In 2016, HB 1713 (Ricky’s Law) modified the Involuntary Treatment Act. The Act integrated crisis response for mental health and substance abuse (SUD), created a new classification of mental health professionals, and mandated the creation of Secure Withdrawal and Management and Stabilization facilities (SWMS) to serve those detained for SUD.

The law also directed WSIPP to evaluate the effects of the law. We evaluated the outcomes for those detained to SWMS, comparing them to people never detained but who had received voluntary detoxification treatment in the same period.

In the six months following treatment, SWMS clients were less likely to:

• Receive SUD treatment;
• Experience homelessness;
• Be treated in the emergency department or be hospitalized;
• Receive any state financial supports.

We found no significant difference in rates of mental health treatment, arrest, or employment.

Our benefit-cost analysis found that, compared to the detox group, SWMS returns $0.19 per dollar spent. We estimate that benefits will exceed costs 6% of the time. That is, compared to the detox-only group, the cost of the program exceeds the benefits we are able to estimate.

This is the second report in a two-part series focused on wilderness therapy programs. Wilderness therapy combines therapeutic elements with outdoor activities in a natural setting to help support individuals with a range of behavioral, emotional, and substance use issues.

In 2021, the Washington State Legislature directed WSIPP to research wilderness therapy programs in the context of behavioral health treatment and prevention. As part of this assignment, we were asked to assess the “interest and likelihood of support” for wilderness therapy programs among interest groups like “state prevention coalitions and tribes.” We interviewed ten individuals representing a variety of stakeholder perspectives in Washington.

Generally, we found that interview respondents view wilderness therapy as potentially beneficial for the individuals they serve or those who live in their communities. However, we found that most respondents had concerns about cost, safety, access, and the lack of information about programs. Respondents also expressed wanting legislators to be aware of issues related to program flexibility, equitable access, and ongoing outreach if they consider policy decisions related to wilderness therapy in the future.

The first report on this topic was published in June 2022 and can be found here.

The 2021 Washington State Legislature directed WSIPP to review the research for any relationships between adolescent substance use and adolescent nutrition on subsequent mental illness in early adulthood.

For substance use, we found that adolescent alcohol use was associated with an increased risk of later depression. Adolescent cannabis use was associated with an increased risk for depression and psychosis, but we found no evidence that adolescent misuse of opioids or cocaine is associated with mental illness in young adults.

For nutrition, we found that higher quality diet in adolescence was associated with a lower risk for later depression. Obesity during adolescence was associated with an increased risk for depression in young adults, especially in females. Finally, we found no evidence of a link between adolescent intake of omega-3 fatty acids and any mental illness in young adulthood.

Wilderness therapy programs are set in natural or remote settings and embed therapeutic elements into daily outdoor activities like camping and backpacking in order to build program participants’ personal and interpersonal skills. Some programs serve individuals with behavioral, mental health, and substance use disorders.

In 2021, the Washington State Legislature directed WSIPP to conduct a research review of wilderness therapy programs and assess stakeholder interest in Washington. We identified 88 studies evaluating programs serving youth and adult populations in need of behavioral, mental health, and substance use support. Due to limitations in the literature, we could not estimate whether or not wilderness therapy programs are effective or determine if the approach is cost beneficial. In this report, we describe our systematic literature review and summarize the main themes from the literature including program models, populations served, and general findings.

A second report, due December 2022, builds on this report and will focus on the interest of stakeholders who currently participate in wilderness therapy programs in Washington or want to in the future.

Before 2016, two separate systems existed for the involuntary commitment of individuals in crisis due to mental health (MH) or substance use disorders (SUD). The 2016 Legislature passed E3SHB 1713—called “Ricky's Law”—to integrate both conditions into Washington’s existing Involuntary Treatment Act (ITA). The legislation required the Washington State Institute for Public Policy (WSIPP) to evaluate the changes resulting from Ricky’s Law.

As part of the integration, Ricky’s Law (1) created the designated crisis responders (DCRs)—a single professional designation responsible for conducting all ITA investigations, both MH and SUD, and (2) established Secure Withdrawal Management and Stabilization (SWMS) facilities. WSIPP interviewed DCRs from across the state to learn about their experience when determining whether to detain people under Ricky’s Law and whether to place people in SWMS facilities.

This report—the second in a series of three— provides an in-depth look at the integrated ITA detention and placement processes from the DCR perspective. We present themes from interviews conducted with DCR managers and DCRs throughout Washington. The interviews provide an understanding of the mechanisms that may affect outcomes, provide an on-the-ground perspective of the implementation and ongoing application of Ricky’s Law, and inform our approach for the third report.