Sen. Manka Dhingra (D-Redmond) represents Washington State’s 45th Legislative District. She’s a member of the Senate Behavioral Health Subcommittee and has helped pass legislation to transform the state’s behavioral health system—reorienting it around prevention rather than crisis response—during her time in the Senate.
Dhingra traveled to Arizona this month to learn about RI International—a global organization that offers mental health and substance use crisis services—and how it addresses crisis care needs. The trip served as an educational opportunity as Washington behavioral health officials make plans to implement the national 988 suicide prevention call line. Residents suffering from a mental health crisis will be able to receive assistance through the universal call line, which will be activated in Washington on July 16th.
In this Q&A, Dhingra discusses what she learned during her trip, and whether any of Arizona’s behavioral health practices might be useful in Washington.
State of Reform: What motivated you to learn about crisis response systems in other states?
Manka Dhingra: “We had outreach in a lot of different states. We found that there was a Georgia model and an Arizona model, and both sounded promising. Both of their systems are crisis response numbers similar to 988. The people answering are able to handle crises. Only 10% of the calls they get [require] a mobile response. Only 3% need law enforcement. I felt it was important to make sure we had people in Washington get a tour to see what that looks like.
[The RI International] crisis center has a philosophy of [helping] every person, every time. In Washington, we struggle a lot with people gaining access to care. There are hoops and barriers to go through. In Phoenix, you just show up and they accept you. One of my big goals was to introduce Washingtonians to that model because the state pays for the first 23 hours of care. Your insurance doesn’t matter.”
SOR: You were impressed with RI International’s use of SAMHSA’s “Peer First” treatment model, which features peer support workers who have been successful in recovery and help others in similar situations. What are some benefits of that model?
MD: “One cool thing about the facility we visited was that it had a peer-run housing program, and another long-term facility that had different levels of care. They have a robust peer system; 60% of the staff had lived experiences. My personal objective was to share with my cohorts just how much we can use peers in the system. They can be a peer navigator. They also had a therapist. Understanding pathways to get credentialing is huge. I would love to see peers in ERs for disorders.
A peer is in position to check in with patients over time, and that engagement leads people to seek treatment. Using them in different ways to do outreach makes them an important part of a care team. There are a lot of ways they can be vetted in treating people. A lot of this is about having a connection or lack of connection. I believe that’s a missing link in Washington.”
SOR: Would an RI International model work well in Washington?
MD: “RI will be opening a facility in Federal Way. I have heard it could open in September or October, but it will be sometime by the end of this year.
The RI model of [treating] every person, every time is different. The second important component is having everyone at the facility trained to handle everyone coming in. They have to be able to handle individuals who might be volatile. They don’t do that in Washington. They say very few individuals need medical clearance, so those are barriers; making sure staff are equipped to handle escalation and are not required [to have] medical clearance.
And the 23 [state-paid] hours makes life a lot easier. Could they consider doing that in Washington? As a state it’s much cheaper to offer that model compared to what we’re currently doing. We’re already paying for individuals to go to ERs or jails, which are much more expensive. From a fiscal perspective, it’s cheaper for the state to do this. So I think we looked at a model that makes sense. People get the care they need when they need it.”
SOR: Do you have plans to tour additional facilities to learn about other crisis response systems?
MD: “We will tour crisis facilities [in Western Washington] and the middle region. Then we’ll go to Spokane and do the same thing with crisis providers there. In Spokane, they upgraded their system; it’s similar to what we were seeing and we’re pleased.”
This interview was edited for clarity and length.