In 2021, the Washington State Legislature passed House Bill 1477, which directed the Behavioral Health Institute at Harborview Medical Center (BHI) to lead the Crisis Response Improvement Strategy (CRIS). BHI collaborated with Health Management Associates to develop and manage the CRIS Committee, the CRIS Steering Committee, and several CRIS subcommittees. Those groups collectively developed recommendations related to the funding and delivery of an integrated behavioral health crisis response and suicide prevention system in Washington state.
The CRIS Steering Committee submitted its final report to the Governor and Legislature on December 31, 2024. It included 22 recommendations in the following areas:
- Funding – An overarching recommendation (not included as one of the 22)
- Promoting equity – Five recommendations
- Services – One recommendation
- Prevention – Three recommendations
- System quality and oversight – Three recommendations
- Cross-system collaboration – Four recommendations
- Staffing and workforce – Five recommendations
- Technology – One recommendation
Information about each of the 22 recommendations is in the final report. The report notes that many of the recommendations require legislative and/or state-agency action, as well as a continued investment of resources.
In 2026, BHI is evaluating implementation the recommendations. Due to limited time and funding for the evaluation, it focuses on the following three recommendations:
- Ensure there are crisis response services available in all regions so that people have access to care wherever and whenever needed.
– Due to concerns that uptake of 988 might be limited in rural parts of the state, the evaluation is comparing per capita rates of 988 calls in rural and urban counties across the state. - Encourage and provide support for ongoing collaboration between first responders and behavioral health providers to support a safe, effective, appropriate, and unified behavioral health crisis response that minimizes law enforcement involvement.
– Trends in referrals of 988 calls to the 911 system are being examined across the three 988 call centers serving WA state. - Integrate peers – an essential component of the crisis response workforce – into all parts of the system.
– The evaluation is using qualitative methods to investigate the way certified peer specialists are included in mobile crisis response teams across WA state.
Further information regarding CRIS meetings, reports, and other resources can be found on the Washington State Health Care Authority’s CRIS webpage.