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The Revised Code of Washington (RCW) pertaining to involuntary treatment was enacted in January of 1974, with subsequent amendments. The adult law can be found at RCW 71.05. The law pertaining to minors can be found at RCW 71.34.

The law aims to:

  • Put an end to inappropriate, indefinite commitment of the mentally ill
  • Provide prompt evaluation and short-term treatment
  • Safeguard individual rights
  • Provide continuity of care
  • Promote and encourage community-based care
  • Protect the public safety.
The law defines a mental disorder as "Any organic, mental, or emotional impairment which has substantial adverse effects on an individual's cognitive (thought) or volitional (action) functions."

The criteria are as follows:

  • HARM TO SELF: A substantial risk of serious harm indicated by threats (written or verbal) or attempts to commit suicide or inflict physical harm on one's self.  
  • HARM TO OTHERS: Behavior that has caused harm or places others in reasonable fear of sustaining harm. Can be written, verbal or actual assaultive acts.
  • PROPERTY DAMAGE: Behavior that has caused substantial loss or damage to the property of others.
  • GRAVELY DISABLED: Behavior that results in the individual being in danger of serious physical harm resulting from the failure to provide for his/her needs of health and safety or, the individual has shown a deterioration in routine functioning which is evidenced by a repeated and escalating loss over his/her actions and is not receiving necessary care for health and safety needs.

Only Designated Crisis Responder (DCRs) can initiate the process. In King County, the DCRs have the responsibility for detention of individuals who fall within the purview of the Involuntary Treatment Law (RCW 71.05 and RCW 71.34).

Initial referral can be from anyone, such as the police, family, a neighbor, a landlord, the hospital emergency room or hospital in-patient unit. The DCR interviews the person making the referral, takes a statement and gathers all pertinent information. The person referred is evaluated by the DCR, who determines whether there are appropriate alternatives to hospitalization, and whether the person would accept voluntary hospitalization. If neither are an option and the person meets the terms of the statute, the DCR will detain the person.

The person will first be medically examined by a community emergency department. After medical clearance, the DCR and hospital social worker will facilitate transfer to an Evaluation and Treatment Hospital (E&T). If the patient has certain medical challenges or has special needs, they may be held temporarily at the community hospital until those needs are stabilized.

The initial detention period is for 72 hours of observation and treatment. During this period a decision is made whether the person needs further inpatient treatment.

If the person still meets legal criteria after this initial observation period, a court hearing is held at the end of the 72 hours to hear testimony from the relevant witnesses regarding the person's need for additional involuntary treatment. If the court finds that the patient is committable under the law, they may be held for an additional 14 days (or 90 days of outpatient treatment).

At the end of the 14 days, the treatment facility may ask the court to order further treatment (on an inpatient or outpatient basis) for a period of 90 days (180 days in the case of juveniles). Again, a court hearing is held. At the end of 90 days, another hearing may be held to commit the patient for 180 days. Under the law, no one may be held for longer than 180 days without another court hearing to review the person’s status and the evidence supporting continued hospitalization.

The law allows for the hospital to medicate a committed person against their will for short-term treatment (up to 30 days) if there is a second, concurring medical opinion approving medication. For continued treatment beyond 30 days, a special court hearing is required to determine if there is legal justification for compelling the administration of medications.