The depression was mild at first but then deepened, remembers Jennifer Stuber. It was the winter of 2011, and the economy remained sluggish—tough times for her husband Matt Adler, a successful Seattle corporate attorney. There were sleepless nights, severe anxiety, a crumbling loss of self-esteem. It became so unmanageable he couldn’t work and took a leave of absence.
“He was treated by a psychologist and a psychiatrist. No one took the signs seriously. The psychiatrist seemed almost annoyed,” says Stuber. “There’s a lot of fear in terms of liability and so on associated with having someone on your caseload who may be suicidal.”
On February 17, 2011, Adler shot himself, one of nearly 1,000 Washingtonians who kill themselves every year—a suicide rate 15 percent above the national average. Adler was 40 years old, the father of two young children.
“I started to read his medical records and reached out to mental-health professionals,” Stuber recounts. “They told me they were really sorry for my loss, but that they were not surprised, because the training in suicide prevention, they said, is pretty much nonexistent.”
The death of her husband led Stuber, a professor of public policy at the University of Washington’s School of Social Work, on a journey aimed at training all healthcare providers, including the state’s 140,000 doctors and nurses, how to recognize and treat a potentially suicidal person. But major obstacles—not the least being a recalcitrant state medical and psychiatric associations—still stand in the way.
Rep. Tina Orwall was approached by Stuber about a year after Alder’s suicide. Stuber knew Orwall had a background in social work and might be sympathetic to her cause. “Tina gets it. She understands the issue, and she’s a fighter,” says Stuber.
Two years ago, the south King County Democrat introduced and oversaw passage of the Matt Adler Suicide, Assessment, Treatment and Management Act of 2012. The measure made Washington the first state to require prevention training for mental-health professionals such as social workers and counselors. The legislation, which took effect in January, mandates six hours of training every six years in suicide assessment and treatment.
Stuber says the state House Democratic Policy Committee, back in 2012, wanted to go further and include doctors, nurses, and other primary healthcare providers. But the Washington State Medical Association fought it, so this provision, which conservative lawmakers also objected to, was left out.
The legislative battle continues. Orwall is back with House Bill 2315, which would do what the Policy Committee wanted to do two years ago. It stipulates the inclusion of six hours of suicide-prevention training among the 400 hours in “continued medical education” required over the course of eight years by the state Department of Health. The bill also includes mandated training for chiropractors and naturopaths.
In early February, the House passed the bill 94-3. The Senate, though, is a different story. The Washington State Medical Association (WSMA) and the Washington State Psychiatric Association (WSPA) have loosed their lobbyists. Both groups say they don’t want government telling them what kind of continued education they should take, all the while questioning the effectiveness of the prevention training.
In a statement sent to Seattle Weekly, the WSMA writes, “While six hours of training is not an onerous amount of time, it’s irresponsible to mandate strategies that are not proven successful.”
This from Daniel Crawford, president of the WSPA: “ . . . training in suicide risk assessment and management has not been shown to improve the ability of an individual professional to prevent suicide with an individual person.”
Orwall is not impressed by the argument, citing an October 2013 report by the UW School of Nursing that surveyed more than 2,000 healthcare professionals in Washington and found that 85 percent “of responding providers believed that providers in their profession should be trained in suicide prevention.”
“We are only asking for six hours,” says Orwall, who notes that 60 percent of those who take their own lives have seen their primary physician within 30 days of their suicide. “As far as how effective it is, if we can save one life from just six hours of training out of 400 hours, why wouldn’t we do that?”
“It’s not about effectiveness of the training,” opines Stuber, who last year co-founded the UW-based suicide-prevention group Forefont. “The doctors just don’t want anyone telling them what to do. I want to be fair. We can’t be sure what impact it will have, but it’s worthwhile to see how it might help.”
It was Sen. Jan Angel who, while in the state House, proved to be an important ally in getting the 2012 Adler bill passed. At one point during the debate, the Port Orchard Republican rose from her seat in the Capitol chamber and spoke about how her own husband killed himself in 1993.
“It was the hardest speech I ever gave,” Angel tells Seattle Weekly. “I sensed he was depressed. He went to his family doctor and was given sleeping pills. After he died, I called his mother with the bad news, and she told me that there were suicide attempts on his father’s side three times. Yes, it’s time we have this conversation about prevention [training].”
In her maiden run for office in 2008, Angel recalls that the very first door she knocked on, in Gig Harbor, was answered by a woman who confided to her that her daughter had tried to commit suicide the night before.
“No, I don’t think six hours is too much to ask to save a life,” adds Angel, who on Feb. 27 joined her six colleagues on the Senate Health Care Committee in approving the legislation and referring it to the Senate Ways and Means Committee, which on Monday night passed the bill unanimously, despite the continued opposition of the WSMA.
It now goes to the Rules Committee and then a full vote in the Senate. “It’s still in critical condition. It’s not done yet,” observes Rep. Orwall.
However, it took a significant compromise to cut the deal and gain passage in the 23-member Ways and Means Committee. In an amendment added to the bill by Sen. Linda Evans Parlette (R-Wenatchee) and signed off on by Health Care Committee chair Sen. Randi Becker (R-Enumclaw), the legislation was watered down so that the six-hour training would be on a one-time-only basis and not ongoing. “I don’t think doctors need continuous training,” says Sen. Becker.
Asked whether the state medical association supports a one-time six-hour training period, spokeswoman Susan Callahan wrote in an e-mail, “No, we do not. The WSMA opposes mandatory CME [continuing medical education].”
If it gets the legislative green light before the session ends March 13, the prevention training program, with a cost in state dollars of less than $100,000, would begin this coming fall.
“We didn’t get everything we want,” says Rep. Orwall, “but still, this is a huge step forward. We’re not done yet.”