In the midst of a prolonged heat wave two years ago in July, I talked with Washington State Representative Nicole Macri about her work on homelessness, housing justice, and behavioral health issues. Macri has worked at Downtown Emergency Service Center (DESC) in various capacities for the past twenty-two years. In the Washington State House of Representatives she serves on the Health Care and Wellness Committee.

In Seattle, as throughout much of the West, we're in another prolonged heat wave. Excess heat is deadly, especially for the elderly, people living with mental health and substance use disorders, and people who have to work--and live--outside. People who live in isolation. Excess heat events are becoming more frequent due to the effects of climate change. When I spoke with Rep. Macri two years ago, she had visited Harborview Medical Center, our area's Level 1 Trauma Center.

When she visited Harborview Medical Center, all the area hospitals were on alert because of the extended heat wave causing heat-related injuries. “The emergency room Medical Director said, ‘This afternoon, we had no available ambulances to go on call in Seattle because they were all at emergency departments waiting to transition their patients to the ED,’ but they struggle to do that because the hospitals are all backed up.” Rep. Macri told me that at that moment, she realized that our medical system is going through a crisis similar to what the behavioral health system has been in for years. She said, “So we have all these people who are homeless, living with severe behavioral health conditions. They are trying to get in the front door, usually through the crisis system, and the crisis system is totally overloaded and can’t respond.”

Rep. Macri went on to talk about her legislative work on community behavioral health policy and investments. "It's a long endeavor. I knew that going into it, but it seems like every year we go back to the Legislature, we discover how a gap in the system is really profoundly harming people. It's like a dam that's just spurting water everywhere... And as behavioral health concerns have become more universal as more families have seen the impacts of the stress of the pandemic, there has been more of a focus on behavioral health. But we certainly didn't have a system that is or will be anytime soon ready to respond to the growing needs we see in the community." Towards the end of our conversation Rep. Macri added, "I just wonder and hope that we continue to have the same conversation of not making the sam mistakes; that tightening of the belt has a disproportionate harm to vulnerable communities and does not help us recover economically as quickly as investing in the communities that need the most support during these challenging times."