King County Crisis and Commitment Services
King County Crisis and Commitment Services provides:
- All initial crisis outreach services for persons who are not enrolled in outpatient services in King County.
- Evaluation of people with mental disorders for possible involuntary detention in psychiatric facilities according to the mental illness law in the State of Washington. The mental illness law for adults is RCW 71.05. For youth 13 through 17 years of age the law is RCW 71.34.
In King County, Crisis and Commitment staff who perform these duties are all employed by the county. Under the law, they are referred to as Designated Mental Health Professionals (DMHPs). See frequently asked questions about the King County Mental Health System and available services and programs in our system. Please call us if you need assistance or would like more information about our services.
How do I know if someone needs mental health services?
Often it is the family and others close to the person with psychiatric problems who first notice the changes that identify the need for professional help. Early warning signs may include one or many of the following:
- change in sleep patterns - waking up many times during the night, sleeping a lot during the day or getting hardly any sleep at all
- being socially withdrawn from others - stops seeing friends or loses interest in his/her appearance
- unable to function at work or in schoo - missing days from work/school or losing his/her job
- talks about things that don't make sense to you - laughs or mumbles to her/himself, speech may be very fast and/or the person seems to jump from one subject to another
- may have unusual beliefs - thinks that others are after him/her or plotting against him/her or that his/her mind is being controlled by an outside force or that someone is putting thoughts into his/her mind.
It is important to keep in mind that this kind of experience is often extremely frightening and painful. It is common for the person to express fear and pain through anger and suspicion towards those closest to him/her. It is, therefore, important that the family try to focus on his/her feelings rather than on angry behavior; as the person might respond to their suggestion that he/she get professional help, either in the community or in the hospital.
What should I do if the person refuses to accept help?
Often an individual cannot accept the need for help. You should contact the Crisis Clinic at 206-461-3222. This is the centralized access point for all telephone crisis services in King County, including for children. (For more information specific to youth and families in crisis, see "Youth, Children and Families".) A trained Crisis Clinic volunteer worker who is supervised by a professional person will gather information about the person's recent behavior, previous problems and treatment, and assess how acute the situation is. If the situation needs an immediate outreach, your case will be referred to King County Crisis and Commitment Services. The DMHP on duty will then contact you and arrange to see the person as soon as possible. If the person is able and willing to go to an agency for a walk-in or scheduled appointment, your case will be referred to the nearest agency.
When the outreach team sees your family member, they will evaluate his/her mental condition and the need for treatment. They may discuss the possibility of hospitalization. Every effort will be made to arrange for treatment in the community, short-term crisis stabilization, or voluntary hospitalization. These are always the first choices.
Involuntary Treatment through King County Crisis and Commitment Services
If the person refuses all voluntary help, s/he may be appropriate for involuntary treatment. It is important to remember that a mental disorder alone is not sufficient to justify an involuntary detention.
Under state mental illness laws, these are the specific circumstances where a person can be considered for involuntary hospitalization:
- if s/he has threatened harm towards others or her/himself
- or s/he has substantially damaged someone else's property
- or s/he is endangered because s/he is not caring for his/her basic needs such as eating sleeping, clothing and shelter due to his/her mental disorder
- or s/he shows severe deterioration in functioning ability and is not receiving essential care
As part of the investigation, the DMHP will be looking for evidence that substantiates any of the circumstances.
If it appears that involuntary detention is necessary, the DMHP evaluating the person will take a written statement from the person who has witnessed first hand the behavior providing evidence for detention. This statement is called a "declaration." It is important to understand that this document is a certified statement of facts and that the person who gives the statement is agreeing to testify in court, under oath, at a commitment hearing.
If the person evaluated is appropriate for involuntary treatment, one of the following will happen:
- If no emergency exists, KC CCS may petition the court for an order to detain the person on a non-emergent basis. In this situation a judge reviews the evidence provided by the DMHP, and may make a decision that the person can be involuntarily hospitalized. If the judge signs the order agreeing that the individual should be hospitalized, the DMHP then places the person in an appropriate facility.
- If imminent danger exists, the person will be immediately detained and placed into a facility for a 72-hour detention period.
A member of the immediate family will be verbally advised and/or given or mailed a notice of detention, and the team will arrange for involuntary hospitalization at a local treatment facility. The team will arrange for transportation from the person's location to the hospital after he/she has been involuntarily detained. People can be sent for involuntary treatment only to certified Evaluation and Treatment Facilities such as Harborview Medical Center, West Seattle Psychiatric Hospital, Northwest Hospital Geriatric-psychiatric Unit, and Fairfax Hospital. The inpatient care is for an initial period of 72 hours.
Extension of involuntary treatment
If the facility staff decide that further inpatient care is necessary, they must petition the court and a commitment hearing will take place. At the court hearing the patient is present with either his/her private attorney or an appointed attorney. The county prosecuting attorney represents the facility. A Superior Court commissioner or judge presides, hears the evidence presented by witnesses, and makes the decision. S/He may do one of the following:
- Order the person to remain for up to 14 additional days of involuntary treatment in a facility. The facility may release the person whenever staff think treatment is complete.
- Order the person to 90 days of "less restrictive treatment," (180 days in the case of a juvenile.) This means that the person has to enter outpatient treatment as the court order dictates. Most often the court order will specify that the person has to participate in treatment at a mental health center and must take such medication as is recommended by the mental health center.
- The commissioner/judge may accept the patient's agreement to enter treatment voluntarily.
- The judge may dismiss the case and let the patient go free.
Sometimes the mentally ill person needs more time in the facility or in outpatient treatment after the 14-day period and continues to refuse this on a voluntary basis. It may then be possible to file a petition for 90 days of court-ordered treatment. For each additional commitment period, another court hearing is required. The court has to be persuaded each time that the person still needs involuntary treatment and meets the legal criteria. This is to protect the patient from inappropriate commitment.
The main purpose of inpatient care for psychiatric patients is to provide safety for the person and others, as well as to evaluate and treat the acute symptoms of the person's mental disorder. The involuntary treatment law is intended to provide short-term care. Control of the acute symptoms is, at this time, best accomplished with medication and a structured environment. The family can be expected to be involved in the treatment, when that is appropriate, by attending family conferences. A major task for the facility staff is to make proper discharge plans. They may also facilitate alternative living situations and follow-up care.
The educational needs of the family and the mentally ill person regarding his/her particular disorder and what to expect in the future must also be addressed. Therapists at the treatment facility should teach individuals how to best manage his/her disorder in order to minimize the need for frequent re-hospitalization and maximize the person's functioning in the community.
In addition to adults, the Crisis Clinic serves as the entry point to crisis services for children and ensures a single, countywide, integrated and comprehensive system of crisis response for residents of all ages. For children that are not already enrolled in services in the KCMHP, Greater Seattle YMCA 's Children's Crisis Outreach Response System (CCORS) provides the 24-hour mobile outreach, stabilization beds and services, and linkages to community supports needed by youth and families in crisis. CCORS outreach team primary goal is to safely and quickly contain the crisis, and develop an individualized service plan in collaboration with child and family.