Training, Quality Assurance Lacking In Washington Forensic Mental Health Program
The state of Washington is on a hiring spree for forensic psychologists. They’re needed to help address a backlog of mentally ill jail inmates whose competency to stand trial is in question.
A federal judge has said the long wait times are unconstitutional. But this isn’t the only problem facing the state’s forensic mental health program.
In Hollywood, forensic psychology has a certain cachet. But the actual job of a forensic psychologist is not quite so glamorous.
“They’ll often be yelling. Sometimes intelligibly, sometimes unintelligibly,” said psychologist Julia McLawsen. She’s described what it can be like to go into a county jail to evaluate a severely mentally ill inmate.
“A strong odor of ammonia and sometimes feces,” she added.
That’s because some inmates will smear human waste on themselves or their cell walls. McLawsen was first introduced to this work as a pre-doctoral intern for Washington’s Department of Social and Health Services. After completing her PhD, she hired on as a state psychologist doing inpatient evaluations of criminal defendants at Western State Hospital.
Inefficiencies and lack of training
McLawsen thought it was going to be a career.
“In fact, my husband and I had bought a house in Tacoma with the expectation that this would be a wonderful job,” she said.
But soon, McLawsen was disenchanted. She felt the bureaucracy and inefficiencies in how work was assigned undermined the quality of her evaluations. And she said there was no formal, ongoing professional development program for forensic evaluators like herself.
“I don’t think that early-career psychologists want to find a job and professionally stagnate until they’re allowed to retire,” McLawsen said. “I think that’s a pretty dismal outlook.”
So in 2013 she left -- after less than a year. McLawsen now does forensic evaluations of jail inmates on a part-time contract basis for Pierce County.
But her concerns were amplified last year. That’s when DSHS received a 68-page consultant’s report on the state of the state’s forensic mental health program. That report identified several shortcomings, including “a lack of systematic training and oversight” for the state’s 32 forensic clinicians.
Dr. Neil Gowensmith at the University of Denver was one of the report’s authors.
“Most states are where Washington is currently: hiring forensic evaluators. Asking their supervisors to show ‘em the ropes,” he said.
And then sending them out on their own.
Gowensmith said Washington’s evaluators are talented and skilled, but the stakes are too high to leave training to “catch as catch can.” His report recommended that Washington establish a formal training and certification program for these psychologists.
“You want to make darn sure that you’re only putting people who truly are incompetent to stand trial in the hospital for competency restoration,” Gowensmith said.
More money, new priorities
Records obtained from DSHS show a wide disparity among the state’s evaluators in the percentage of people they find incompetent: from 13 percent on the low side to nearly 70 percent on the high side. DSHS says it’s aware of this variation and plans to address it. In fact, the agency is quick to acknowledge the lack of a formal quality assurance program—blaming the “cash-starved” nature of forensic services.
“We were doing the most that we could do with the resources that we were given,” assistant DSHS secretary Jane Beyer said in March. At the time she painted a picture of a forensic mental health system under siege as the number of requests for evaluations spiked 30-percent in three years.
“We had multiple demands that were facing us at the same time,” Beyer said.
The month after Beyer gave that interview, a federal judge in Seattle ruled the state is violating the rights of mentally ill jail inmates by making them wait weeks, even months to be evaluated. The new state budget dedicates more than $40 million to hire more evaluators, pay them more and open more hospital beds. The money will also fund a new training and certification program.
McLawsen called the infusion of money “encouraging.” But she offered this stunning comparison.
“I can do the same, if not more work than I did as an employee at Western State Hospital in about 12 hours a week.”
McLawsen explained that she’s able to manage her workflow more efficiently outside of the state system.
DSHS says a top priority is to be more efficient. But for her part, McLawsen said she’s “not at all tempted” to return to work as an evaluator for the state.