I am on the Suicide Prevention Alliance for the State of OR. It is an amazing group of people dedicated to reducing the rates of youth suicide in youth in Oregon. Between being apart of this group, and Trump, I am learning a lot of how governments work, and don’t work.
Over the past 1 1/2 years, I have learned a lot about the process from start to finish on how a law comes to be (at least in Oregon) (and honestly, it still confuses me). I had the honor to testify on a couple, one that passed with much modification (to my dismay), and another. The one that did not pass in its original form was to mandate 3 CEUs (Continuing Education Units) across the board every six years in Suicide Prevention. This would have included doctors, nurses, chiropractors, counselors, school counselors, and the list goes on. There were a group of us who testified for the law in person. I was so nervous, but felt my contribution was crucial, as an acupuncturist that understands the implications of having mandated CEUs, and a loss survivor. I testified in front of a group of Senators, and they were teary by the end. I was so impressed with the people who got up and testified for this important legislation. Then the opposition had a chance. The people who did not want this law to go into effect were the Oregon Nurses Board and the Oregon Doctors Board. I listened to them that they did have some education on this in their training, but that they already had a lot of things they were mandated to do, one more was a strain (I am paraphrasing). I almost got out of my seat and said are you fucking kidding me? I may have mouthed it.
Let’s get to what happened. This particular one got amended. The only way it would pass is if it got changed to it being “suggested” that they take credits in it. Then, when they renew their license, they report it to the state what course they did take. Basically, it made it like what most CEUs are, optional. I imagine that when the next session comes along, we will have a report with abysmal numbers of providers having took the courses, and will then retry saying making it optional is not an option anymore (I can’t wait for that scathing testimony). But, that is just my cynicism at this point learning how hard this process is. We were asking for 3 hours every six years. To keep in mind, I have to have 60 hours in varied subjects, mostly in Oriental Medicine every 4 years to keep my acupuncture license current. It really is not hard.
The next bill was geared toward processes on discharge from Emergency Departments after a behavioral health crisis. This was a complicated bill, but one I was passionate about as well. There were several things that did not happen in my circumstance, that after learning all I have in Suicide Prevention, should have happened. The bill did pass, and I learned after a bill passes, there is something called a RAC (Rules and Advisory Committee) that happens. Basically, this is the meat and bones where stuff gets done. It is the “how to” manual for the bill. It is open to anyone (I think) to be apart of, and all vested parties are encouraged to be apart and comment along the process. This was a big group of insurance companies, hospitals, counties, state, clinics, ER docs, etc. I was there purely as an advocate. In fact, I introduced myself as an advocate with some really messed up lived experience. You go through the bill line by line, make comments, things are talked about between all said parties, and if there is an understanding and agreement (or as much as there will be), it will be taken into consideration and the bill is modified here and there with those recommendations.
There was one passage that bugged me, and this was what I contributed in between meetings:
“under Div 520 Hospital Services
333-520-0070 ED and Emergency Services
4. A hospital shall adopt, maintain, and follow written policies that pertain to the release of a patient from ED whom is seen for a behavioral health crisis. The policy shall include, but is not limited to
c. If indicated by behavioral health assessment, conduct a best practices suicide risk assessment and if indicated, develop a safety plan and lethal means counseling with patient and designated caregiver.
OK. My thoughts.
I lost my husband and four year old daughter to a murder suicide 5/8/14, I found them. The January prior, he had a manic episode that hospitalized him. Since their death, I have worked on advocacy in this field and have learned a ton. There were a lot of things that did not happen when he was released from the hospital: effective and thorough communication with me and they never once asked me if we had a gun in the house (the two main things relevant to this bill).
When you are in the midst of a behavior health crisis, it is not just the person who is experiencing it, it is the whole family. The reason this law is so important, is that there are clear guidelines of what needs to happen with release, as well as the communication and follow through with patients and families.
I feel the section above needs to be more concrete. It states “if indicated by behavioral health assessment, conduct a best practices suicide risk assessment and if indicated, develop a safety plan and lethal means counseling with patient and designated caregiver.” EVERY person who is presenting in the ED with a behavioral health crisis should have a suicide risk assessment. EVERY person who has a behavioral health crisis should develop a safety plan and have lethal means counseling as well as their caregivers.
When you say “if indicated” and you have for instance, someone who does not want to be there and is smart enough to answer all the questions “right” it may not “be indicated” then to do those things. They may then die by suicide upon release. What happens if it is busy there and it slips through the cracks because it is not mandatory, only “if indicated.”
I have a teenager. I tell her all the time rules happen because of a reason. If I do not spell things out very clearly, she will find a way around it or an excuse for it not to happen. If you say that this needs to happen with every person who walks through the door with a behavioral health crisis, which to me is a duh, you will prevent suicide. You will ask do you have a gun in the house to both the patient and designated caregiver. The patient may not answer truthfully, but the caregiver (which was me) would have said yes. Then it would be spelled out what could happen. Me personally, I would have removed the gun. They may still be alive. If there was better communication with me, I would have walked away with more knowledge of suicide prevention, perhaps a brochure. There would have been follow up.
This is why these bills are so important. This is not a guarantee to catch everyone. But when you have people coming in with behavioral health crisis, every person should have an assessment. You absolutely will then provide thorough and competent care. “
So, based on that, it did get changed to better, but still not good, there were still loopholes. At the last and final meeting of this committee, I was determined to get this one passage changed. Make it so that the loop hole was closed. And I did. I was shaking as I shared my story, felt like I was fumbling over my words, but I got through it. There was then a lot of back and forth about it until this woman on the phone commented. She said (paraphrasing), I want to apologize Stephanie, you just shared such a personal and heart wrenching story with us and we just went on with business as usual. I want to say I cannot even imagine what you have been through and how important this is. Let me see if I understand what you are trying to change. Then she said it, but not completely, and another woman, sitting right next to me piped in and said, I think you want this one passage out and this is why, right? I said, YES! The moderator said, are there any objections to that? No. And that was that.
I know this is a longer one, but I wanted to share with you what I have been up to. The Alliance is one way I am channeling this never ending grief into change. The thing is, we can all do this. If I have learned nothing else, is that we get to have a say. As you can see, it does not always turn out the exact way you want it to, but sometimes, with one passage at a time, you can make long lasting changes that can make a difference.
The yellow portion is what got changed from my first comments. The crossed out is what I wanted changed during the final meeting. “If indicated” should not be there. They should be doing this regardless!
