Caught in the vicious cycle that’s all too common across the U.S. today, hundreds of people with serious mental illnesses in Pierce County, Washington, have been committed to the hospital for short-term interventions, then discharged to a community with inadequate resources to meet their needs, only to lapse into crisis and be recommitted to the hospital or taken to jail—over and over again. The Bazelon Center’s settlement of a lawsuit promises to break the cycle, and in the process show how it can be done elsewhere.

The suit, filed against the state’s Department of Social and Health Services in February 2005, challenged Western State Hospital’s practice of discharging patients to “unsafe places” such as homeless shelters, indigent hotels, abusive family situations, even the street. For example, a woman with schizoaffective disorder was repeatedly sent—over her community caseworker’s objections—to live in a car with a boyfriend who hospital staff knew had abused her.

Representing the Washington Protection and Advocacy (P&A) System as plaintiff, the Bazelon Center sought a requirement that all future discharges meet professional standards.

The settlement requires the hospital to hire a full-time discharge coordinator and mandates that the parties collaborate in developing and implementing a discharge-planning policy and a plan to provide residential and other services to at least 100 county residents.

The case also addresses the financing issues that have kept the revolving door to the hospital spinning. In a typical pattern, as Western State has downsized, the money saved has not shifted to fund the housing and support services needed by people with serious mental illnesses in the community. In Washington, counties’ resources are further reduced because they pay a penalty when they exceed their allocation of hospital beds—which they inevitably do when people with serious psychiatric disorders again lapse into crisis for lack of community support and are committed to the hospital.

The settlement ends the county penalties for one year. Further, it commits the state social services department to seek an additional $2.5 million from the Legislature to develop and provide intensive outpatient community mental health services and housing in Pierce County. If the funds are not appropriated, the plaintiffs will return to court.

With participation in policy development and diligent monitoring by the plaintiffs’ attorneys, the settlement can halt the revolving door for people with serious mental illnesses in Pierce County.


Superior Court for Pierce County, Washington


February 2005




Washington Protection and Advocacy System


Department of Social and Health Services of Washington State