons with developmental disabilities. The department may limit
admissions to this specialized program in order to ensure that expenditures for services do not
exceed amounts appropriated by the legislature and allocated by the department for such
services. The department may establish admission priorities in the event that the number of
eligible persons exceeds the limits set by the department. An order for treatment less restrictive
than involuntary detention may include conditions, and if such conditions are not adhered to, the

69

designated mental health professional or developmental disabilities professional may order the
person apprehended under the tenns and conditions ofRCW 71.05.340.
(2) If the court or jury finds that grounds set forth in RCW 71.05.280 have been proven,
but finds that treatment less restrictive than detention will be in the best interest of the person or
others, then the court shall remand him or her to the custody of the department or to a facility
certified for ninety day treatment by the department or to a less restrictive alternative for a
further period of less restrictive treatment not to exceed ninety days from the date ofjudgment:
PROVIDED, That if «the grol:lfl:es set forth ifl: RC'N 71.05.280(3) are the basis ofeommitmeH:t))
the committed person has been detennined to be incompetent pursuant to RCW 10.77.086(4),
then the period of treatment may be up to but not exceed one hundred eighty-days from the date
ofjudgment.
(3) The person shall be released from involuntary treatment at the expiration of the period
of commitment imposed under subsection (1) or (2) ofthis section unless the superintendent or
professional person in charge of the facility in which he or she is confined, or in the event of a
less restrictive alternative, the designated mental health professional or developmental
disabilities professional, files a new petition for involuntary treatment on the grounds that the
committed person;
(a) During the current period of court ordered treatment: (i) Has threatened,
attempted, or inflicted physical hann upon the person of another, or substantial damage upon the
property of another, and (ii) as a result of mental disorder or developmental disability presents a
likelihood of serious hann; or

(b) Was taken into custody as a result of conduct in which he or she threatened.
attempted or inflicted serious physical hann upon the person of another, and continues to present,
as a result of mental disorder or developmental disability a likelihood of serious hann; or
(c) Is in custody pursuant to RCW 71.05.280(3) and as a result of mental disorder or
developmental disability presents a substantial likelihood of repeating similar acts that threaten.
attempt. or inflict physical hann upon the person of another. or substantial damage upon the
property of others, considering the « ehargee erimifl:al behavior)) acts committed, life history,
progress in treatment, and the public safety; or
(d) Continues to be gravely disabled.
If the conduct required to be proven in (b) and (c) of this subsection was found by a judge
or jury in a prior trial under this chapter, it shall not be necessary to reprove that element. Such
new petition for involuntary treatment shall be filed and heard in the superior court of the county
of the facility which is filing the new petition for involuntary treatment unless good cause is
shown for a change of venue. The cost of the proceedings shall be borne by the state.

70

The hearing shall be held as provided in RCW 71.05.310, and ifthe court or jury finds
that the grounds for additional confinement as set forth in this subsection are present, the court
may order the committed person returned for an additional period of treatment not to exceed one
hundred eighty days from the date ofjudgment. At the end of the one hundred eighty day period
of conunitment, the committed person shall be released unless a petition for another one hundred
eighty-day period of continued treatment is filed and heard in the same manner as provided in
this subsection. Successive one hundred eighty day commitments are permissible on the same
grounds and pursuant to the same procedures as the original one hundred eighty-day
commitment.
(4) No person committed as provided in this section may be detained unless a valid order
of conunitment is in effect. No order of commitment can exceed one hundred eighty-days in
length.

71

Appendix A-8
Joint letter from
Eldon Vail
Department of Corrections
and
Robin Arnold-Williams
Department of Social and Health Services

72

STATE OF WASHINGTON

STATE OF WASHINGTON

September 10, 2008

Daniel Satterberg
King County Prosecuting Attorney
W400 King COllnty COlIrt House
516 Third Avenue
Seattle, Washington 98\ 04
Dear Mr. Sauerberg:
The sudden and violent death of Shannon Harps on New Year"s Eve, 2007, and the marc recent
deaths of six persons in Skagit County have provided strong reason to take a critical and in-depth
look at statutes, programs and policies covering offenders with mental illness. The Dangerously
Mentally III Offender (DMIO) White Paper Draft provides a comprehensive review of issues and
we would like to urge consideration of the following recommendations.
First, revisions to the Washington State Involuntary Treatment Act (ITA) may be needed to
increase its applicability to offenders with mental illness:
•
•

•

Adding a mandatory outpatient commitment provision for individuals with a
significant history and risk for violence.
Allowing Designated MeIllal Health Professionals (DMJ-IP) to give great weight to a
prior history of violence, including records of prison behavior, when considering
initial detainment, as well as, subsequent civil detainment hearings before ajudge.
rvlodifying initial placement and evaluation processes in the case of high-risk
offenders under correctional supervision to improve safety and ensure a full review of
circumstances.
Expanding the definition of 'Iikelihood of serious harm' to further clarify what
constitutes a violent act and to include other readily identifiable risk factors.

The following additions or enhancements to programs for offenders with mental illness arc also
worth considering by the Legislature:
Applying the DMlO/CIAP model orpre~release engagement, enhanced social service
support, and interagency cooperation to an expanded group of high-risk offenders

73

Dan Sancrbcrg
September 10, 2008
Page 2

•

with mcntal illness leaving prison, \\~th a need for active treatment and collaborative
supervision.
Developing a forensic assertive community treatment (FACT) program to bring the
intensivc services of the evidence based practice of assenive community treatment to
offenders under correctional supervision.

And finally, increased collaboration among correctional, menIal health, and DMHP staff may
allow more effective management of risk:
•

•

Development of "best practice models" to identify ··high alen" cases and share
information between imeragency teams and designated mental health professionals at
the community level so that recommendations and coun deliberations about offenders
under supervision will be bener infomled;
Removal of regulatory and agency policy barriers to sharing of infonnalion across
agencies to facilitate collaborative crisis prevention and intervention planning.

DOC and DSHS applaud the leadership of the King County Prosecutor's Office in bringing the
taskforce together. Although the Shannon Harps tragedy occurred in King County, and the olher
tragic deaths occurred in Skagit County, they could have happened anywhere in our state. We
look forward to working with you to help keep communities safe.
Sincerely,

-u

Eldon Vail
Secretary
Department or Corrections

Robin Arnold-Williams
Secretary
Depanment of Social & Health Services

cc: Cheryl Strange, Deputy Secretary, Department or Corrections
Richard Kellogg, Director Mentall-lealth, Department of Social and Health Services
John Lane, Executive Policy Advisor, Office of the Governor
Kari Burrell, Executive Policy Advisor, Omce of the Governor

74

Appendix A-9
Submission from
The King County Prosecuting Attorney's Office

75

DANIEL T. SATTERBERG
PROSECUTING ATTORNEY

Office of the Prosecuting Attorney
W400 King County Courthouse
516 Third Avenue
Seattle, Washington 98104
(206) 296-9067
FAX (206) 296-9013

Proposals for Policy Maker Consideration:
Mentally Ill and Violent Criminal Offenders
The interplay between the mental health system and the criminal justice system carries
the potential for inherent tension. Mental health systems are primarily focused on the
welfare of the patient; prosecutors think first about public safety. When the stakes are
highest and criminal conduct most violent, there are often unsatisfactory resolutions of
this conflict under the current system. This is an area where policy makers must set clear
guidelines and create systems that provide treatment to violent and dangerous mentally ill
offenders in ways that adequately protect community safety.
For non-violent mentally ill offenders, we embrace those areas where the criminal justice
and mental health systems have collaborated to develop innovative programs, like Mental
Health Court and Drug Court, where the justice system can be used as an effective
intervention point for application of mental health treatment therapies.
Any reform of the mental illness treatment system must start with the addition of capacity
-- in the state hospitals, the county evaluation and treatment facilities, and community
resources. This critical infrastructure has not kept pace with the growth in the state's
population or in response to pressing needs in the community. According to a recent
presentation by the Greater Columbia Regional Service Network (RSN), the King County
RSN, and the Spokane County RSN:
•
•
•
•
•

Since 2000, the state population has grown 13%, but the number of
available community and state psychiatric hospital beds has decreased
15%;
In King County, between January and September 2008, 260 mentally ill
patients were detained and "boarded" in unsecure hospital emergency
rooms because appropriate psychiatric beds were not available;
Washington State is 51st in the nation (including the District of Columbia)
in community inpatient capacity (i.e. licensed evaluation and treatment
facilities);
Washington needs an additional 763 community-based psychiatric beds
just to bring its capacity to national average;
King County currently has only 362 psychiatric beds for children, adults,
and geriatrics. Only 168 of these beds are for patients who are
involuntarily detained.

Prosecuting Attorney
King County

The lack of capacity can drive policy and practice in ways that endanger the community
in ways policymakers never intended. For instance, Washington's state psychiatric
hospital capacity has been fluctuating downward over the past several years with civil
capacity recently unable to meet the demands of the civil commitment process. There is
a need for Western State Hospital to maintain its current capacity of 647 civil beds, and
to possibly add an additional 30-bed ward to respond to heightened public safety
concerns. Washington State cannot afford to fall further behind with regard to capacity.
Below are nine potential reform concepts that policymakers should consider in their
examination of how the State of Washington deals with violent mentally ill offenders and
the current intersections of mental illness and criminal justice:
The DMIO Program and Supervision Tools
The supervision of an inmate released to the community under the DMIO (or new
acronym CIAP) program ranks among the most difficult and precarious jobs given to
state employees. The Community Corrections Officers (CCO) in the James Williams
case were remarkable public servants, dedicated and ingenious. They appear to have
used all of the tools at their disposal to both get help for Mr. Williams and to protect the
community:
•
•
•

Administrative sanctions for violations of sentence conditions;
New criminal charges, for threats against a mental health caseworker;
Attempted involuntary commitment through the civil Involuntary Treatment Act
(ITA) process.

The CCOs used each of these available tools. The question is: Were the tools in their
toolbox the right ones?
Our view is that a mentally ill offender who has been convicted of a violent crime, served
his time in prison, and is released to the streets under the DMIO program is situated much
differently than a mentally ill person with no criminal history.
If a Dangerous Mentally Ill Offender under DOC (Department of Corrections) supervision is
showing symptoms of decompensation, and the CCO is concerned about a risk to public
safety, there should be adequate tools that grant the CCO the authority to quickly remove the
offender from the streets and into a secure setting where treatment and stabilization can
occur. The current tools available to CCOs who supervise Dangerous Mentally Ill
Offenders are ineffective for these reasons:
•

Administrative Sanctions for Sentence Violation: The 60-day jail sentence for
sentence condition violations does not provide treatment. Instead, it offers only a
short period of incarceration, during which the offender often further
decompensates.

•

New Criminal Charges: The conduct causing concern to the supervising CCO might
not constitute a new crime. For example, the concerning conduct might be general

77

Prosecuting Attorney
King County

statements of homicidal intent, for which there is often no corresponding or
appropriate criminal charge. Even if the offender can be charged with new crimes,
this option does not automatically result in necessary treatment or stabilization.
•

The Civil ITA Option: The due process oriented system of the ITA courts stands as
an important safeguard against government abuse of the involuntary commitment
law. It does not, however, make sense for a violent offender already under criminal
jurisdiction.
As a practical matter, "boarding" such a person in an unsecure hospital emergency
room puts many people at risk, and in many cases, does not provide the environment
necessary for stabilization.
The threshold for commitment, designed to protect law-abiding citizens
experiencing mental health issues, may be higher than is necessary for dangerous
mentally ill offenders.

Here are some proposals policymakers should consider in determining whether additional
tools should be available to those dealing with Dangerous Mentally Ill Offenders:
1.
One proposal is to allow DOC the authority to remove DMIO/CIAP-designated
offenders the streets to a secure treatment facility within DOC jurisdiction. The CCO
should be able to arrest and hold the offender and offer treatment whenever the CCO
believes public safety is at risk. Additional criminal jurisdiction may be necessary in order
to permit a CCO to supervise such offenders in the community, and revoke community
placement quickly. These Dangerous Mentally Ill Offenders are simply not appropriate for
the ITA process.
2.
For other, non-DMIO/CIAP offenders who are under DOC supervision, it may be
appropriate to have those individuals who are found to meet the standards for involuntary
civil commitment skip the current statutorily-required 72-hour and 14-day local
commitments (eliminating the need to hold them in hospital ER beds) and instead be
returned to DOC or sent to a secure DSHS facility for further 90 and 180-day periods of
evaluation, treatment and stabilization.
3.
Another proposal is to create an outpatient civil commitment program for
Dangerous Mentally Ill Offenders over whom the DOC supervision has elapsed. Under
this approach, a person with a demonstrated history of criminal convictions for crimes of
violence and mental illness and who is no longer on active DOC supervision, but still
presents a substantial likelihood to commit further violent acts, could be civilly
committed to an intensive outpatient treatment and supervision program. The threshold
for commitment would be lower than the present ITA commitment standards for nonoffending citizens.
Outpatient commitment could also be initiated prior to release from prison, or following
commission of a recent overt act in the community. Outpatient commitment would

78

Prosecuting Attorney
King County

continue until a court determines that the person no longer presents a substantial risk of
danger to the community. If outpatient commitment was not working and the person
presented a risk of danger to the community, the person could then be referred for the
civil commitment under the ITA process.
Determinant-Plus Sentencing Enhancement Option
4.
Another proposal would be to add a Determinant-Plus sentencing enhancement
for violent mentally ill offenders. Although most individuals with a mental illness are not
violent, and most violent offenders are not mentally ill, a subset of mentally ill offenders
present a continuing and persistent danger to community safety.
Under a determinant-plus sentencing enhancement approach, a person would first need to
be convicted of a violent crime in accord with current criminal procedures, including the
opportunity to claim insanity or diminished capacity. Following the conviction, the same
jury would determine whether the offender's mental condition was a substantial factor in
the commission of the crime and whether the offender presented a substantial likelihood
of re-offense due to this mental condition.
If the jury agreed with this special allegation, the offender would be sentenced to both a
standard range and a maximum term. Upon completion of the standard range, the
offender's release prior to the maximum term would be within the discretion of the
Indeterminate Sentence Review Board (ISRB), just as we do with sex offenders under
current law. If the ISRB determined that the offender's mental condition allowed release
consistent with community safety, the released offender would face lifetime supervision.
A classification system should also be created to assign a risk level to offenders subject to
this sentencing structure.
This approach would give DOC maximum flexibility over offenders under this sentence.
It would be more expensive than the current system.
SVP-Type Commitment Option
5.
The legislature could also create a civil commitment law for violent or dangerous
mentally ill offenders that more closely resemble our state's Sexually Violent Predator
(SVP) commitment laws. This approach would recognize that certain dangerous
mentally ill offenders have long-term conditions that may be best addressed in an
institutional setting.
A civil commitment model that focuses on dangerously mentally ill offenders could be
designed to include a relatively short stay in a mental health facility, then release to a
less-restrictive alternative. This approach would address the long-term need for mental
health services and avoid current problems where defendants are released from prison to
environments where mental health treatment and medications become voluntary or are
difficult to enforce. Because it provides the most cautious approach to release, it would
be the most expensive model.

79

Prosecuting Attorney
King County

Criminal Competency Changes
6.
Another proposal would be to authorize and require certain defendants to remain
at Western State Hospital (WSH) after their competency has been restored and while they
are awaiting trial.
In State vs. Leemah Carneh, the defendant is charged with killing Josie Peterson, her
boyfriend Taelor Marks, and Josie's grandparents, Richard and Jane Larson. The crime
occurred in March, 2001. However, to this date, seven and a-half years later, the defendant
has not been brought to trial. Mental health issues have affected the defendant's competency
to stand trial. Yet, this is not a situation where the defendant can never be made competent.
Mental health professionals at Western State Hospital have been able to make Carneh
competent. However, he loses competency quickly once he has been released from WSH
and returned to jail, where he refuses to take medications.
WSH believes it is not authorized to hold a defendant pending trial, even though that would
be the best way to maintain the defendant's competency until a trial can be completed. This
pattern of having to continually restore the defendant's competency has caused years of
delay in bringing this case to trial.
In certain serious cases, it is appropriate for the defendant to remain at a state hospital in
order to ensure that the defendant remains competent while awaiting trial so that justice
and finality in the case can be achieved.
On a related note, when criminal charges are the impetus for finding an offender
incompetent to stand trial and this finding leads to ITA commitment, state hospitals
should be required to periodically re-evaluate the offender's competency. Currently, the
only way to trigger a re-evaluation of the offender's competency is to re-file criminal
charges. Hospitals do not currently share information with prosecutors regarding the
status of these offenders. Instead, prosecutors must periodically re-file criminal charges
to trigger a re-evaluation of the offender's competency.
"Guilty, But Mentally Ill"
7.
Thirteen states offer a "Guilty, But Mentally Ill" (GBMI) or "Guilty, But Insane"
(GBI) option to juries, in conjunction with their "Not Guilty By Reason of Insanity"
standard. Various models of GBMI/GBI allow defendants to be found criminally liable
for their violent acts, but be sentenced to either a psychiatric treatment facility or a
specialized treatment program within a corrections institution for all or part of their
criminal sentence.
GBMI/GBI findings provide offenders specialized treatment, but also protect public
safety by ensuring offenders receive significant commitments in a secure facility.
GBMI/GBI findings also typically impose increased supervision for offenders after their
release.

80

Prosecuting Attorney
King County

Decades ago, it could be predicted that an offender found "Not Guilty By Reason of
Insanity" (NGRI) would spend as long at Western State Hospital as they would in prison for
their crime. However, recent advancements in the effectiveness of psychotropic drugs have
allowed the mental health system to stabilize criminally insane offenders in a relatively short
period of time. This has lead to the community release of some offenders who have
committed murder after only a few years of treatment. Here are two recent examples from
King County:
In State v. Thomas Gergen, the defendant was charged with Murder in the First Degree and
Manslaughter in the First Degree for fatally shooting his pregnant wife and killing their
unborn child in January 2003. At the time of the crime, the defendant also shot himself in
the jaw. He was found Not Guilty by Reason of Insanity, and was committed to Western
State Hospital in February 25, 2004. In just over two years, in October, 2006, the defendant
was allowed to leave the state hospital to work and socialize in the community. In just over
five years from the murder of his wife and unborn child, the defendant, at Western State
Hospital's recommendation and with the court's approval, was released from Western State
Hospital and allowed to move into a residence in the Bellevue area.
In State v. Pamela Mills, the defendant was the caretaker of her elderly parents, Charles and
Viola Mills, whom she stabbed to death on December 1, 2002. Mills was charged with two
counts of Murder in the First Degree, and found Not Guilty by Reason of Insanity. She was
committed to Western State Hospital on July 1, 2004. A little over two years later, in
November, 2006, the defendant was allowed to leave the hospital to work and socialize in
the community. She was released from Western State Hospital and allowed to live in the
community in May, 2008, after less than four years of commitment for killing her parents.
The Gergen and Mills cases are just two examples where defendants are released back into
the community within a very short time after committing murder. Most members of the
public would be shocked to learn that those deemed NGRI do not receive long-term,
inpatient mental heath treatment in a secure environment. While an increase in the types
and effectiveness in psychotropic medication has led to an increase in patient functionality,
it has also greatly reduced the amount of time violent offenders spend in a secure facility. It
seems grossly inadequate to victims and their families that murderers are allowed to walk
free so shortly after being declared criminally insane and unaccountable for their crimes.
Creating a GBMI option in Washington would allow defendants to be treated for their
mental illness, but would still impose a sentence commensurate with the criminal conduct.
Used in conjunction with NGRI, a GBMI option would give juries a way to recognize that
mental illness played a contributing factor in an offender's crime, without completely
excusing accountability.
Other Proposals
8.
Allow information relating to civil commitments under ITA to be used in
determining bail and making release decisions in criminal cases. The potential
dangerousness of a defendant is an important consideration for prosecutors in
determining how much bail to seek, and for judges who determine whether bail should be

81

Prosecuting Attorney
King County

imposed or whether the defendant should be released on personal recognizance.
Information relating to a defendant's civil commitment history can be highly relevant in
determining risk to public safety, and this information should be allowed to be used for
these purposes. Disclosure of this information would not necessarily lead to higher bail
amount because this information could also potentially reveal that a defendant who
suffers from mental illness does not pose a danger to the public.
9.
Create a 180-Day Less-Restrictive Alternative Option in civil commitment
proceedings for persons who have previously been found Not Guilty by Reason of
Insanity. Some persons who have been found Not Guilty by Reason of Insanity have
their supervision by the court terminated, either because the maximum term of
supervision has expired, or they have demonstrated an extended period of nonsymptomatic behavior and appear to have their mental illness under control. Should
these persons later decompensate or otherwise become subject to a civil commitment
proceeding, any less-restrictive alternative ordered during the ITA process should last
180 days, with an in-patient commitment of the remainder of the 180-days if they are
unable to follow the order or decompensate. Given that they have in the past committed
criminal acts due to their mental illness, a full six months of court-ordered out-patient
treatment is warranted.
Reform in this arena must begin with the recognition of the complexity of the issues, and
the inherent tension between mental health treatment and public safety. The success of
policy changes will depend on building sufficient additional capacity for treatment beds
within DOC, DSHS, local emergency and treatment facilities, and community outpatient
programs. It will cost money, but to invest nothing and hope for better results from the
system is not a realistic expectation.

82

Appendix A-10
Memorandum from
Captain Scott Strathy
King County Sheriff's Office.

83

Date:

October 31, 2008

To:

Dan Satterberg, King County
Prosecuting
Attorney

From:
Re:

Via:

Direct

Captain Scott D. Strathy, King County Sheriff’s Office

SHANNON HARPS WORKGROUP - RECOMMENDATIONS

“He was a walking time bomb.”
-

Chief Deputy Dean Byrd, Mason County Sheriff’s Office, describing
Shawn Roe, suspected of killing Richard Ziegler and Forest Service
Officer Kristine Fairbanks.

“The cops knew him well.”
“Our office is stunned… we did not see this coming.”
-

Comments of DMIO workgroup participants referring to Isaac Zamora,
suspected of killing Skagit County Sheriff’s Deputy Anne Jackson and five
civilians.

“He killed his mom, threatened politicians, threatened to kill his dad, threatened
officers of the
law, then comes out here… it would have been nice if they would have
contacted us.”
-

Comments of Pierce County Sheriff’s Deputy Ed Troyer referring to Daniel
Tavares Jr. and addressing the lack of communication between
Massachusetts police, the Washington State Patrol and the Pierce County
Sheriff’s Office after the shooting death of Brian and Beverly Mauck in
Graham
84

These quotes, associated with three recent Washington State tragedies,
highlight the concerns shared statewide by local law enforcement
professionals in dealing with violent mentally ill offenders and offenders who
make serious threats to harm others. Repeatedly we see some combination
of a similar scenario played out; clearly troubled individuals, often on law
enforcement’s radar screen, living in and moving about our communities.
Family members, neighbors, friends, and work associates begin to see the
individual’s behavior inhibitors dissipate. Mental health issues such as
delusional, controlling, or paranoid behavior become more recognizable. This
is sometimes coupled with substance abuse or the discontinuance of
prescribed medication. Some of these individuals become quick to anger or
behave irrationally. In the cases that result in violent behavior, the same
question is always asked with the benefit of 20/20 hindsight:
“Why wasn’t something done to prevent this tragedy?”
As we have learned from our work group’s discussions, individuals officially
designated as Dangerous Mentally Ill Offenders commit a very small
percentage of overall violent crime. Although not a perfect system, as
evidenced by the murder of Shannon Harps, the Department of Corrections
clearly understand the magnitude of its DMIO responsibility and recognizes
the need to vigorously monitor the individuals in the program. In King County,
most DMIOs live within the city limits of Seattle. As a result, the Seattle Police
Department and the DOC have developed a close working relationship to
assist each other in monitoring resident DMIO program participants. From
what I have observed at the work group meetings, I have no doubt that the
DOC will take the lessons learned from the Harps murder very seriously and
will pursue appropriate changes to further heighten the accountability of
DMIO program participants.
However, the DMIO system cannot solve the greater problem of violent
mentally ill offenders and offenders who make threats to harm. What lessons
have we learned by studying the Harps murder case that can assist the
greater community of Washington State Law Enforcement agencies deal with
these issues? Are there relationships that need to be formed, resources that
need to be procured, training that must take place? How can local law
enforcement be better equipped to recognize and address individuals in their
own communities that might be moving towards to committing a violent
offense. How do we move towards preventing the violent events committed
by violent mentally ill offenders and offenders who make threats to harm who
fall outside the DMIO program, but whose violent behavior is escalating to the
point where they pose a real threat to community safety?

85

Here are some of my thoughts and recommendations on these important
issues:
•

Overt threats and threatening behavior must tracked and assessed.
When local law enforcement officers encounter individuals that have
threatened violence, they must have the tools available to them to
properly document and route pertinent information. Protocols should
be established to conduct risk assessments of those making threats to
harm in order to assess their dangerousness. Both Isaac Zamora (the
man charged with killing Deputy Jackson in Skagit County) and Shawn
Roe (the man accused of killing Forest Service Officer Kristine
Fairbanks) were both apparently well known to local law enforcement.
Would the routine use of a risk assessment tool by local or regional law
enforcement been helpful in identifying Zamora and Roe’s escalation
towards violent events? It may be time for local law enforcement and
the behavioral science community to join forces to share perspectives
and develop an expertise that can give constructive guidance to law
enforcement officers who must deal with these individuals in their
communities. Law enforcement could develop sound, scientifically
based risk assessment tools which would assist them in evaluating
dangerousness. When a threats case came to the attention of patrol
officers or detectives, they could refer the case to these law
enforcement specialists for a formal assessment. In the event of arrest
and charging, this information could be provided to the court for the
purpose of bail recommendations and conditions of release.

•

Communication and protective intelligence sharing barriers must be
broken down. – Information must be shared in order to be useful. Our
front line officers and deputies should have immediate access to risk
management information when confronting potentially violent
individuals in our communities. This is a matter of both public safety
and officer safety. Knowing all you can about who you may confront in
a violent event is the first step towards developing a police response
strategy that minimizes risk to all our community members. There
appears to be a general misunderstanding of HIPAA and other privacy
protection laws among local law enforcement. Law enforcement
officers fear violating the privacy rights of individuals that may have
histories of substance abuse, mental illness, and competency
evaluations. We are often reluctant to seek the very information that
may assist us in peacefully resolving or avoiding a violent incident.
There must be a clear understanding as to what information is routinely
available to law enforcement for “protective intelligence.” Technological
information sharing systems must be developed and/or improved.

86

•

Encourage cooperative efforts between State and Local Law
Enforcement and DOC.-There are excellent examples of State
and Local Law Enforcement working together to identify and track
potentially violent individuals, and there are examples of complete
breakdowns in communication. Both the King County Sheriff’s Office
and the Seattle Police Department are engaged in on-going programs
that bring state and locals agencies together to work for a common
cause. These cooperative relationships must be further encouraged to
promote the sharing of protective intelligence. An example of a
breakdown in communication occurred with the release of Daniel
Tavares Jr., an offender who killed his mother, threatened to kill law
enforcement and other officials, and relocated in Pierce County.
Tavares killed a young couple who lived next door in a senseless
rampage. Had there been an efficient inter-agency communication
process in place this terrible tragedy might have been prevented.
Local law enforcement should have been informed of this offender'
s
dangerous history and his threats to kill in order to adequately protect
their community. Breaking down the communication silos that often
exist between law enforcement agencies is critical to successfully
monitoring threats to public safety. As a starting point, we should
identify what formal and informal interagency cooperative agreements
are in place now, and what gaps exists that need to be filled.

•

Encourage cooperative efforts between Local Law Enforcement and
the Mental Health Community. - As first line responders, local law
enforcement must be trained in a wide variety of aspects related to
mental health and community safety. Our officers and deputies must
be able to recognize the signs and stages of de-compensation and the
potential movement towards a violent event. If signs of decompensation are observed, what is the next step? To whom do we
report? What is the proper course of action in dealing with someone
who is ‘off their meds?’ Law Enforcement needs to be aware of and
understand the sensitive and unpredictable relationship between drug
and alcohol abuse and mental illness. Law enforcement needs to given
more guidance on the basics of involuntary commitment (RCW 71.05),
including under what circumstances a referral needs to be made to this
system, and what are the concrete steps to making a referral.

87

The Sheriff'
s Office appreciates the opportunity to participate in this
workgroup. As you know, the issues discussed in this workgroup are of critical
importance to law enforcement as we are on the front lines dealing with real
life scenarios involving violent mentally ill offenders and threats every day. I
am more than willing to continue working on these issues in the future, and I
am hopeful that the efforts of this workgroup will result in some important
changes on the ground.
Thank you.

Cc: Sheriff Sue Rahr
Chief Carol Cummings
Major Dave Jutilla

88

Appendix A-11
E-mail from
Jo-Ellen Watson
King County Crisis and Commitment Services.

89

Rogers, Ethan
From:
Services

Watson, Jo-Ellen - King County Crisis and Commitment

Sent:

Friday, October 31, 2008 11:07 AM

To:

Rogers, Ethan; DMIO workgroup

Subject:

Inpatient Capacity for DMIO Paper

Importance:

High

Attachments:

Boarding Information Sheet - July 2008.doc

Since 2004, King County and other Washington State Counties have been
experiencing a severe shortage of in-patient psychiatric beds (E&T beds) for
detained patients. This shortage has resulted in a phenomena referred to as
"boarding." When a patient is "boarded," the patient is detained by a DMHP but
remains at a hospital emergency department or medical unit awaiting an inpatient bed to open up at an Evaluation and Treatment facility. DSHS grants a
"one-bed certification" to the hospital boarding the patient to allow the ITA
detention to continue. The patient remains the boarding hospital'
s responsibility.
The boarding problem has reached critical proportions. In 2008, King County
Crisis and Commitment Services has boarded an average of 64 patients each
month representing all age ranges. The average days from detention to
appropriate placement is 1.4 days, but some patients have remained in non- E&T
facilities for 14 days or longer. Every hospital emergency department and many
in-patient medical units in King County have been in the position of caring for
boarded patients. Emergency departments are not appropriate settings, are not
secure, and are not well prepared to treat individuals who are detained and are
awaiting an appropriate placement.
Any changes resulting in the expansion of our commitment laws must take into
account the lack of inpatient capacity and the complexity of patient care,
specifically in this sub-population of mentally ill persons with a history of violence.
For a more detailed explanation of boarding please see the attached information
sheet that KC CCS leaves at a hospital each time a detained patient is boarded
in a non-Evaluation and Treatment Facility in King County.

90

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20:6

Appendix A-12
E-mail from
Trish Blanchard and Declan Wynne
Sound Mental Health
and
Jo-Ellen Watson and Michael Leake
King County Crisis and Commitment Services.

93

Rogers, Ethan
From:

Blanchard, Trish; Wynne Declan - Sound Mental Health;
Watson, Jo-Ellen; Leake, Mike - King County Crisis and
Commitment Services

Sent:

Friday, October 31, 2008 12:01 PM

To:

Rogers, Ethan; DMIO workgroup

Subject:

DMIO Workgroup Recommendations

Importance:

High

The following recommendations were developed during a meeting involving
representatives from Sound Mental Health'
s Community Integration Assistance
Program (CIAP, formerly called DMIO), King County Crisis and Commitment
Services, the Seattle Police Department'
s Crisis Intervention Team, and the
Department of Correction'
s Special Needs Unit. The purpose of the meeting was
to staff a specific problematic individual, but also resulted in the identification of
recommendations that could be made to this workgroup.
These recommendations have been made in collaboration between Trish
Blanchard and Jo-Ellen Watson and additional members of these groups.
1. There should be a consistent reminder to key stakeholders that there does not
need to be a correlation between the predicate crime and mental illness for an
offender to be designated a DMIO. This is unlike the similar "MIO Community
Treatment Program (CTP)," created by SSB 6002.
2. For the DMIO statewide selection committee (which gives final approval of
which inmates will be designated as DMIO) to make decisions, there needs to be
validated documentation of crimes and mental health evaluations.
3. Referrals of DMIOs to RSNs and out-patient treatment agencies need to occur
no less than 3-5 months prior to the earliest release date in order to provide
adequate pre-release assessment and engagement services.
4. A pre-release assessment completed by CIAP/DMIO team should be made
available to the office of the Designated Mental Health Professionals where the
DMIO offender will reside. This assessment would include a psychological
profile, behaviors exhibited while in prison, as well as a complete description and
dates of each previous offense.
5. A Rapid Response Team should be developed in King County, consisting of
one representative from CCS, SMH-CIAP, DOC-Special Offenders Unit, and
Seattle CIT, in order to staff specific and emerging situations with this particular

94

sub-population of offenders. The purpose of the team would be to develop a
cross-system crisis plan evaluating the needed response and determining which
system best meets the community'
s and offender'
s needs: Civil Commitment,
Criminal Justice (if a new crime committed), or revocation of community
supervision. If successful and resources are available, the project could be
expanded to other high-risk populations.

95

APPENDIX B
Glossary and Acronyms
Boarding – A patient detained for involuntary mental health treatment should receive
that treatment at an Evaluation and Treatment facility. However, when a
Designated Mental Health Professional takes the patient into custody to start that
evaluation and treatment, the beds in the local E&T’s are often full. When this
occurs, the patient must be “boarded” in a hospital emergency room (psychiatric
emergency room or otherwise) until a bed becomes available at an E&T. The
boarding of a patient at an emergency room can last several days, even beyond the
initial 72 hour detention period.
Case manager - An employee of an out-patient mental health treatment agency who
helps a mental ill person arrange for their treatment and other needs, such as
housing.
CCO - "Community Corrections Officer" - An employee of the Department of
Corrections assigned to supervise offenders in the community, during the offender's
period of post-incarceration supervision.
CIAP - "Community Integration Assistance Program" - The term DSHS uses to
describe the general DMIO enhanced services program. It is also the name of a
specific program of services provided to DMIOs living in King County. The
program in King County is run by Sound Mental Health, an out-patient mental
health service provider. If a DMIO living in King County participates in this
program, up to $10,000 in additional funding per year may be available to assist the
DMIO's integration into the community. Currently, the funding is available for the
first five years after a DMIO's release from prison.
Competency to stand trial - Relates to a person's ability to be tried in criminal courts.
If, due to a mental illness, a person is unable to assist their attorney or is unable to
understand the basics of the court process, they are not competent to stand trial.
District Court - A court of limited jurisdiction. District Courts are part of county
government. Among other duties, District Courts handle most misdemeanor cases
occurring in unincorporated parts of a county.

96

DMHP - "Designated Mental Health Professional" - This is a social worker, nurse, or
other mental health professional who has been designated by a county government
to investigate, evaluate, and determine whether a person in the community should
be detained because the symptoms of a mental illness make the person a risk to
themselves, others, or other's property. DMHPs have the authority to detain a
person and are the only officials able to initiate a civil mental health commitment of
a person in the community. In some counties, the DMHP is a county employee; in
others, the DMHP works for a mental health treatment provider agency and has
other duties. Up until a few years ago, the acronym was "CDMHP," with the "C"
standing for "County."
DMIO - "Dangerously Mentally Ill Offender" - A designation applied to certain
persons upon their release from prison, due to the existence of a mental disorder and
a perceived risk for reoffending. The designation occurs when the Department of
Corrections identifies and recommends that an inmate be so designated, and then a
board consisting of representatives from DOC, DSHS, the Department of
Developmental Disabilities, community mental health treatment providers, the
Regional Support Network, law enforcement, and chemical dependency treatment
providers approves the recommendation.
DOC - "Department of Corrections" - The part of Washington State government
which oversees the state prison system. DOC also oversees the post-release
supervision of offenders.
DSHS - "Department of Social and Health Services" - The part of Washington State
government that, among many other duties, oversees mental health treatment at the
state level. This includes managing many of the funding options for those with
mental health issues who need public assistance. It also includes running the two
state mental health hospitals, Western State Hospital and Eastern State Hospital.
E&T - "Evaluation and Treatment Facility" - A local mental health facility which can
provide involuntary in-patient treatment at the local level under the Involuntary
Treatment Act. An E&T can be part of a larger medical facility and consists of
locked units. The statutory definition of Evaluation and Treatment Facility is found
in RCW 71.05.020(16).
ESH - "Eastern State Hospital" - One of two state-run, long term, in-patient mental
health treatment facilities for adults. It is located in Spokane County.
FACT - "Forensic Assertive Community Treatment" - This is a mental health
services program which is usually a variation of a "PACT" team, and is targeted for
clients who are often repeatedly jailed for reasons related to mental illness. The
strategies used are similar to PACT teams, although CCOs or other professionals of
the criminal justice system may be considered part of the team. The only FACT
team of this type in Washington State is run by Sound Mental Health in King
County.

97

Felony - In Washington State, a crime where the maximum punishment is greater than
one year of confinement. Felony crimes are prosecuted in Superior Court.
Gross Misdemeanor - In Washington State, a crime where the maximum amount of jail
time is over 90 days but no more than one year. Gross misdemeanors are usually
prosecuted in Municipal or District Court, but can be heard in Superior Court.
When used in a general sense, including in most instances in this report, the term
"misdemeanor" is used to denote both Gross Misdemeanors and Misdemeanors.
HIPAA - "Health Insurance Portability and Accountability Act" - This is a federal
law which, among other things, prohibits disclosure of a person's health information
to others. While there are exceptions which allow for the providing of the
information, there are also stiff fines if the information is disclosed improperly.
ITA - "Involuntary Treatment Act" - The set of Washington State laws through which
a person may be civilly detained for involuntary mental health treatment, if they
present a risk to themselves or others. For adults, the ITA is found in RCW 71.05.
For juveniles, the ITA is found in RCW 71.34. Involuntary treatment under the
ITA can include court-ordered out-patient treatment.
KC CCS - "King County Crisis and Commitment Services" - The agency in King
County which employs DMHPs. It is part of the King County government and
DMHPs in King County are county employees.
L.R.O. - "Less Restrictive Order" - Also known as a "Less Restrictive Alternative"
(L.R.A.). This is an order issued by a judge in an ITA proceeding which requires a
person to do out-patient mental health treatment. Failure to follow the order, or
decompensation, can lead to DMHPs recommitting the person to an E&T.
MHAD - "Mental Health Advanced Directive" - This is a document by which a
person, while in a compensated state of mental health, attempts to direct what
mental health treatment they will receive should they decompensate.
MHC - "Mental Health Court" - This usually refers to a program offered by either a
Municipal or District Court for people charged with misdemeanors who have
mental health issues. This is part of criminal proceedings. By "opting-in" to the
program and following its treatment requirements, the defendant receives a break in
regards to the criminal charges. Less frequently in King County, it refers to the
civil ITA proceedings in Superior Court.
MHD - "Mental Health Division" - This is a Division of DSHS. It oversees many
components of mental health treatment and programs in Washington State,
including the DMIO program (called CIAP by the Mental Health Division) and
Eastern and Western State Hospitals.

98

MHP - "Mental Health Professional" - Generally, any psychiatrist, psychologist,
ARNP, social worker, therapist or other professional who works with people with
mental illness. An "MHP" should not be confused with a "DMHP."
Misdemeanor - When used in a general sense, including in most instances in this report,
the term "misdemeanor" is used to denote all non-felony crimes, where the
maximum amount of jail time is one year or less. Misdemeanors are further
classified into Gross Misdemeanors and Misdemeanors. In Washington State, a
crime is classified as a Misdemeanor if the maximum punishment is 90 days in jail
or less. If the maximum punishment is more than 90 days but no more than one
year, the crime is classified by statute as a Gross Misdemeanor. Most misdemeanor
crimes are prosecuted in Municipal or District Court, but can be heard in Superior
Court.
Municipal Court - A court of limited jurisdiction. It is part of city government. Among
other duties, Municipal Courts handle most misdemeanor cases occurring within the
city's boundaries.
NGRI - "Not Guilty by Reason of Insanity" - A plea in criminal cases where a person
admits doing the acts constituting a crime, but claims that the effects of a mental
disease or defect means they should not be held criminally responsible for their
acts.
Offender - A person who commits acts constituting a crime and who are being held
legally, if not criminally, responsible for it. Offenders include those found guilty of
a crime and those found Not Guilty by Reason of Insanity.
OAA - "Offender Accountability Act" - The Offender Accountability Act is legislation
which gives CCOs latitude in imposing conditions on those they supervise, and also
allows certain violations of conditions to be handled administratively, rather than in
a court proceeding.
PACT - "Program of Assertive Community Treatment" - This is an out-patient
mental health service program designed to work with the highest users of mental
health treatment services. The clients of PACT teams usually have the hardest time
maintaining stability and are often incapable or unwilling to engage in treatment
with more typical providers. PACT teams attempt to engage their clients in the
clients' community settings, with some of the features of in-patient treatment
brought to the client. There are ten PACT teams statewide, including two in King
County. In some states, a "PACT" team is known as an "ACT" team.

99

PES - "Psychiatric Evaluation Specialist" - This is an employee who works at the King
County Jail and evaluates inmates who appear to be showing symptoms of mental
illness. While they work at the jail, Psychiatric Evaluation Specialists are employed
by the Public Health Division of King County government. (n.B., while not used in
this report, "PES" is also the acronym used for Harborview Medical Center's
psychiatric emergency room - known as Psychiatric Emergency Services)
RSN - "Regional Support Network" - a single or multi-county based entity responsible
for arranging mental health services for adults and children with mental illness who
are eligible for public-assistance through programs such as Medicaid.
SMH - "Sound Mental Health" - An out-patient mental health treatment agency. It is
one of 16 agencies in King County which contract with the Regional Support
Network of King County to provide most of out-patient mental health treatment and
case management in King County.
SOU - "Special Offender Unit" - This is a special residential center within the
Department of Corrections. Inmates with the most severe symptoms of mental
disorder are housed and treated at the SOU. The SOU is located at the DOC facility
in Monroe, and houses about 400 inmates.
Special Needs Unit - A unit of Community Corrections Officers in King County
assigned to supervise offenders with mental health issues. There are normally eight
members on the unit. The caseload of a CCO on the Special Needs Unit consists of
offenders who have been designated DMIO, offenders who have plead NGRI, and
other offenders who have no special designation but have been referred to the unit
due to the existence of mental illness.
SPD - "Seattle Police Department"
Superior Court - A court of general jurisdiction. Superior Courts are part of county
government and are authorized to handle all criminal cases, including all felonies.
Superior Courts also have jurisdiction over all civil mental health commitment
cases under the ITA.
WSH - "Western State Hospital" - One of two state-run, long term, in-patient mental
health treatment facilities for adults. It is located in Pierce County.
WSIPP - "Washington State Institute for Public Policy" - A state-sponsored, nonpartisan research institute created by the state legislature to examine issues as
directed by the legislature.

100

APPENDIX C
Legal Standards Related to Mental Illness
The extent to which a mental illness affects a person's actions and ability to
understand what is going on around them can impact what happens to the person in court.
Legal standards have been created to determine when the impact should occur. Some
standards were created by the legislature, others by the courts. Here are some of those
legal standards applicable in Washington State, and the impact they have in court when it
is found that the standards are met.
1.

Standards used in criminal prosecutions:

Competency:
Competency relates to the ability of the State to bring a defendant to trial.
Definition:
A defendant is incompetent to stand trial if, at the time the defendant is at court,
and due to a mental illness, a person:
(1) is unable to understand the nature of the charges (also described as unable to
have a rational as well as factual understanding of the court proceedings);
or
(2) is unable to assist in his defense.
Impact:
If a defendant is incompetent to stand trial at the time they are before the court,
the criminal prosecution cannot proceed. The State may be allowed to treat a defendant
to make them competent. If the defendant remains incompetent, the criminal case must
be dismissed.

101

Diminished capacity:
Diminished capacity is a defense to criminal charges.
Definition:
Diminished capacity is an assertion that at the time of the criminal acts, and due
to a mental condition (not amounting to insanity), the defendant did not possess the
requisite mental state necessary to commit the crime charged. An example of a mental
state is "intent," such as whether a person had the intent to cause the death of the victim.
Impact:
Once a defendant has exerted a diminished capacity defense, the State must prove
beyond a reasonable doubt that the defendant did have the capacity to possess the mental
state. If the defendant is successful in exerting a diminished capacity defense, the
defendant is found Not Guilty of the charged crime.
Insanity:
Insanity is a defense to criminal charges.
Definition:
The definition of insanity is known as the M'Naughten rule. A person is legally
insane if, at the time of the commission of the offense, and as a result of mental disease or
defect, the mind of the defendant was affected to such an extent that:
(1) the defendant was unable to perceive the nature and quality of the act with
which the defendant is charged;
or
(2) the defendant was unable to tell right from wrong with reference to the
particular act charged.
Impact:
A defendant may assert as a defense to a crime that they were legally insane at the
time of the criminal acts. Once asserted, the defendant has the burden to prove by a
preponderance of the evidence that they were legally insane. If successful, the defendant
is found Not Guilty by Reason of Insanity. A defendant found NGRI may be subject to
hospitalization and supervision if the court believes that the defendant remains a risk in
the community.

102

2.

Standards used in civil mental health commitment proceedings:

Legal standards for civil detention:
Civil detention due to a mental disorder is based on the severity of the risk
presented. These are the legal standards used during the initial stages of a civil mental
health commitment. These standards are found in RCW 71.05.020, which is part of the
Involuntary Treatment Act.
Definitions:
Likelihood of serious harm: A person presents a likelihood of serious

harm if:

(a) they present a substantial risk that:
(i) Physical harm will be inflicted by a person upon his or her own person,
as evidenced by threats or attempts to commit suicide or inflict physical harm on
oneself; or
(ii) physical harm will be inflicted by a person upon another, as evidenced
by behavior which has caused such harm or which places another person or
persons in reasonable fear of sustaining such harm, and the behavior includes a
"recent overt act"; or
(iii) physical harm will be inflicted by a person upon the property of
others, as evidenced by behavior which has caused substantial loss or damage to
the property of others;
OR
(b) the person has threatened the physical safety of another and has a history
of one or more violent acts ("violent act" means behavior that resulted in
homicide, attempted suicide, nonfatal injuries, or substantial damage to property);
Grave disability:
"Gravely disabled" means a condition in which a person, as a result of a mental disorder:
(a) Is in danger of serious physical harm resulting from a failure to provide for
his or her essential human needs of health or safety; or
(b) manifests severe deterioration in routine functioning evidenced by
repeated and escalating loss of cognitive or volitional control over his or her
actions and is not receiving such care as is essential for his or her health or safety;

103

Impact:
A Designated Mental Health Professional can place a person into a locked
psychiatric treatment facility for up to 72 hours if, at the time the DMHP sees the person,
that person either presents a likelihood of serious harm or is gravely disabled due to a
mental disorder. If, at the time of a court hearing within those 72 hours, the person
continues to presents a likelihood of serious harm or is gravely disabled due to a mental
disorder, the court can order up to 14 more days of in-patient treatment. Detention
beyond the 14 days can continue, first for 90 more days and then for successive periods
of 180 more days, if the person meets legal standards different but closely related to the
standards listed above. Two significant differences in the legal standards for longer
detentions are that a person cannot be hospitalized for more than 14 days if they have
only made threats prior to their hospitalization, and a person cannot be hospitalized for
180 days if they are only at risk for intentionally hurting themselves.

104

APPENDIX D
Involuntary Civil Mental Health
Commitment (ITA) Caseflow
in King County - Adults
FROM DMHP INVESTIGATION
TO
LONG TERM (180-DAY) COMMITMENT
AT WESTERN STATE HOSPITAL

105

DMHP
Investigation
Non -emergency
Emergency
(imminent risk)

Court approval

72 hour in-patient stay
(Harborview Medical Center, Fairfax, Navos,
N.W. Hospital Gero - Psych)
Hospital files 14 - day petition

14-DAY HEARING (BENCH TRIAL)
** PAO /Defense Involved **
OR
90 Day Less
Restrictive
Alternative

14 day in-patient stay
(Harborview Medical Center, Fairfax, Navos,
N.W. Hospital Gero -Psych)
By day 11, hospital files 90-day petition

Misd . Competency
Dismissal
(Misdemeanor “ Flip ”)

Revocation
** PAO/Defense Involved**
90-DAY HEARING (BENCH or JURY TRIAL)
** PAO /Defense Involved **
OR
90 Day Less
Restrictive
Alternative

90 day in-patient stay
Western State Hospital
By day 87, WSH files 180 -day petition

Felony Competency
Dismissal
(Felony “ Flip ”)

Revocation
** PAO/Defense Involved **
180-DAY HEARING (BENCH or JURY TRIAL )
** Atty. Gen./Defense Involved **
OR
180 day in-patient stay
Western State Hospital
By day 177, WSH files 180 - day petition

180 Day Less
Restrictive
Alternative

Revocation
** PAO/Defense Involved **

PAO = King County Prosecuting Attorney's Office

106

APPENDIX E
A Primer of Mental Health System Components
TABLE OF CONTENTS
A.

CIVIL MENTAL HEALTH SYSTEMS .........................................................107
1. The Involuntary Treatment Act and civil mental health court ..............107
a. The interface between criminal competency and civil commitment .......109
2. Designated Mental Health Professionals ..................................................109
3. The Regional Support Network and out-patient services providers ......110
a. Sound Mental Health's CIAP program for DMIOs ..................................111

B.

CRIMINAL JUSTICE AND THE MENTALLY ILL PRE-ADJUDICATION ....................................................................................111
1. The criminal courts and the basics of prosecution ..................................111
a. Superior Court .........................................................................................112
b. District and Municipal Courts .................................................................112
2. Specialty criminal mental health courts for misdemeanors ....................113
3. Mental health services in the King County Jail .......................................114
4. Defendants not competent to stand trial due to mental illness ...............116

C.

CRIMINAL JUSTICE AND THE MENTALLY ILL POST-ADJUDICATION ..................................................................................118
1. The Department of Corrections and the prison system ..........................118
2. The Department of Corrections and community supervision ................121
3. Dangerous Mentally Ill Offenders .............................................................122
4. DOC's Special Needs Unit in King County ...............................................123
5. Defendants found Not Guilty by Reason of Insanity ...............................124

107

A.

CIVIL MENTAL HEALTH SYSTEMS
1.

The Involuntary Treatment Act and civil mental health court

The Involuntary Treatment Act is the set of laws which allow a person to be detained for
mental health treatment through a civil legal action. The ITA is found in RCW 71.05 for
adults and RCW 71.34 for juveniles.
Under the ITA, the existence of a mental disorder alone is not sufficient to justify an
involuntary detention. The mental disorder must be having a substantial and adverse
effect on a person's ability to control their actions, to the extent that the person presents a
risk to themselves or others. These are the specific circumstances by which a person can
be considered for involuntary hospitalization, assuming that the mental disorder led to the
existence of the circumstance:
•
•
•
•
•
•

if the person attempted to or actually harmed another person;
if the person has committed a recent overt act which causes another person to be
reasonably concerned for their safety;
if the person has threatened another and has a provable history of violent acts;
if the person has threatened or attempted to harm themselves or has actually
harmed themselves;
if the person has substantially damaged someone else's property;
if the person is endangered because they are not caring for their basic needs such
as eating, sleeping, clothing and shelter due to their mental disorder; or the person
shows severe deterioration in functioning ability and is not receiving such
essential care.

Under RCW 71.05, local officials known as Designated Mental Health Professionals, are
assigned to conduct the investigation into whether someone should be involuntarily
detained for mental health treatment. DMHPs are the only ones authorized to
involuntarily detain individuals from the community who are a risk to themselves or
others due to a mental disorder.
If the person evaluated appears appropriate for involuntary treatment, one of the
following will happen:
1. If imminent risk exists, the DMHP will immediately detain the person.
2. If the risk is not imminent, the DMHP will petition the Superior Court for an
order to detain the person. In this situation a judge reviews the evidence provided
by the DMHP, and decides whether the person should be involuntarily
hospitalized. If the court agrees with the DMHP, the judicial officer signs an order
authorizing the DMHP to detain and hospitalize the individual.
Once the DMHP detains an individual, the DMHP places that person into local mental
health hospitals defined as Evaluation and Treatment Facilities (E&T's). If the E&T
108

wishes to treat a patient for more than 72 hours, the E&T must file a petition with the
Superior Court before the 72 hours expire. This petition requests fourteen days of
additional treatment. By statute, the Prosecutor's Office is charged with representing the
E&T's. The patient also is represented by an attorney, and a full evidentiary hearing can
occur over whether the patient should remain hospitalized. The rules of evidence,
including the rule prohibiting the introduction of hearsay as substantive evidence, apply.
The E&T has the burden to prove by a preponderance of evidence that the patient
presents a risk to themselves or others and that treatment cannot safely occur in an outpatient setting.
If a patient is detained, the E&T can later petition for 90 days of additional treatment.
The grounds for a 90-day petition differ somewhat from the grounds for the initial or 14day detention, and the burden of proof rises to a clear, cogent, and convincing evidence
standard. A patient can contest a 90-day petition and can even request a jury trial on the
issue. If a patient is detained as a result of a 90-day petition, the patient will be
transferred to Western or Eastern State Hospitals, the long term in-patient mental health
facilities in Washington State. If the state hospital believes detention beyond the 90 days
is necessary, the hospital can petition for 180 days of further in-patient treatment. The
Attorney General's Office represents the state hospital at the hearing for the 180 days of
additional treatment. The state hospital can petition for additional 180 day periods of
treatment, and can do so whenever the current period of treatment is about to expire, but
180 days is the longest period of treatment that can be sought in any one petition.
Throughout the ITA process, courts also have the authority to order a patient into outpatient mental health treatment, through what is known as a Less Restrictive Order.
L.R.O.'s are used to compel a patient to remain in out-patient treatment and take their
medication while in the community. Case managers with local out-patient mental health
providers, such as Sound Mental Health, usually monitor patients on L.R.O.'s. Patients
who are alleged to have violated the L.R.O. or to have decompensated can be placed back
in an E&T by the DMHPs on a revocation petition, and that can also be the subject of
litigation.
Treatment facilities, whether a local E&T or a state hospital, have the ability to
administratively discharge a patient before the court-ordered treatment period expires. If
a facility discharges a patient outright, the facility automatically ends the civil
commitment proceedings without further court action. The facility can also decide to
conditionally release a patient administratively, which has the same effect and
ramifications of an L.R.O. The discharges and releases described in this paragraph occur
solely at the treatment facility's discretion.
In King County, there are four adult Evaluation and Treatment Facilities that treat
involuntary patients and file ITA petitions into King County Superior Court. The E&T's
are Fairfax Hospital, Navos In-Patient Services (formally known as West Seattle
Psychiatric Hospital), Harborview Medical Center, and the Gero-psychiatric Unit of
Northwest Hospital. The E&T's in King County file about 2200 14-day petitions per
year. There are 16 primary out-patient service provider agencies operating in King

109

County. These are the agencies which contract with the Regional Service Network to
provide out-patient services. Most persons designated as DMIOs work with Sound
Mental Health for out-patient services.
a.

The interface between criminal competency and civil commitment

Referrals for civil commitment can also come through the criminal justice system. When
a defendant is not competent to stand trial and they cannot be made competent, their
criminal case will be dismissed. At that point, the criminal court will usually refer a
defendant for civil commitment. Just because a defendant is incompetent to stand trial
does not mean the defendant will necessarily be civilly committed, because, with one
exception, the grounds for civil commitment are not legally connected to the grounds for
determining competency to stand trial.
If the criminal charge was a felony, the defendant is sent directly to a state hospital,
which has the ability to file a 180-day petition, avoiding the 72-hour, 14-day, and 90-day
stages. The grounds on which a defendant can be committed in this manner include the
defendant is incompetent to stand trial and may commit similar criminal acts (this is the
one exception where criminal competency and the grounds for civil commitment are
legally connected). In King County, if the criminal charge was a misdemeanor and the
crime was serious enough, the defendant will also be sent to WSH where WSH has the
ability to file a 90-day petition, avoiding the 72-hour and 14-day stages. If the criminal
charge was a misdemeanor and not as serious, the misdemeanor court will make a referral
to the King County DMHPs, who will evaluate the defendant and decide whether there
are grounds to detain to an E&T for an initial 72-hour hold.
WSH professionals and DMHPs must do their evaluations using the legal grounds for
civil commitment, and cannot commit just based on the competency dismissal. For
example, a defendant may not be competent to stand trial on a criminal trespass charge
and it is clear they have a mental disorder. However, if it cannot be shown that they are
not providing for food, clothing, and shelter, they are neither gravely disabled nor
presenting a likelihood of serious harm, and would not be detained.
2. Designated Mental Health Professionals
In King County, all Designated Mental Health Professionals work for the county and are
part of an agency known as King County Crisis and Commitment Services (KC CCS).
KC CCS is a part of the Mental Health, Chemical Abuse and Dependency Services
Division of the King County Department of Community and Human Services. The work
of KC CCS is a component of the King County Regional Support Network. The duties of
KC CCS include evaluating people with mental disorders for possible involuntary
detention in psychiatric facilities according to the Involuntary Treatment Act. In addition
to detaining persons under the ITA, DMHPs are responsible for all initial crisis outreach
services for persons in King County who are not currently enrolled with an out-patient
service provider. The services of KC CCS are available 24 hours a day.

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KC CCS DMHPs usually first try to guide a person they contact to voluntary programs.
DMHPs do not detain due to mental disorder alone, and must explore less restrictive
options to detention first. If a person refuses all voluntary help, the person may be
appropriate for involuntary treatment. If a DMHP determines that the person evaluated is
appropriate for involuntary treatment, they will either detain immediately or petition the
court for an order to detain, depending on whether the existing risk is imminent or not.
Once the person is detained, the DMHP will arrange for the person to be sent to a
certified Evaluation and Treatment Facility. As noted earlier, the facilities in King
County for adults are Harborview Medical Center, Navos In-Patient Services (formally
West Seattle Psychiatric Hospital), Northwest Hospital Geriatric-psychiatric Unit, and
Fairfax Hospital. The inpatient care is for an initial period of 72 hours.
3. The Regional Support Network and out-patient services providers
Washington State's current civil mental health system structure originated out of a reform
effort which began in 1989. Legislation enacted in 1989 shifted responsibility and
accountability for services from state agencies to county-based entities called Regional
Support Networks (RSNs). Through legislative mandate and/or a contractual agreement
with the State of Washington, an RSN is responsible for arranging services and supports
for adults with severe and persistent mental illness and children with severe emotional
disturbances who are eligible for services through public-assistance programs such as
Medicaid. Most RSNs consist of several counties. King County is populous enough to
be an RSN in and of itself. The King County RSN was established in 1990 and is
managed by the Mental Health, Chemical Abuse and Dependency Services Division of
the King County Department of Community and Human Services.
A second phase of mental health reform occurred in 1995 with the implementation of the
Medicaid managed care system for outpatient health services. The King County RSN
began to deliver Medicaid services under this new structure in response to a federal
waiver granted to the state to establish regionalized administration of the Medicaid
program. This managed care structure is designed to increase access to care, client
satisfaction, administrative efficiency, and create greater accountability for outcomes and
quality. To receive Medicaid services through an RSN, a person must have a covered
mental illness diagnosis, have a functional impairment measured by a standard
functioning protocol, and in some cases have additional risk factors.
King County, through the RSN, offers a wide variety of mental health services to clients
based on their individual needs. Mental health services are provided through a network
of community mental health agencies that contract with the RSN. There are currently 16
agencies with whom the RSN primarily contracts with, and many other sub-contracting
agencies. The network includes providers who specialize in certain areas of care.
Services offered vary by provider but can include the following: 24-hour crisis response,
interpreter services, brief interventions, case management, psychiatric and medical
services, in-home services, employment/vocational services, homeless outreach and
engagement, housing/residential services, day treatment, individual and group therapy,
family therapy, psychiatric consultation to schools, medication management, cultural
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consultations and culturally appropriate care, education and training opportunities, and
consumer/advocate run services.
a.

Sound Mental Health's CIAP program for DMIOs

One of the community mental health agencies is Sound Mental Health. Sound Mental
Health has a specific program designed for defendants who are being released from
prison and have been designated as Dangerous Mentally Ill Offenders. Although this
program is for those convicted of felonies, the program is civil in nature and not part of
the actual criminal system. The services that Sound Mental Health provides to DMIOs
are part of the Regional Support Network's civil treatment structure. Sound Mental
Health's program for DMIOs is known as the Community Integration Assistance Program
(CIAP). The SMH staff assigned to this program only work with DMIOs, and they begin
working with the DMIO three months before the DMIO's release from prison. The case
manager to DMIO ratio is one to ten, which is a much smaller case manager to client
ratio than most other programs. It is also a multi-disciplinary team approach, with
chemical dependency treatment providers, Community Corrections Officers, and a
Seattle Police liaison all considered part of the team. The medication prescriber, an
ARNP, also works with far fewer patients than prescribers in other programs. The CIAP
program is based on an intensive service model, with most DMIOs being seen at least
once a day and sometimes multiple times per day as the client's condition warrants. The
contacts occur both in the SMH office and at the DMIO's residence. The CIAP program
also has easier to access housing options for the DMIOs, as SMH has agreements or
partnerships with several housing providers, and SMH staff begins working on the
housing issue even while the DMIO is still in prison.
B.

CRIMINAL JUSTICE AND THE MENTALLY ILL PRE-ADJUDICATION
1. The criminal courts and the basics of prosecution

A person who commits a crime will be prosecuted in Superior Court, District Court or
Municipal Court. Felony crimes are prosecuted in Superior Court. Misdemeanor crimes
are prosecuted in District or Municipal Court. Most criminal cases progress through the
court system in the same manner. First, a case is investigated and put together by a law
enforcement agency. Depending on the severity and location of the crime, the law
enforcement agency will then refer the case to either the Prosecutor's Office (a county
agency) or a City Attorney's office. Once a case has been referred, a county or city
prosecutor will review the case for legal sufficiency and, following filing standards, will
file the case into the appropriate court.
Once a case is filed, the defendant is arraigned. A defendant must plead guilty or not
guilty at the initial arraignment, and most plead not guilty. If the defendant pleads not
guilty, the case is set for a pre-trial hearing, and eventually may be set for a trial. While a
case is in the pre-trial stage the prosecutor and defense attorney negotiate the case, review

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the evidence, and discuss possible defenses the defendant may raise to the crime. At any
point a defendant may decide to plead guilty. In doing so, the defendant is agreeing to
admit guilt, or at least accept punishment, for the crime, usually in exchange for a
specific recommendation from the prosecutor at sentencing.
If the case is not resolved before trial, the case is either tried before a jury of citizens
(jury trial) or before a judge (bench trial). If a case goes to trial, a defendant may be
found guilty or not guilty. If found not guilty the case is over and the court has no
jurisdiction over the defendant. If found guilty, a judge will impose a sentence on the
defendant. Punishment may involve imposition of some combination of incarceration
(prison, jail, or a jail alternative such as work release or electronic home detention),
community service, a fine, restitution, a period of supervision by the state Department of
Corrections or county probation services, and certain affirmative treatment conditions
such as substance abuse, mental health, anger management, or domestic violence
treatment.
Below is a description of the courts in King County.
a. Superior Court
An adult defendant who is charged with a felony criminal offense as defined by the
Revised Code of Washington will have his case prosecuted in King County Superior
Court by the King County Prosecutor's Office. A felony offense is defined as any offense
that carries a maximum of more than one year in jail. Felonies are divided into classes.
A class A felony is punishable by up to life in prison, a class B felony is punishable by up
to 10 years in prison, and a class C felony is punishable by up to 5 years in prison. The
length of confinement time in a defendant's specific sentence on a felony case is
determined by looking at the seriousness of the crime and the defendant's criminal history
and locating the combination of those factors on a "sentencing grid" created by the
Sentencing Reform Act. The judge in many cases also will impose a period of postincarceration supervision. When under supervision, the defendant is in the community
but must abide by certain conditions. A Community Corrections Officer from the
Department of Corrections is assigned to monitor the defendant to make sure the
defendant complies with the imposed conditions.
A defendant who violates the conditions of supervision can be put back in jail or prison.
Depending upon when the original crime occurred, the violation will be reviewed either
by a Superior Court judge or a DOC administrative officer. For each violation, a
defendant could receive an additional sixty days of incarceration.
b. District and Municipal Courts
Misdemeanors and gross misdemeanors are crimes that carry lesser maximum
punishment (up to one year in jail) than felonies. The term "misdemeanor" is often used
to refer to both gross misdemeanors and misdemeanors, and that will be the practice here.
Superior Courts have jurisdiction to hear misdemeanor cases. However, most

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misdemeanors are filed in District and Municipal Courts. District and Municipal Courts
cannot hear felony cases, and they are therefore called courts of "limited jurisdiction."
A misdemeanor crime occurring in unincorporated King County will be filed into King
County District Court, and the prosecution will be handled by the District Court Unit of
the King County Prosecutor's office. A misdemeanor occurring within city limits will be
filed into Municipal Court, and that city's City Attorney's office will prosecute the case.
The City Attorney's office will also prosecute violations of that city's Municipal Code.
No matter whether the misdemeanor is filed in District or Municipal court, the procedure
from the commission of the crime through the finding of guilt is similar to the felony
process described above.
The sentencing phase for a misdemeanor is quite different than for felonies. The District
or Municipal Court Judge has complete discretion to impose as much confinement time
as the judge feels appropriate, up to the maximum of one year (ninety days for some of
the least serious crimes). The judge can also suspend part or all of a sentence or defer
sentencing. If the judge suspends or defers the sentence, the judge can impose
supervision and conditions of supervision for up to two years.
A defendant who violates the conditions of supervision on a misdemeanor charge can be
brought back before a District or Municipal Court judge. As a sanction for violating
supervision conditions, the judge can impose more jail time. The length of the sanction
can be up to the time remaining from the original sentence.
2. Specialty criminal mental health courts for misdemeanors
Both King County District Court and Seattle Municipal Court have special divisions
which are designed to handle misdemeanor defendants with mental illness. These
criminal Mental Health Courts represent an effort to increase effective cooperation
between two systems that have traditionally not worked closely together - the mental
health treatment system and the criminal justice system. The primary goal of these courts
is to improve public safety. In order to improve public safety, the mission of these courts
is to achieve the following outcomes for the mentally ill misdemeanant population: faster
case processing time, improved access to public mental health treatment services,
improved well-being, and reduced recidivism.
Mental Health Courts are "opt-in" courts, which means the defendant can choose to "optin" and agree to the mental health court program, or the defendant can choose to "optout" and have their case prosecuted in regular criminal court. Mental Health Court offers
misdemeanor defendants with mental illnesses a single point of contact with the court
system. A team approach is used for each case, with the team including the judge,
prosecutor, defender, treatment court liaison, and probation officers. The hallmarks of
the program include:
•

Defendants may be referred to the Mental Health Court from a variety of
different sources. In-custody defendants are often referred by jail psychiatric
staff who have screened for mental health issues. Defendants may also be

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referred for consideration by police, attorneys, family members, or probation
officers. A defendant may be referred by another District Court at any point
during regular legal proceedings if the judge feels the defendant could be
better served by the Mental Health Court. Some cases originally filed as
felonies in Superior Court can, at the discretion of the King County
Prosecutor's Office, be reduced or "dropped down" to misdemeanor charges
and referred to the Mental Health Court of the District Court.
•

The Mental Health Court reserves the right not to accept cases into its
jurisdiction if a person does not meet eligibility criteria. Likewise,
participation in the program is voluntary, as defendants will be asked to
waive their rights to a trial on the merits of the case and enter into a
diversion or plea agreement with a community-based treatment emphasis.

•

A court liaison to the treatment community is present at all hearings and is
responsible for linking the defendant with appropriate services developing
an initial treatment plan with the treating agency.

•

Defendants participate in court ordered treatment plans and successful
participation may result in dismissed charges, early case closure, or reduced
sentencing.

•

Defendants are placed on probation and the case is assigned to a Mental
Health Court Mental Health Specialist Probation Officer. These officers
have mental health backgrounds and carry substantially reduced caseloads in
order to be able to provide a more intensive level of supervision and
expertise to this traditionally high-needs population.

•

The Seattle Municipal Court has jurisdiction over all misdemeanor and gross
misdemeanor offenses allegedly committed by adults within Seattle City
limits that are referred by a City agency. The referring city agency is usually
the Seattle Police Department, but other city agencies (e.g. Animal Control,
Health, Revenue, etc.) refer cases, too. It also has jurisdiction over criminal
traffic misdemeanor and gross misdemeanor offenses allegedly committed
by teenagers 16 and older.

Any misdemeanor case where the competency of the defendant is raised is also filed into
or transferred to Mental Health Court. If a person is treated and “restored” following a
competency proceeding they then have the right to “opt-out” of the court.
3.

Mental health services in the King County Jail

Most defendants who are arrested on either a new charge or detained on a probation
violation will be booked into the King County Jail. Once booked, all defendants go
through an extensive intake process. During the intake process, inmates are interviewed
by corrections officers and a nurse. Inmates also complete an initial medical screening

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form on which they may list any medical or mental health concerns. All health services
provided in the jail, whether medical or psychiatric, are administered through King
County Public Health, not the King County Department of Adult and Juvenile Detention.
Nurses check inmates to make sure they have no outstanding medical concerns which are
more serious than the jail's medical facilities can address. If an inmate's medical
condition is such that they cannot be admitted to the jail, they are sent to a hospital until
they are medically cleared for return to the jail.
Inmates with severe mental health issues, unlike those with strictly physical medical
issues, are not sent anywhere for care but are admitted to jail. As a result, the King
County Correctional Facility has developed a detailed mental health evaluation and triage
process for inmates with possible mental health issues. Any inmate with possible mental
health issues are evaluated by staff of Jail Health Services, Psychiatric Services, which is
part of King County Public Health. This process usually starts when an inmate is sent to
an area of the jail known as Psychiatric Receiving for evaluation. Through this triage
process, the correctional staff attempts to identify, within 24 hours, those inmates that are
mentally ill and in need of specialized services. Psychiatric Services staff also attempt,
whenever possible, to gather mental health information on inmates from as many
collateral sources as possible. Inmates sent to the jail psychiatric unit are seen within 24
hours by a Psychiatric Evaluation Specialist (PES). Once those inmates are identified,
the PES makes a decision on the severity of the inmate's mental health condition and
makes a recommendation about where an inmate should be housed within the jail. Then
a treatment team reviews the housing decision after seeing the inmate the next day and
makes a final housing recommendation.
A mentally ill inmate might go into one of four housing settings: (1) the Acute Unit; (2)
the Sub-Acute Unit; (3) the Sheltered Housing Unit; or (4) General Population.14 Two
themes are always present in the jail's housing process for inmates. First, universal
suicide precautions are in place while the inmate's psychiatric needs are being assessed
and any inmate who appears to be suicidal is closely watched and can be housed in
isolation or group suicide prevention cells. In either setting, these inmates are on 15
minute watch to prevent any harm. Second, the jail always attempts to shift inmates to
the least restrictive housing option possible. If an inmate's mental illness symptoms
improve, the inmate will be moved to a lesser restrictive unit. When an inmate is in
general population, if any mental health issue arises, the inmate will be referred or rereferred to psychiatric services for an evaluation and to redetermine appropriate housing
status based upon the inmate's condition.
As part of caring for mentally ill inmates, the jail must not only decide how to house and
protect these inmates but must also attempt to administer appropriate treatment to them.
The goal is to improve the mentally ill inmate's symptoms, not just to warehouse the
inmate or prevent harm. Mental health treatment in the jail focuses primarily on the
administration of medications to the mentally ill. Psychiatric Services staff are able to
convince well over 50% of inmates to take medications voluntarily. However, treatment
14

For a detailed description of these units please see the King County Correctional Facility-Jail Health
Services Mental Health Evaluation and Triage Process flow chart at the end of this appendix.

116

can become limited because jail staff cannot force an inmate to take medication except in
extremely rare circumstances.
Staff attempt to learn as much information about a mentally ill inmate as they can,
including current courses of psychiatric medication. Staff works with the inmate to
ensure the continuation of medications while the inmate is detained and also work on
encouraging the inmate to take their medications. The jail treatment teams will evaluate
each mentally ill inmate to determine the best regiment of medication for each individual.
The treatment teams may change medications as medically indicated but they never
attempt to move an inmate to less expensive medication. Instead, they will keep each
inmate on the most appropriate medication even if that medication happens to be the most
expensive. The other focus of the treatment team is helping mentally ill inmates with
discharge planning once released. This includes trying to help the inmate with obtaining
out-patient mental health services.
Psychiatric Services staff does what they can to treat mentally ill defendants while they
are detained. Most would probably agree that jail is not a therapeutic setting for those
with severe mental illness and ideally they would like to see more resources to treat these
inmates elsewhere in the community. There is a strong sentiment that the jail should not
be a de facto housing placement for the mentally ill. Psychiatric Services staff try to
remain neutral on issues of guilt and innocence when treating inmates and prefer to see
themselves as administering much-needed medical care to patients rather that
administering criminal justice to inmates.
The jail staff will also make referrals to the DMHPs for civil commitment when they feel
there are grounds. However, they mostly make these referrals on misdemeanor cases, or
felony cases where the case is over, because the local psychiatric facilities are unlikely to
accept inmates who are charged with felonies.
4. Defendants not competent to stand trial due to mental illness
A defendant must be competent to stand trial before they can be criminally prosecuted. A
defendant is not competent to stand trial if the symptoms of their mental illness make the
defendant unable to assist his attorney, or if the defendant is unable to understand the
basics of court, such as the roles of the judge, prosecutor, their attorney, etc. It is a
violation of the defendant's Constitutional rights to force the defendant to stand trial
while incompetent. However, the State may be allowed to try to restore a defendant's
competency so that they may stand trial. The process for restoration of competency
includes providing the defendant with mental health treatment. If a defendant becomes
competent through treatment, the case continues and the defendant must stand trial for the
charges against him. If a defendant is not restored to competency, the criminal case will
be dismissed and further mental health treatment may follow through the civil
involuntary treatment process.
The issue of a defendant's competency is raised when a defendant's attorney, the
prosecutor, or the judge articulates a reason to doubt the defendant's competency. Once a
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question over the defendant's competency has been raised, the proceedings are suspended
while the defendant is evaluated by a mental health expert, usually a psychologist from
Western State Hospital. If the psychologist determines in their professional opinion that
the defendant is incompetent, the criminal proceedings remain suspended while the issue
of whether the defendant can be made to competent is explored. What happens to the
criminal case of an incompetent defendant varies whether the charge is a felony or a
misdemeanor.
If the criminal charge is a felony, the judge will send an incompetent defendant to
Western State Hospital so that the mental health professionals there can treat the
defendant and attempt to restore the defendant's competency. The initial period of inpatient treatment is 90 days. Depending upon the likelihood of success for restoration,
the State can seek an additional 90 days and then an additional six months of treatment at
WSH. This can include forced medications if the charge is serious enough. If
competency is restored, the criminal prosecution will resume. If the defendant cannot be
made competent, the judge must dismiss the case. When a felony case is dismissed
because the defendant is not competent to stand trial, the defendant will be returned to
WSH, where WSH can petition to initiate a civil mental health commitment under the
civil Involuntary Treatment Act.
If the criminal charge is a misdemeanor, and the charge is defined by statute as "serious,"
an incompetent defendant will be sent to WSH to see if competency can be restored.
However, on a misdemeanor charge, the period for restoration is significantly shorter and
the maximum time for this commitment is 29 days. If competency is restored, the
criminal prosecution will resume. If competency cannot be restored, the judge must
dismiss the case. In this situation in King County, the defendant will be returned to
WSH, where WSH can petition to initiate a civil mental health commitment under the
ITA.
If the criminal charge is a misdemeanor, but the allegations do not rise to the level
allowing for competency restoration, the criminal case must be dismissed.
Contemporaneous with the dismissal, the judge may order the defendant to be detained
for up to 72 hours to allow the local Designated Mental Health Professionals to examine
the defendant for possible civil mental health commitment under the ITA.
Once a criminal case is dismissed because a defendant is not competent to stand trial, the
judge no longer has any ability to supervise or impose conditions on the defendant.
However, the dismissal is "without prejudice," meaning that the Prosecuting Attorney or
City Attorney has the ability to refile charges when they deem it necessary and
appropriate. Competency can still be an issue in any subsequent filing, and the same
procedures for determining and restoring competency will be used.

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C.

CRIMINAL JUSTICE AND THE MENTALLY ILL POST-ADJUDICATION
1. The Department of Corrections and the prison system

When a defendant receives a sentence longer than 12 months, even if it is 12 months and
one day, the defendant is committed to the custody of the Department of Corrections.
DOC is Washington State's prison system, as well as the department which provides postprison supervision of offenders. Each offender entering the DOC system starts their
commitment by going through the reception center at Shelton Corrections Center.
During the initial stop at Shelton's reception center, offenders are screened for both
medical and mental health issues. Mental health professionals evaluate each offender to
determine who has a need for mental health services. Once a mental health professional
identifies an offender who is in need of mental health services, they look at the offender's
diagnosis and whether the offender can be treated for his mental illness within the general
population of DOC.
DOC must handle and treat all of its mentally ill offenders within the prison system.
DOC does not contract with outside agencies for those services and may not rely on the
services and facilities of any other system such as Western State or Eastern State
Hospitals. Therefore, all mentally ill offenders are treated and managed exclusively by
DOC staff and qualified mental health professionals who are part of the DOC staff. All
in-patient and residential treatment programs for DOC offenders are operated solely by
DOC.
As part of the initial evaluation, the mental health professionals determine whether an
offender needs to be put on medication or whether the offender's current mental health
medications must be continued. DOC also must determine whether an offender is so ill
that he needs to be hospitalized.
If an offender is so ill that he must be hospitalized, DOC will transfer him to an acute inpatient setting within DOC. This setting is similar to a hospital setting for the mentally
ill, but it is contained solely within DOC. The acute in-patient setting is staffed with
medical professionals who have the credentials to assess and treat the mentally ill.
Offenders are sent to the acute in-patient setting for stabilization of their condition and
will remain there until their condition is stabilized. Once an individual is stabilized, he is
evaluated to determine whether he is well enough to maintain appropriate behavior within
the general population of the prison.
A number of mentally offenders within the DOC system can function fine within the
normal prison population. If it is determined that an individual can return to the general
population, he is returned there and referred to one of many "out-patient" mental health
programs within DOC. Out-patient programs at the different DOC facilities offer
defendants help with medication management and provide psycho-educational groups in
which the defendant may participate. Psycho-educational groups help offenders learn to
manage their mental illness and provide information on a host of issues relating to mental
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illness including information on how to recognize and control things that triggers their
mental illness.
If DOC mental health professionals determine that an offender is not stabilized enough to
maintain appropriate behavior in the general prison population, that offender will be
referred to a "residential" setting within the prison system. Residential settings provide
more services and more protection for the most mentally ill offenders. There are three
residential treatments centers within the DOC system. First is the Special Offender Unit
(SOU) at Monroe Prison. The SOU is a self-contained residential treatment center and
the largest within DOC. The SOU at Monroe houses about 400 offenders. Generally, the
most severe mentally ill are housed within this center.
Second is the residential center at Walla Walla Prison. This unit resembles a cross
between an in-patient setting and a residential setting because it is very small and
contains only 14 to 16 beds. The unit is not self-contained. Finally, there is the
residential center at McNeil Island Prison. This unit contains about 78 beds.
When DOC is attempting to place mentally ill offenders within the system, it must
continuously balance the desire to place an offender in the least restrictive environment
possible while at the same time ensuring the protection of the most vulnerable mentally
ill offenders. Prison can be a very dangerous place for a mentally ill offender because of
the high number of dangerous and predatory offenders within the system. These
predatory offenders will often target the mentally ill within DOC, perhaps watching for
times when a mentally offender receives a package or money from home and then taking
advantage of the situation.
Likewise, mentally ill offenders can also present an extreme threat to the general
population. Due to their significant mental illness, mentally ill offenders can be violent
and unpredictable. It is exactly this unpredictably which causes concern and
management issues for DOC. At times, offenders are paranoid and operating under
delusions known only to the offender. Therefore, an offender could strike out at any time
and for a reason known only to the offender. The reasons are most often not based in
reality, but are merely products of the offender's mental illness. Because of the
unpredictability of some mentally ill offenders within DOC, it is impossible to predict
when they might act out. DOC must also consider this factor when deciding where to
place a mentally ill offender.
Therefore, the three residential programs within DOC are structured to be better equipped
for both protecting the mentally ill from other inmates in the general population and also
for dealing with the often violent and unpredictable nature of a mentally ill offender.
Residential programs have more staff and more resources to address and manage these
issues.
Mental health professionals at DOC can seek to involuntarily medicate an inmate through
an administrative process. They can do so on an emergency basis for up to 72 hours. If
they wish to involuntarily medicate for a longer period of time, the treating psychiatrist

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must make a written request and submit it to a special administrative committee. The
initial request is for 14 days. The treating psychiatrist can then request an additional 180
days of involuntary medication, and repeat the request every 180 days. Each time a
treating psychiatrist requests authorization or an extension of authorization for forced
medication, the special administrative committee will hold a hearing and review the
request. The inmate can contest whether involuntary medications are necessary and call
or cross-examine witnesses. If a majority of the committee, including a psychiatrist who
is not part of the treatment team, decides that the inmate is gravely disabled or constitutes
a likelihood of serious harm to themselves, others, or property (these are terms which
come from the civil Involuntary Treatment Act laws), medications can be administered
involuntarily by the treatment team.
It is important to note that an offender's mental illness and placement in a mental health
program at DOC, whether it is in-patient, residential treatment or outpatient, is
independent of that offender's overall risk classification. All prison inmates, whether
mentally ill or not, are assigned a classification based on their perceived level of risk.
The risk level of an offender also dictates the type of facility in which he will be placed.
Risk levels at DOC range from a 1 (lowest risk) to a 5 (highest risk). DOC must not only
take into account an offender's mental illness when deciding where to place him but must
also work with the offender's classification level. This complicates where an offender is
placed because certain facilities only service offenders of certain risk levels. The highest
risk level 5 is also known as Intensive Management Status. The SOU unit at Monroe
serves offenders up to levels 3, 4 and 5 and is the largest in the system so it receives
many of the most dangerous and difficult to manage of the mentally ill offenders.
The Washington State prison system tries to be progressive in managing and treating
mentally ill offenders. All mentally ill offenders are given a continuum of care
throughout their stay at DOC, and DOC always engages in very purposeful release plans
for each and every mentally ill offender approaching their release dates. In fact, the
release plans for mentally ill offenders are similar to discharge summaries for patients
from hospitals. These release plans may do even more to help offenders plan for their
release into the community. The release plans involve DOC staff, the offender, and
community members. The plans are aimed at helping offenders transition to the
community outside DOC. DOC helps set up appointments for treatment and care, sets up
housing for offenders if possible, and helps offenders obtain all needed medication upon
release.15
All mentally ill offenders, even those not designated as Dangerously Mentally Ill
Offenders, are given detailed release plans. Offenders designated as DMIO may have
additional funding to help pay for the DMIO's treatment and housing upon release.
Unlike DMIO offenders who may receive some funding, other mentally ill offenders do
not receive these funds and must rely on DSHS benefits and possibly housing or other
resources provided by family or friends.
15

Williams went through this release planning phase, with DOC successfully cajoling Williams to go along
with their plans, at least when he was first released.

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Finally, DOC keeps very detailed logs of an offender's placement, classification, behavior
and infractions while in the prison system. Because the offender is confined to a public
prison, all information is public and there are no confidentiality restrictions on disclosure
of that information. Therefore, anyone who requests such information is entitled to
receive it. This includes information about whether an offender had been placed in SOU
while in DOC custody. All DOC Community Corrections Officers have immediate
access to the system which maintains logs of offender information and prison behavior.16
That access includes the ability to read narratives about each of an offender's infractions
while in prison. While DOC does not specifically send this information to the State, the
Court, the CCO, or the defendant's treatment providers upon release, anyone can get they
information if they ask.
2. The Department of Corrections and community supervision
Whether, and under what conditions, an offender will be supervised in the community
after they are released from prison has been a frequent subject of legislation over the
years. As a result, while many offenders are subject to supervision in the community
upon release, the official name of the supervision varies depending on when the
defendant was sentenced and when the defendant is released. Official names include
Community Custody, Community Placement, and Community Supervision, and the name
can even change during the period of supervision. A bill, HB 2719, passed by the
legislature this year acknowledges the resultant confusion and attempts to provide some
clarity.
Most defendants who leave prison after serving time for violent offenses will be on some
version of supervision while in the community. The length of supervision is determined
by the nature of the crime, and if a defendant was released early, the amount of earned
release time is added to the original amount of community supervision. Specific
conditions of supervision may have been imposed by a judge. Since 2000, when the
Offender Accountability Act (OAA) became effective, the Department of Correction
decides most supervision conditions.
Every offender undergoing supervision is assigned a Community Corrections Officer.
The CCO is a DOC employee responsible for monitoring the defendant while on
supervision. The CCO has the ability to arrest and jail an offender who does not comply
with conditions. The standard conditions of supervision include reporting to the CCO as
directed, obtaining CCO approval of residence, engaging in work or schooling, no
possession or use of alcohol, street drugs, or firearms, and no contact with the victim.
Crime specific conditions, such as anger management or mental health treatment, can be
imposed when connected to the crime. DOC also monitors whether the defendant is
paying court ordered fees, fines, and restitution.

16

Specific treatment information may be considered confidential under HIPAA, and some information may
be archived, impacting the speed with which information could be obtained.

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When a defendant violates a condition of supervision, the defendant could be subjected to
up to 60 days confinement per violation. A defendant has a right to a hearing before a
sanction is imposed. If the defendant was sentenced pre-OAA, the hearing will be before
a judge. If the sentence was post-OAA, the hearing will be an administrative hearing
before a DOC hearing officer. Rather than arrest and a jail, a CCO may allow the
defendant to enter into a stipulated agreement, wherein the defendant avoids jail by
agreeing to additional conditions, such as going through in-patient chemical dependency
treatment.
3. Dangerous Mentally Ill Offenders
In 1999, the Legislature attempted to address the issue of prison inmates who were both
dangerous and mentally ill, but whose release into the community was unavoidable. To
do so, the Legislature created the designation "Dangerous Mentally Ill Offender." The
process to have an inmate designated DMIO begins about two years before the
anticipated release date. A computer program uses an algorithm to identify all inmates
who have mental illness. The case of every inmate identified by the computer program is
then analyzed by DOC staff. When the staff decides that an inmate presents such a high
risk to others due to mental illness so as to warrant a DMIO designation, they present the
inmate to a board for further consideration and final approval of the DMIO designation.
The board is made of professionals and includes representation from DOC, DSHS, the
Department of Developmental Disabilities, community mental health treatment providers,
the Regional Support Network, law enforcement, and chemical dependency treatment
providers.
If the board approves of the DMIO designation, DSHS representatives begin to work with
the defendant at least three months before the defendant's release. Their goal is to
convince the DMIO to engage in out-patient treatment. The DMIO will also be assigned
to a special unit for DOC supervision, if such a unit exists in the area where the DMIO
will live. The DMIO will also be examined by DMHPs for possible civil commitment in
the days before the DMIO's scheduled release into the community.
If the DMIO engages in out-patient mental health treatment after their prison release,
their out-patient provider has the ability to tap into a source of extra funding. This
funding averages about $10,000 per year per engaged DMIO, and is in addition to any
funding from other sources, such as Social Security. The extra funding is often used for
housing, but has enough flexibility that it can be used for almost anything which will help
keep a DMIO mentally stable, such as education or to help the DMIO remain employed.
Only those DMIOs who are engaged in mental health treatment are eligible for the extra
funding. DSHS cannot obligate a person to engage in treatment, and therefore from the
DSHS perspective, the extra funding is a voluntary program. However, DOC often has
the ability to impose engaging in mental health treatment as a condition of supervision.
This makes a DMIO's participation in the program mandatory from DOC's perspective,
because a DMIO who does not participate can be arrested and subject to sanctions,
including jail.

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Presumably, additional attention and resources will lead to the DMIO being more
psychiatrically stable, reducing recidivism and creating overall savings for the system.
Early studies of the DMIO program, by David Lovell of the University of Washington
and by Gregg Gagliardi and Polly Phipps of the Washington State Institute for Public
Policy (WSIPP), bear this out.
These studies indicate that the DMIO program is successful in several areas. Over the
first 18 months of release, DMIOs committed new crimes at a rate 19% lower than a
similar group released before the program started. They also got into treatment sooner,
(two weeks on average rather than six months), and stayed in treatment longer, with a
60% higher rate of defendants staying in treatment for at least nine months. DMIOs also
tapped into additional funding sources sooner (in 26 days rather than 54 days), and more
often (72% of DMIOs versus 41% of non-DMIOs). DMIOs were also in substance abuse
treatment more often than the other group, 53% to 19%. The WSIPP study found that for
every $1.00 spent on DMIOs, $1.24 is saved through reduced incarceration costs,
prosecution costs, etc.
The extra funding for DMIOs is not a continuing resource. Currently, the extra funding
is available for the first five years after the DMIOs release from prison. However, there
has been discussion among officials to cut back the number of years the funding would
be provided. Furthermore, in many parts of Washington State, the extra funding is not
utilized, either because there is not an out-patient provider with a program for DMIOs, or
the Regional Support Network does not contract with providers because of liability
concerns.
4. DOC's Special Needs Unit in King County
King County is large enough that DOC has created a unit dedicated to supervising
offenders with mental health issues. The unit is called the Special Needs Unit. This
group of eight Community Corrections Officers has smaller caseloads - 25 to 30
defendants, rather than the approximate 40 defendants most CCOs supervise. The
Special Needs Unit is assigned to supervise all DMIOs living in King County. There are
about 45 DMIO designated offenders in King County supervised by the Special Needs
Unit. The unit also supervises all offenders who are under supervision due to a finding of
Not Guilty by Reason of Insanity. Currently about 15 persons living in King County and
found NGRI are supervised by the Special Needs Unit. The remainder of the Special
Needs Unit's caseload is offenders whose mental illness is so prevalent that they have
been referred by other units specifically for supervision by the Special Needs Unit.
Most Special Needs Unit CCOs have mental health backgrounds. They will usually see
each offender once or twice per week, and often much more if the condition of the
defendant seems to warrant it. Their teamwork within the unit is more overlapping than
in most units, with each member becoming quite familiar with the offenders on the other
CCOs' caseloads. For instance, if a CCO is checking in on an offender and is in an area
where another CCO also has an offender, the CCO will check-up on both offenders if
possible.
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The Special Needs Unit CCOs keep in close contact with their defendants' out-patient
treatment providers. For DMIOs, mental health case management in King County is
provided by Sound Mental Health, which has a program dedicated to case managing
DMIOs. Besides communicating about any particular offender for which there is
heightened concerned, the CCOs and SMH meet once a week to review the status of all
DMIOs. This meeting is also attended by other agencies, including the Seattle Police
Department, housing representatives, and chemical dependency treatment providers.
Other than their pre-CCO training, their experience, and their wits, a Special Needs Unit
CCO has no more tools to work with a mentally ill offender than any other CCO working
with an offender, mentally ill or not. This means that a Special Needs Unit has only four
ways to take a defendant off of the streets (this does not include NGRI offenders). First,
a CCO can use the violation hearing process. If there has been a violation of conditions
of supervision, the CCO can put the defendant in jail and file a violation report. The
maximum amount of time a defendant can serve is 60 days per violation. Second, if a
defendant's new conduct rises to a criminal level, a law enforcement agency can be
contacted and the defendant can be arrested and charged. Third, the CCO can encourage
the defendant to enter into a psychiatric hospital voluntarily, although most DMIOs will
not qualify as good-faith voluntary patients. Finally, a CCO may make a referral to the
Designated Mental Health Professionals for civil involuntary mental health commitment
under the Involuntary Treatment Act.
5. Defendants found Not Guilty by Reason of Insanity
If the symptoms of a defendant's mental illness impacted a defendant's ability to think
and act (or not act) at the time the defendant engaged in felony criminal behavior, the
defendant could be found Not Guilty by Reason of Insanity (NGRI). In Washington
State, the issue of whether a defendant was insane at the time the defendant committed
the criminal acts is governed by the M'Naughten standard of insanity. Under the
M'Naughten standard, there is a presumption of sanity, unless the defense proves by a
preponderance of the evidence that as a result of mental disease or defect, the mind of the
defendant was affected to such an extent that (1) the defendant was unable to perceive the
nature and quality of the act with which the defendant is charged; or (2) the defendant
was unable to tell right from wrong with reference to the particular act charged. The
defendant has the right to have the issue of insanity tried before a jury. Often, a
defendant will decide to waive the right to a jury and have a judge alone decide the issue,
or the prosecution agrees an NGRI finding is appropriate and an "agreed" finding is
entered by a judge. An NGRI finding means the defendant is not criminally responsible
for their acts; however, it can still lead to in-patient mental health treatment and/or close
supervision of a defendant living in the community.
Once a defendant has been found NGRI by a judge or jury, the judge or jury also decides
whether the defendant remains a risk to community safety and security. If so, the court
retains jurisdiction over the defendant. The court can order the defendant to a state
psychiatric hospital for in-patient treatment. The court can also order the defendant to be
released into the community but on conditions which usually include supervision and out125

patient treatment. The court's jurisdiction can be up to the maximum possible sentence of
the crime charged, including life, and therefore, some defendants are under the court's
jurisdiction for decades, with the court's authority only ceasing with the defendant's
death.
At any one time in King County, there are between 125 and 140 defendants who have
been found NGRI on criminal charges and who are either in in-patient treatment at
Western State Hospital (WSH) or are on conditional release and must comply with courtordered treatment and other conditions, including supervision. Community supervision is
done either by the Department of Corrections (even though the defendant was not
actually found guilty of the offense and placed on traditional supervision) or by Western
State Hospital. When DOC is the supervising agency, the defendant is usually assigned
to the Special Needs Unit, the unit which also supervises DMIOs. The Special Needs
Units supervise NGRI and DMIO defendants in very similar manners, but the officers of
the Special Needs Unit have the ability to place an NGRI defendant into WSH rather than
just jail if the officers see a need to remove the defendant from the community.
The status of NGRI defendants can change, either because WSH believes the defendant's
mental health is improving and they can safely transition into the community, or because
the defendant decompensates or violates their conditional release and DOC or WSH
believes they need to return to in-patient treatment at WSH. When a defendant is
returned to WSH, the treatment needs of the defendant usually determine how long the
defendant will remain in in-patient treatment. The statutory scheme requires WSH or
DOC to periodically file written reports with Superior Court and the Prosecuting
Attorney's Office for all NGRI defendants and also requires periodic reviews for those on
conditional release. WSH has developed a program called the Community Program.
This program helps a defendant to transition slowly and successfully from an in-patient
ward to living in the community.
The NGRI statutory scheme allows defendants to petition for conditional release or to
petition for court supervision to end permanently. The defendant is afforded an attorney
for all hearings. When the defendant is requesting conditional release, the defendant
usually has the burden to prove that they can be safe in the community.

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127

APPENDIX F
The Charging Documents Filed in
State v. James Anthony Williams,
King County Cause Number 08-1-01211-1 SEA

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129

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131

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APPENDIX G
Recent Media Articles on
DOC's Special Needs Unit in King County

135

http://seattlepi.nwsource.com/local/356469_dangerside26.html

Randy Vanzandt, left, a Department of Corrections community corrections officer, visits with Parish
Cockett at his independent living residence in West Seattle last month. Cockett, who has a history of
assault, has done well on medication since Vanzandt'
s supervision began in 2001. Vanzandt is one of
seven officers supervising more than 200 criminal offenders with a history of mental or developmental
troubles. (Dan DeLong / P-I)

Corrections officers face daily struggle to keep offenders, public
safe
Wednesday, March 26, 2008
Last updated 7:59 a.m. PT

By CAROL SMITH
P-I REPORTER

Just before first light, Randy Vanzandt pedaled downtown, past the Seattle Emergency
Center, where some of his offenders hang out, and left down Yesler Way. Throughout the
city, the eight-to-five office crowd queued up for its first caffeine hits of the day. Ahead
of him, he could make out a young woman, buzz cut, all edges, angular bone and harsh
words -- someone he knew.
The woman had a warrant out for failing to show up for supervision. "I rolled up on her
and invited her to take a walk," he said. Then he strolled both her and his bike the
remaining 1 1/2 miles to the Department of Corrections' special needs unit south of the
stadiums.
Vanzandt, lanky and affable, chuckles at the recounting of his commute.

136

His shift hasn't started yet, and he's already made his first arrest of the day.

Invisible dangers
Vanzandt is one of seven corrections officers in charge of supervising more than 200
offenders who have severe mental illness, personality disorders or developmental
disabilities along with histories of petty crime, drug addiction, assault, robbery or murder.
Their caseload also includes the state's "Dangerous Mentally Ill Offenders" -- people
coming out of prison who have psychiatric histories that warrant extra supervision and
support.
James A. Williams, charged in the random stabbing death of a young Seattle woman on
New Year's Eve, was one of theirs. So was Daniel Culotti, who was shot dead after
attacking a stranger in Westlake Plaza in 2006. So was Paul Pearson, who threw lighter
fluid on three pedestrians in downtown Seattle in January 2007, setting a woman's hair on
fire.
The dangerous mentally ill who wander the streets of Seattle go unseen by most of us.
Some blend with the office crowd. Others are the homeless we hurry past, avoiding eye
contact until we cease to notice them at all.
The special needs corrections staff does see them -- in alleys, and hospital waiting rooms,
and needle-littered parks. They spy them on MySpace or Internet dating sites.
It's a job few take, or want. They get spit on, sworn at, and are paid less than corrections
staff for other jurisdictions on top of it. They've learned not to bring up their occupation
at parties.
"When people find out what you do," said Patty McGuinness, another of the corrections
officers. "It's a conversation stopper."

'Word salad'
Mornings in the office resemble an improv skit with overnight messages providing the
scenario. The police called -- one of their offenders passed out in the library with a needle
in his arm and insists he wasn't using. Sound Mental Health called -- someone was a noshow for the third time. An apartment manager called -- "There's been a bit of an
incident. ... "

137

Occasionally the offenders leave messages, too -threatening, pleading or on a good day, just
checking in. Sometimes, it's hard to tell what they're
saying.
"It's just total word salad," Vanzandt said.
The corrections crew scrambles to fish their
offenders out of jails and emergency rooms, arrest
those with warrants out, drive some to appointments
and knock on the doors of others. Sometimes a
quick eyeballing is enough to assess whether
someone is at "baseline" or beginning to fall down
the rabbit hole of their disease.

Dan DeLong / P-I

Community Corrections Officer Patty
McGuiness talks with a woman inside the
King County Jail in Seattle after the
woman was arrested for violations of
supervision earlier this month. Officers
work to keep their offender stable and
out of trouble through jail, treatment or
housing.

"We try to plan things, but in this business you
never know," Dan Weiss said, adjusting the geekcool glasses that suit his mellow manner. Weiss is
prepping for the morning sweep with fellow officers Kathy Woik, "the queen of
structure," and McGuiness, who projects an unflappable maternal compassion no matter
what chaos unfolds.
Woik's morning, too, has started with a jolt.

"Can you believe it, Brett Favre is retiring?" Woik, an avid Green Bay Packers fan,
shakes her head and chews over the news. "I've seen him block. He's a guy who would do
whatever it takes, you know?"

The corridor
The corrections officers usually hit the field in groups of three. They go out armed with
handcuffs, fast reflexes and a dark sense of humor. "Got pepper spray?" one asks as they
head out.
Their unmarked van, painted drizzle gray, is unnoticeable to most of us, but well known
to the city's street people. For many, it's their only touchstone with reality. "In a weird
way, they start to think of us like family," Weiss says.
With its battered laptop docking stations and its Happy Meal hula girl mascot mounted to
the dash, the van functions as part mobile office, part holding cell and full-time command
center.
On this morning, the van rolls down Western Avenue, slowing as it passes the Millionair
Club. As soon as the van appears, a stringy-looking man ducks his head and edges
backward through the clump of day laborers gathered in front.

138

"Hey, there's one of ours," said Thomas McJilton, the driver, his watch cap pulled down
against the chill. McJilton, a former roofer, is the only one of the crew who doesn't come
from a mental health background. Among the rest of them, they have 60 years as
counselors and case workers. His colleagues rag him about that to his face, but call him
"a natural" behind his back.
Weiss, riding shotgun, peered at the guy moving opposite the crowd and shook his head.
"Not anymore," he said. "He's done."
McJilton turned left, looping through "the corridor," a territory bounded by South
Jackson and Wall streets and Sixth Avenue and the waterfront, where their offenders like
to hang out. They clatter past a disheveled woman in purple, who waves at them. She,
too, is designated dangerous, and mentally ill, but they have no business with her today.
That makes two offenders in as many blocks. Before the next few hours are up, they will
have spotted, stopped or spoken with a dozen more.

Missing tools
In between stops, their phones ring constantly. They duck in and out of conversations on
their Nextels the way stunt drivers weave through traffic, trying to get their offenders into
treatment, or housing or jail, manipulating the system to try to keep them stable and out
of trouble.
McGuiness hunches over her phone in the back of
the van, waging a verbal chess match with a young
man under her supervision for robbing a bank. He
doesn't believe he's schizophrenic. He's stopped
checking in, and hasn't been taking his meds. She's
trying to get him to come back to see her so she
doesn't have to arrest him for violating his
supervision.
"No," she says patiently. She's been over this with
him many times already. "You can't hire yourself to
give a second opinion on yourself." A long pause. "I
understand that, but you're not qualified to give a
second opinion."

Dan DeLong / P-I

Community Corrections Officer Thomas
McJilton looks for offenders in Victor
Steinbrueck Park in Seattle. Corrections
officers and their gray van are well
known to Seattle street people. "In a
weird way, they start to think of us like
family," one officer said.

The officers have to make judgment calls within a
system that seems as irrational as the offenders they supervise.

They can put their offenders in jail, but not a mental hospital. They can order them to
take their meds, but they can't force them. If they manage to convince the county mental
health professionals their offenders need emergency mental treatment for their own
safety, or the public's, the odds are the offender will bounce back after 72 hours because

139

of lack of beds in specialized psychiatric care. They know housing is critical for a
mentally ill offender's stability -- but there is almost none.
"I have only the tools in my toolbox," McJilton said. "And the tools I have aren't
necessarily the right ones."

Night sweep
Just before quitting time, the group crams into supervisor David Aiken's office for an
emergency meeting. The staff has just gotten word the Dangerous Mentally Ill Offender
program may have to cut services for participants from five years to 2 1/2. That would
mean 40 of their offenders could lose their housing by April 1.
"Homeless DMIOs (Dangerous Mentally Ill Offenders) are a huge concern," Aiken said.
"We don't want that to happen."
With no solution in sight, the meeting breaks up so the late crew can do a night sweep.
McGuiness, McJilton and Weiss grab bulletproof vests and climb back into the van.
The colors have nearly bled out of the day, but it's not long before they land on a skinny
guy in a familiar red jacket on a Pioneer Square street corner. McJilton throws the van in
reverse and screeches backwards.
"Drop it, Omar," Weiss yells. Omar's bag of Cheetos lands on the ground, and he leans
against the van while they pat him down. He's been designated dangerous by the state and
has a warrant out for going AWOL on his supervision. His supervisor has been trying to
get him into inpatient treatment for months. He has a habit of slicing himself open and
putting chicken bones and other foreign objects inside. He's also homeless.
Before this shift is up, they will arrest one more -- a chronic alcoholic woman whose
belongings are crammed into a plastic bag from Harborview, along with her discharge
instructions.
Weiss reads it through. The instructions say, "Do not drink alcohol."
It's dark by the time the team drives into the tunnel entrance to the jail to unload the pair
for booking.
Omar cooperated, McJilton said a few minutes later as he drove the emptied van back
into the rain. "It's cold out, and he knew he had a bed for the night."

P-I reporter Carol Smith can be reached at 206-448-8070 or carolsmith@seattlepi.com.
© 1998-2008 Seattle Post-Intelligencer

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http://seattlepi.nwsource.com/local/356465_dangerousmain26.html

Dan Weiss, one of seven Department of Corrections special needs unit officers, scans the street for
mentally ill offenders under their supervision who are in violation or have outstanding warrants. Many
offenders are homeless or live on the street. About once a month officers patrol at night checking to
see if offenders are where they'
re supposed to be. A computer in the van allows them to check the
warrant status of offenders. (Dan DeLong / P-I)

Dangerous and mentally ill: A system in restraints
Wednesday, March 26, 2008
Last updated 7:59 a.m. PT

By CAROL SMITH
P-I REPORTER

Before James A. Williams was charged with stabbing a young Seattle woman to death, he
stood before a King County Superior Court on a different occasion, accused of assaulting
a different stranger, and asked to speak in his own defense.
In the midst of a passionate and rambling argument explaining why he shot a stranger at a
Seattle bus stop, he paused to deliver this judgment:
"I didn't even ask to be born," he told the judge. "If I had my way I would never have
been born, but unfortunately, I was."

141

In some sense, it is a wish echoed by a mental health system that failed to predict the
emergence in the last few decades of a class of violent, mentally ill offenders, such as
Williams.
The year Williams, 48, was born, the United States was on the cusp of a grand
experiment to free the mentally ill from insane asylums, a shift that would eventually and
disastrously claim him as a casualty and, if what he is accused of is true, cost Shannon
Harps, 31, her life. Harps, a Sierra Club worker, was walking outside her Capitol Hill
condominium at about 7 p.m. on New Year's Eve when a man attacked her with a butcher
knife and commanded her to die. Williams' DNA was found on the
knife.
That such a tragedy occurred in King County, which offers a
comprehensive and progressive system for dealing with mentally ill
parolees, has both the public and the mental health community asking
what went wrong.
It's a question underscored by a spate of gruesome killings linked to
mental illness around the country, from the most recent campus
shooting in Illinois, to the psychiatrist who was hacked to death in her
New York office last month.
Since April 2000, 512 Washington inmates have been designated as
dangerous and mentally ill, the same designation Williams received
when he got out of prison in 2006 for the bus stop shooting. Of those,
466 are living in the community. Those who volunteer to enroll in a
special supervision program receive extra help with housing and mental
health care in addition to being closely monitored by the Department of
Corrections.
But about half of the "dangerous mentally ill" either can't or don't
participate. Only 222 actually receive services through the program -some because they live in areas of the state where no mental health
counselors will take such patients on, or where no housing will accept
them. Others simply reject the help.

Shannon Harps,
a Sierra Club
worker who lived
on Capitol Hill,
was murdered
with a butcher
knife outside her
home on New
Year'
s Eve.
James Williams
(below) has
pleaded not guilty
to the crime.

Williams' case, like the nearly identical case 10 years ago when a
psychotic man stabbed a Seattle firefighter to death outside the
Kingdome after a Mariners game, has once again forced the issue of how society deals
with those who are severely mentally ill and have criminal histories -- a population that
has been exploding even as the resources to deal with it have dwindled. At the same time,
laws intended to safeguard the rights of the mentally ill seem instead at cross-purposes
with keeping the public safe. To be committed to a mental hospital today, even for a brief
period, an individual must be in imminent, provable danger of harming himself or others.

142

Nervous breakdown
Williams should have been a success story. He was one of 70 dangerous mentally ill
offenders living in King County, which does provide services and has some housing that
takes psychiatric patients with violent histories. Despite getting intensive intervention,
supervision and financial help, he slipped the grasp of the medication that kept him
somewhat stabilized, and the efforts of a dozen caseworkers, corrections officers,
counselors and others who struggled to keep him from exploding.
The reasons have their roots in the history of psychiatric care in the last half of the last
century. Williams' own story, pieced together from psychiatric records included in public
filings, and court records obtained by the Seattle P-I, is a case history of the dark side of
deinstitutionalization.
Williams was born in 1959 in Camden, Ark., at the tail end of the decade that also
produced Thorazine, the first "miracle" anti-psychotic medication. For the first time,
doctors had a medicine to treat delusional symptoms, opening the door for treatment
outside the restraints of a hospital. Like the social change it helped instigate, however, the
medicine also had nasty side effects that made many patients refuse to take it. Neither
deinstitutionalization, nor the medicines that spawned it, worked as intended.
Williams was only 8 when his mother died under mysterious circumstances. He never
knew his father. After his mother's death, he was shuffled among households, living with
various aunts and grandparents.
At age 12, he had his first "nervous breakdown" and was admitted to Arkansas State
Hospital for about a month for treatment of "obsessive, psychosomatic thoughts." After
his release, he dropped out of seventh grade and started doing drugs. Eventually, he
graduated from huffing lighter fluid off rags to shooting methamphetamine.
At 17, he was convicted of burglary and landed in an Arkansas penitentiary for the first
time. Meanwhile, his mental health continued to deteriorate, and signs of a virulent antisocial personality disorder began to emerge in a foreshadowing of his future.
In 1982, after breaking up with a girlfriend, he told doctors he had "such hatred for her
that he has serious thoughts about taking a knife and going and cutting her up."
According to his treatment notes, "He spends a great deal of time thinking about how he
would like to get even with people whom he believes to be the blame for what has
happened to him." Doctors diagnosed him with schizophrenia. He was 22.
The conclusion doctors made 25 years ago: "Prognosis is considered poor at this time
because of apparent lack of motivation to follow through with any treatment
recommendations"
That prognosis would prove prophetic.

143

Missing pieces
Over the next decade, a series of progress notes from Arkansas mental hospitals and
prisons traces Williams' dizzying circuit among hospitals, jail and the streets, a loop that
mimicked that of countless other psychiatric patients. Hospitals, gutted by budget cuts
after deinstitutionalization, had neither the beds nor legal grounds for keeping them.
Prisons and jails were not equipped to treat them. And landlords didn't want them.
This was not the intended consequence of the push for community care of the mentally
ill. Three decades ago, it was far too easy to warehouse patients for abnormal social
behavior, a loose criterion that let families offload their more difficult or embarrassing
relatives.
"People in state hospitals in the early '60s did not get there based on imminent danger,"
said Richard Kellogg, director of the Mental Health Division of the state Department of
Social and Health Services.
In 1963, when President Kennedy signed the Community Mental Health Centers Act, the
vision was to provide prevention, intervention and treatment outside of institutions for all
ages and incomes based on ability to pay.
"But when patients were deinstitutionalized, no one envisioned such a subset (of patients)
with this degree of violence," Kellogg said.
The visionaries missed other pieces necessary to help psychiatric patients succeed in the
community, in particular the need for affordable housing.
"The 1963 act didn't envision the relationship (of outcomes) to housing, and mental
health service is not housing," Kellogg said. "That major point got lost."
Nor did the reformers foresee the effects of a rising street drug culture on crime and a
growing consumer appetite for violent entertainment.
"Our culture changed. We have a more violent culture today," he said. The right
infrastructure wasn't in place to safeguard either them, or the public.
Instead they went to jail, in droves.
"The census of mentally ill in King County Jail is second only to that at Western State
Hospital," said David Aiken, supervisor of the Special Needs Unit, the section of the
Department of Corrections that oversees dangerously mentally ill offenders after release
from prison. A 2006 Department of Justice report says 45 percent of federal prisoners
have symptoms of serious mental illness. The percentages are even higher in local jails -64 percent -- and state prisons --56 percent.

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The population of people with mental illness in jails in turn jammed up what was left of
the state hospital system. The number of beds nationwide, which peaked at about 565,000
beds in the 1970s, is now down to about one-tenth of that, which some argue is no longer
sufficient to meet demand.
Before 1990, Western State Hospital did about 300
evaluations for "competency restoration" a year,
said Mark Allen, a mental health counselor in the
forensics unit at Western. Today, the hospital does
about 3,000 outpatient admissions a year to
determine whether a person is competent to stand
trial.
Western, which is at capacity, has a current patient
census of about 1,000 patients, including 300
criminal offenders. In addition, there are about 230
beds sprinkled around King County that will take
psych patients who are committed involuntarily.

Dan DeLong / P-I

A security officer walks the hall in the
Center for Forensic Services at Western
State Hospital in Lakewood on Monday.
The hospital is at capacity with about
1,000 patients, including 300 criminal
offenders.

But that isn't enough. At any given time, an
estimated 20 percent of those who have been
identified as qualifying for involuntary commitment under the state's strict committal
laws still can't get beds and wait out their 72-hour "holds" in ERs or other nonpsychiatric
facilities. When the holds are up, they walk.
To qualify for a longer stay in the hospital, a patient has to do something extreme. Allen
recalls a mother who pleaded with the mental health community for six months to try to
have her mentally ill son hospitalized. Finally, he stabbed her.
Then he was committed.
"The majority of people with mental illness in the community are not violent and in fact
are not more likely to commit violent crimes than nonmentally ill people," Kellogg said.
"But there is a subset, that we have growing knowledge of, coalescing around cosubstance abuse, multiple admissions, including jail time, and a history of social
inadequacy."
That was Williams' subset.

Clear and present danger
By the turn of the '90s, Williams was a 31-year-old vagrant described in records as
"unkempt, very dirty, agitated, loud and cursing." Now labeled a "chronic paranoid
schizophrenic" he had already cycled on and off powerful anti-psychotics multiple times,
typically abandoning them as soon as he was out of prison or the hospital. Psychiatrists

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say going on and off meds multiple times can erode their effectiveness, creating a class of
patients who become untreatable over time.
In the previous 10 years, he had been committed for "terroristic threatening" of his
grandfather, then jailed for assaulting an elderly woman. He'd been in prison for writing
hot checks, and back in treatment for delusions that his grandmother was trying to kill
him with the TV remote control.
He claimed that medicine was destroying his brain. He was known to carry a knife and
said he slept with a loaded gun. "If people try to mess with me," he told a counselor in
1990. "I will get pleasure in killing them."
Throughout, notes from repeated mental evaluations show Williams' grounding in reality
morphing to quicksand.
"He believed that he was an FBI and CIA agent, and that he also worked for the U.S.
Army, God and the devil," said one such note.
Doctors in Arkansas called him a "clear and present danger" to himself and others.
Then he vanished, and the mental health facility where he was periodically seen
throughout the 1980s "terminated" his chart.
In a disturbing prelude to events to come, Williams popped up in a new city, this time in
Florida, where he racked up three convictions on separate occasions for assaulting a man
with a knife, for bashing another man's face into a fire extinguisher and, ominously, for
terrorizing a woman.
According to the 1993 police report from that incident, "As the defendant rubbed on her
leg (victim), the defendant was talking about 'killing women' and 'cutting women from
their eyes to their throat.' "

Stranger violence
It's not clear when, how, or why Williams arrived in Seattle, but this chapter of his life
starts on another prophetic note.
In 1995, he was arrested for shooting a stranger at a downtown bus stop. In the police
report of that initial incident, there is this bold-face warning: "DO NOT RELEASE!!!
SUSPECT SHOT A STRANGER WITH A LARGE CALIBER PISTOL. THE
SUSPECT IS A DANGER TO ALL CITIZENS ..."
Despite his record, prosecutors determined Williams' prior offenses in other states didn't
qualify him to be prosecuted under the state's three-strikes criteria that would have put
him in prison for life. Instead, Williams was convicted and sentenced to 11 years for the
shooting. In prison, his behavior continued to spiral out of control. He was put in

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restraints for fits of rage, forced to take medication and racked up 248 violations for
damaging property and assaults. When his release date came up in 2006, he was a
textbook case for the Dangerous Mentally Ill Offender program. A judge ordered him to
24 months of community supervision, and Williams agreed to take part in the program.
Although he became increasingly difficult to handle, he was checking in with his
corrections officer as he was supposed to, said those who were responsible for tracking
him.
"Assuming he didn't commit a murder," Kellogg said, "the system worked."

Degree of imminence
The case raises a host of disturbing and complicated issues that come down to how much
risk is too much for society to bear. For sexually violent predators, the state has decided
there is a class of offenders -- Level 4 -- that should remain locked up for mental health
treatment even after serving their prison time because of their danger to the public.
Should a similar risk category be created for violent offenders with certain combinations
of personality disorders, mental health diagnoses and track records with treatment
compliance? Should the public be notified -- as it is with sex offenders -- when offenders
with violent and serious mental health histories are released? Is the bar too high for
getting people committed? And should the three-strikes law be applied differently for
those who have severe mental illnesses?
David Weston, chief of mental health services for the state, said he knew of no other
states that had tried such measures. Washington would be setting precedents.
"I don't think the public mental health system was ever designed to guarantee 100 percent
safety," Kellogg said. "Whether it should be or not, is an open question."
Earlier this month, King County Prosecutor Dan Satterberg convened a task force to
examine the Williams case. It is still in the fact-gathering stage and has yet to draw any
conclusions or propose solutions.
Many of the issues boil down to money -- more money for housing, for treatment centers,
for supervision, say those who are closely watching this case.
The program that monitored Williams is already under financial strain. In 2007, it
overspent its budget by $400,000, and in response may have to slash the number of years
it will provide mental health help to those enrolled from five years to 2 1/2 years. Weston
said he is trying to find other funds to keep services available for the full length of time,
but hasn't found them yet.

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And that won't help the many others who corrections officers say are equally likely to be
dangerous, but who don't fit the eligibility requirements for the mentally ill offender
program and receive no such coordinated assistance at all.
The high thresholds for commitment also frustrate those who track mentally ill offenders.
To be hospitalized, the person must be a danger to self or others, or gravely disabled. And
there must be a trail of evidence, including witnesses, to persuade a court. The threat
must be imminent, not based on hearsay, and specifically related to a serious mental
illness. A threat made by a mentally ill person because he or she is angry or frustrated
wouldn't qualify. In addition, the county, which evaluates people for involuntary
commitment, is also bound by law to ensure they are treated in the "least restrictive"
setting, which usually means in community clinics and housing.
Only "designated mental health professionals," who work for King County Mental
Health, can decide to commit someone against their will. In 2006, these evaluators, most
of whom are not psychiatrists, but do have master's-level degrees in psychology-related
fields, did 5,500 such crisis assessments. Of those, 2,169 patients were hospitalized.
Critics say that isn't enough, and that of those who do get hospitalized, too few get held
long enough. To hold someone for more than 72 hours requires an additional court order.
"We need to change the degree of imminence," said Randy Vanzandt, a community
corrections officer who tracks dangerous mentally ill offenders for a living.
That, however, would cost more. State hospitals are expensive to run. Filling a bed in a
state psychiatric hospital costs $145,000 to $190,000 a year.
Making commitments easier also raises constitutional issues. In our society, you can't
lock people away just because they might do something, or say they're going to do
something.
"There is no perfect way of predicting dangerousness is the bottom line," said Weston,
who also heads the mentally ill offender program in Olympia. "It remains an inexact
science."

Losing it
Reading the "chronos"-- a history of Williams' supervision -- is like watching a man selfdestruct in slow motion.
The community corrections officers, nurses, counselors and social workers assigned to
his case reached out repeatedly to help him. They got him clean-and-sober housing. He
lost it for drinking and drugging. They got him an apartment. He got himself evicted for
threatening residents with a butcher knife. They drove him to appointments at his mental
health clinic and ordered him to take his meds. He flung the medicine in their faces. They

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arrested him multiple times for breaking his supervision requirements in the hopes of
getting him back on meds, or committed to a hospital for treatment. Each time he
eventually was released back to them. His primary supervisor kept at it even after
Williams said he would lay in wait and shoot him with a sawed-off shotgun as he
reported to work
The day Shannon Harps was killed, Williams checked in with his community corrections
officer, who noted he was "barely holding it together."
"But that was his baseline," said Dan Weiss, who saw him that day. "That's how James
was every day."
In September 2007, Williams went to jail for threatening a woman at his housing facility.
He pleaded guilty and received a psych evaluation on his release. How or whether he was
treated in a psychiatric facility after that evaluation is not known because laws keep those
records private.
What is known is that Shannon Harps, an adventuresome traveler, who loved to backpack
and was working to improve the environment, a young woman who impressed her friends
with her grace and integrity, was killed 10 days after Williams' release from King County
Jail.
Williams has pleaded not guilty to the crime.

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P-I reporter Carol Smith can be reached at 206-448-8070 or carolsmith@seattlepi.com.
© 1998-2008 Seattle Post-Intelligencer

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