New bill could be game changer for WA behavioral health, suicide prevention

In September 2020, unsure what else to do to help his wife Holly in the midst of a mental health crisis, Abraham Dairi made the agonizing decision to call 911.

“You feel like you’re being thrown around the system, and you feel like you’re screaming and nobody’s listening,” Dairi said. “You don’t have the answers, the resources you need, and there are very few resources for you to be able to gather the information you need to make informed decisions, and you start feeling very alone. And that decision coupled with systemic failures in Washington’s behavioral health system would end in tragedy.”

“I lost my wife, Holly, on September 19, of 2020, to suicide.”

Now, Dairi is putting the weight of his very recent experience behind a push to expand and enhance the state’s behavioral health and suicide prevention services in a bill proposed by Democratic Representative Tina Orwall.

“I have never seen a bigger opportunity to change the system and to potentially save lives than the 988 system,” Rep. Orwall said.

Orwall is the lead sponsor of HB 1182, casually known as the 988 bill.

“The federal government passed 911 and 988 — at the end of the day, when this is all up and running, people need to know those two numbers,” she said.

In Washington state, 988 is a hotline that anyone can call to get help for a behavioral health crisis.

“You’re going to get the person on the phone, you’re going to try to figure out what they need. If this is really somebody who’s in big distress, we will have the ability to dispatch teams real-time, like 911. Right now, people go to an emergency room and they sit there for hours,” Orwall explained.

“[But this] will serve as a big triage center — there’ll be a coordinated care where they can see what services are available, they can have a GPS of a crisis team to know how far, know where they’re located. They can just ask them, they’re going to know what psychiatric beds are open,” she added.

The idea is to create call centers that will serve as central hubs where information can be shared to ensure all are on the same page in a coordinated care effort. That will be to make sure everyone involved talks to one another and ensures that nobody falls through the cracks.

“We need crisis teams that can be real-time responsive, they need to be specialized,” Orwall described, particularly for groups like veterans and others known to struggle.

Equally important will be the follow up.

“There is going to be follow up,” she promised. “Right now, people call and no one knows what happens. It’s almost like the airport where they know where every plane is, they’re going to know where they’re going to make sure that person actually gets a warm handoff connected to the care. They need to expand the call center, the kind of rapid response crisis, and to expand crisis beds. It could be peer beds, you can stabilize someone in their home.”

There will also be peer-to-peer work to make sure those with lived experience can help those in crisis.

Funding will, at least in part, come in the form of a telecom tax on cell phones that will start at 30 cents in October, and eventually get to at least 75 cents over the next several years.

It’s similar to the funding source for 911, and will be used to build out capacity for the statewide program.

First, they’ll get the call centers up and running, and then, “we have this implementation coalition that’s going to look at where all the gaps in services are.”

“Like what are they? How many crisis teams do we have? How many crisis beds? What’s needed really to implement this system?,” Orwall explained. “And then we’ll move into these next steps.”

Jennifer Stuber lost her husband to suicide in 2011 and now runs Forefront Suicide Prevention Center at the University of Washington. Stuber believes this bill is a game changer for behavioral health.

“It just has huge potential ramifications for good, and so I’m really excited in terms of really creating a system that is far more responsive,” Stuber said, pointing out that “right now, when someone is in a suicide crisis, we basically do one thing: We take them to the emergency room, which is a terrible place to take people [experiencing a mental crisis].”

“They sit there, they may or may not get help, they don’t get good access to things that they need, they get frustrated, they go home, they may even die by suicide,” she noted. “I’ve actually heard that story many, many times from people who’ve gone to (emergency rooms). They might get the police called, because people are afraid or because the person is acting really strangely, and in some cases, perhaps dangerously, and, instead of getting the response that kind of meets people where they’re at, and in that time of crisis it can be very, very scary for law enforcement to be called.”

That was Dairi’s experience last September when he decided to make that 911 call.

“So when you get to that point where it’s ultimate intervention, where it’s literally life or death, in my case, my wife, and you do the only thing you can possibly think or know how to do, which is call 911,” he detailed. “That response is, as it stands right now, not helpful to me as the support system for my wife, or for my wife, in that she’s not going to get mental health trained professionals who are actually coming to assess her and work with her. Instead, it’s a much more confrontational system.”

The situation with Dairi’s wife was escalated by the presence of law enforcement. As he describes it:

Holly was met at the door. She was told that she was going to be taken to the hospital involuntarily, and she wasn’t understanding why or what that meant. All they could really say was, ‘we do know that you have the means to harm yourself and we’re going to have to take you now,’ and obviously somebody in Holly’s situation that’s in the midst of a mental health crisis is going to be super alarmed by the police trying to take them out of her home.

In this case, they did have to physically take Holly out of the home, they had to put her to the ground, they had to put her on a stretcher and strap her down, and created a really ugly, unfortunate scene outside for all of our neighbors to see which created more trauma for her.

Despite all that, Dairi stresses that he does not blame officers who did the best they could in that situation.

“The police are doing the best they can and I’m appreciative for what they did in our case, but it is still somebody who is not trained to deal with somebody in crisis. It’s somebody who’s showing up with a gun, who’s showing up in our case immediately raising the anxiety of Holly,” he pointed out.

Dairi does blame a failed system all the way around, and says these provisions in the 988 bill may have saved his wife.

“Ultimately, in Holly’s case, the situation was handled very poorly and she was released that evening. It was the next day that Holly took her life,” he added.

It’s a tough fight for him so soon after losing his wife, but it’s a fight he won’t give up.

“I’ll keep telling Holly’s story in order to prevent really disastrous situations like this from happening again,” Dairi said.

The bills are expected to get a public hearing soon, and are seen as one of the top priorities for Democrats in a national effort to improve behavioral health care.

Should it pass, it would cost a penny a day to start in the way of the telecom tax – again, the same as 911 is handled. Still, Orwall worries about the lack in services currently offered as there are so many people who are struggling right now.

“We’re still worried we’re going to lose more lives, but I just worry that people aren’t going to focus on what the needs are and they’re going to focus on the fee, and I just don’t want to miss this opportunity,” she said.

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