In less than two weeks, the new 988 system launches. Mandated by Congress in 2020, 988 is basically the mental health version of 911 that launches nationwide July 16. Implementation of the 988 system – and how to pay for everything from staffing to resources – was left up to individual states. Washington State is far ahead of the pack on that front as one of only four states to pass implementation legislation, including a comprehensive funding plan.
Democratic State Rep. Tina Orwall the bill and has high hopes for what she calls a once-in-a-lifetime opportunity.
“Starting July 16 of this year, when you hit that number, Your call will be directed to a clinician who will be able to talk to you about what’s going on, they will be doing suicide assessments, they’ll be helping connect people to resources, whether those are more urgent in nature or follow up. And they really are going to be an important kind of first step for a person who’s having a behavioral health crisis or a loved one who’s worried about somebody who may be in crisis,” explained Orwall, adding that July 16 is just the beginning when it comes to the long-term vision.
“This is more than a three-digit phone number. We’re using this opportunity to rebuild the whole crisis system. And that’s going to take time. Not only is it the call center, but developing these crisis response teams. And then the third component, which is going to take a year or two, is going to be these crisis alternatives, places where people can go in the community to really get support and services they need,” she said.
Those crisis alternatives will be a big lift but will bring no shortage of benefits once the vision is realized.
“We’re creating new centers. Right now, Pierce County has one and they will be building one in Federal Way, and also in Edmonds. We’ve actually put money aside in our capital budget to help create these, and our state still needs to figure out not only how to build them, but how to help them operate over time so that they have the clinical staff and so these will be new resources. And these will be alternatives to emergency departments,” said Orwall.
Part of the reason for those crisis alternatives is that often 911 response can lead to further traumatizing those in crisis.
“We heard from family members that when 911 comes out, they have to be taken to the ground, or put in a police vehicle, or taken into an emergency room where maybe they’re strapped down for four to six hours that’s traumatic for someone who is already experiencing a trauma,” Orwall said.
That was the case with Abraham Dairi’s wife, Holly, who had been to the hospital in crisis three times before she took her own life in 2020. And each time, he had been told she didn’t meet the bar for commitment.
“On Holly’s final night, I was able to prove that she had purchased the means to harm herself. And I turned to the last place I knew, which was 911. Two officers showed up at our front door. Holly was five’10, 106 pounds at this point. She was ripped from our home, thrown on the ground. She was strapped to a stretcher and taken to the hospital. That evening, she told the officers that she would complete her plan following her discharge. She told the hospital that she had the means, she had the plan, and she would kill herself. Still, she was released at 4:30 in the morning alone into an Uber,” Dairi told a House committee during a public hearing on Orwall’s 988 bill.
Holly did follow through with her plan and was dead within hours of being released into an Uber. Dairi said another issue he ran into was the lack of follow up by any of the resources or professionals he’d contacted.
Orwall says 988 will be different.
“One of the unique pieces we’re going to have is a lot of follow up. Right now, you might call in you might get some help. But no one ever calls you back to see did you make that appointment? How are you feeling today? And so the idea is we’re going to stay with that person from the point they contact us until we know that they’re getting the services they need in the communities,” explained Orwall.
Orwall and several lawmakers and others in the behavioral health sector recently traveled to Arizona, where they have similar crisis centers already set up and running.
“They call them receiving centers in Arizona and they call people guests. Guests come into the receiving centers. They’re warm and they’re welcoming and they have what’s called a 23-hour bed and they have a No Wrong Door policy. They do not refuse anyone at this facility. They can be brought in by law enforcement, by clinicians, they can walk in, everybody’s accepted, but they also have some medical staff where they can look if there are any medical conditions and they find that less than 5% actually need to go back to an emergency room,” recalled Orwall.
“They also have longer-term beds on the same site where people can stay three to five days. And in some of them, they actually have up to 30 days. And so when we’re designing these alternatives, they probably need to have different types of beds. Most people go in and out within 23 hours. But you also need that ability for somebody who needs to be there longer,” she said.
The funding for Washington’s 988 system is coming via an excise tax on your phone bill. It’s 24 cents a line right now and that will go up to 40 cents a line in January, a drop in the bucket for the type of system Orwall envisions.
“We have a once-in-a-lifetime chance to really help people that are in crisis. This is about our family, our friends, our neighbors, and getting the help they need. And for less than a penny a day, we can save lives. This is about saving lives and people that are having so much emotional pain that they’re thinking about ending their life. And we know there are resources we can be getting out into the community that would make a difference that would get them through that crisis. I think this is a very small investment that’s going to change lives,” Orwall said.