WA limits spit hoods inside state-run psychiatric facilities

A Washington agency responsible for caring for thousands of psychiatric inpatients now strictly limits how staff use spit hoods inside its facilities, the first restrictions the state's mental health system has placed on a tool that was the subject of a recent Seattle Times investigation and has been tied to dozens of injuries and deaths across the U.S.

Washington's Department of Social and Health Services quietly adopted a policy in June that officially defines spit hoods - mesh and fabric bags intended to prevent disease transmission - as a form of restraint, a legal classification that requires a doctor's order and comes with stringent state and federal reporting requirements.

With the change, DSHS now categorizes spit hoods as a tool akin to other restraints like sedatives and limb straps, which staff can use to subdue patients during emergencies. The rules apply to employees at Western and Eastern State hospitals and several other state-run facilities, but not private ones.

Under the new policy, staff are expected to wear personal protective equipment such as face shields, masks or gowns when they're at risk of getting spit on, and they can only hood patients who are "actively spitting." Physicians must give staff permission before - or in emergency situations, no later than an hour after - a patient is hooded. And staff are required to log each spit hood incident, including details about why a hood was used and who was hooded.

"Moving forward, it will be much easier to determine" how often staff hood patients, said Dr. Brian Waiblinger, chief medical officer for DSHS' Behavioral Health and Habilitation Administration. In general, he said, DSHS aims to keep seclusion and restraint "as low as possible."

The change fell short of some advocates' hope that DSHS would stop using spit hoods altogether.

This is a "positive step that will protect patients," said Todd Carlisle, an attorney with Disability Rights Washington. But "the policy could have simply prohibited the use of spit hoods in state-run psychiatric facilities," he added. "I am disappointed that it does not."

DSHS' policy change follows a 2026 Seattle Times investigation, which found that Washington and 28 other states have used spit hoods inside ERs, hospital wards and ambulances, sometimes in ways that restrict patients' breathing, ignore manufacturers' safety instructions and fall into legal gray areas. Spit hoods are designed to cover a person's eyes, nose and mouth and often cinch or gather at the neck.

Washington is one of at least 15 states that use taxpayer dollars to pay for spit hoods inside state-run psychiatric hospitals, the investigation determined.

For decades, sweeping state and federal restraint laws have governed everything from how long patients are restrained to the less intrusive interventions medical staff are required to try first. But while several experts believe spit hoods should be considered restraints and fall within the scope of existing law, the devices aren't regulated as such.

DSHS' decision to call spit hoods a restraint means the tool now falls under the umbrella of state and federal restraint regulations when used on patients under DSHS care.

This includes a Washington law that bans medical staff from restraining patients as a way to coerce or punish them. In 2024, a Western State Hospital staffer allegedly pulled a spit hood "extremely tight" against the neck of a female patient strapped to a restraint chair who wasn't spitting, according to a patient abuse complaint filed by another employee.

There's virtually no independent research on whether spit hoods are safe or are effective at capturing spit. But several experts told The Times spit hoods can be dehumanizing and dangerous, especially for people with respiratory problems, and should never be used on people being treated for mental illness.

The Times' investigation found that at least five people receiving medical care in the U.S. have died as a result of incidents involving spit hoods. Dozens of people with mental illness have died after being hooded in jail or police custody, and in recent years, Washington and other states have begun regulating how police departments use them.

Some of Washington's largest private psychiatric facilities, including Fairfax and Smokey Point behavioral health hospitals, don't use them. Harborview Medical Center in Seattle stopped using spit hoods in fall 2025 after The Times asked questions about the hospital's use; officials said the decision was made independently of The Times' investigation. Officials said spit hood use was "extremely rare" but that the hospital had kept them in stock for at least 25 years.

Five DSHS-run facilities currently stock spit hoods, officials said, including Western State Hospital, which has used them for more than a decade and in 2018 lost federal accreditation for violating health and safety standards.

Waiblinger said DSHS began working on a spit hood policy last fall after a hospital employee asked whether the agency had one.

It didn't, Waiblinger said, so he convened a group of nursing and other medical staff from DSHS facilities to draft a policy.

"There were differing opinions. Should we continue with this? Should we not?" Waiblinger said. The agency ultimately decided to continue using spit hoods, he said, because of concerns about patients spreading infectious disease.

"We care about all of our patients and the safety of our patients and staff, and the perception of their treatment in our facility," he said. "We want it to be as positive an experience as we can."

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This story was originally published July 9, 2026 at 6:40 AM.