wo years ago, I emailed my best friend a satire that I wrote. I didn’t plan to publish the essay, but I thought it pertinent to our circumstances and wanted to share a laugh. I texted him to check his inbox.
Seconds later, our thread had an emoji representing laughter.
“You read it already?” I replied. “You thought it was funny?”
He liked my message.
“I know you’re a fast reader, but I didn’t think you were *that* fast,” I wrote. It had about 1,500 words.
“It was one word.” Ellipses blinked, followed by a screenshot of a white page with four letters in parentheses centered across the top: (null).
The copy hadn’t gone through. Instead, a Latin word meaning “not any” appeared. As linguaphiles, we often shared Greek, Latin, Old English, and German roots and derivatives. He assumed, like the ancient response implied, “If there was something to it, it’s gone now.”
From then on, (null) became our go-to response for anything unexpected. Over fifteen months of ups and downs, we had opportunities to reference our inside joke. It served as a balm for our difficulties, especially when I discovered my best friend was struggling.
Years earlier, I sought residential treatment when I couldn’t stop thinking about ending my life. I reiterated how my choice turned things around for me and urged him to check-in voluntarily. He did.
When the clinic cleared my best friend to discharge, I worried it was too soon and told him. His responses to my calls and texts began dwindling. He explained the silence was because of his increased focus on routine and self-care. I accepted his justification. I wish I hadn’t.
Three weeks after coming home, my best friend shot himself.
Within hours, I learned what happened. Grief stricken and thrown deep into mourning, I found inexplicable solace in the antithesis of our former reply. I bought us both bracelets: One for me to wear and one for him to be buried with. They said (null).
This year, Alaska Behavioral Health (ABH) expects to serve about 8,000 people from offices in Anchorage, the Matanuska-Susitna Borough, and Fairbanks, making it the state’s largest mental health provider. Chief Operations Officer Joshua Arvidson acknowledges a truism circulating in his profession: the day to help to someone is the day they ask for it.
“Having been a therapist for twenty years, I’ll tell you,” he says, “when I’m meeting a patient for the first time, I often think the first day to help was months ago.” If someone’s reaching out, they’ve hurt for a while. He adds, “People are hesitant to ask.”
ABH expanded its operations and helped shape Alaska’s suicide prevention and intervention responses. “Five years ago, we only served 2,000 Alaskans,” says Arvidson. “We knew we needed to provide better access to care because so many people are struggling.”
Even though suicide is largely driven by three complex problems—anxiety, depression, and traumatic stress—other healthcare needs and environmental experiences amplify it. “We must link physical healthcare with mental healthcare,” Arvidson says. “A distinction does not exist in biology, just in language. Mental health conditions are health conditions.”
ABH uses a model that addresses the whole person by offering wraparound services. “Emerging science shows the quicker we can intervene with evidence-based treatments,” which is clinician-speak for therapy, “the more likely we can create a revolving-door approach,” says Arvidson. This continuum empowers patients with knowledge about who to call when they’re spiraling and how to access integrated medical services, including primary care, internal medicine, mental and behavioral healthcare, therapy, and pharmacy. “We spent the last couple of years building this holistic approach,” he adds.
Given ABH’s rapid growth, the model seems to be working. “People’s profound challenges are very responsive to treatment,” Arvidson says, noting how ABH is helping more Alaskans overcome suicide ideation. “What makes me sad is others still aren’t receiving it.”
These delays reinforce the importance of loved ones, friends, colleagues, and neighbors knowing how to help—especially when an escalation occurs. Organizations throughout Alaska offer immediate relief and assistance.
To ask questions and receive guidance from anywhere in Alaska during regular business hours, dial 211. The social services counterpart to dialing 911 for life-threatening emergencies, this United Way program has specialists who connect callers throughout the state with community resources and programs near them.
Alaska 211 is separate from 311, a call center in the Anchorage area that acts as a non-emergency hotline. Operators can connect or refer 311 callers to municipal departments and services, short of an immediate police or paramedic response.
If a person is considering suicide, facing a psychological crisis, or concerned about someone else’s mental wellbeing, Careline Alaska provides 24/7, statewide support and can be accessed by dialing 988. It recently began partnering with Alaska 211, allowing both systems to share a database and make referrals.
Both Careline Alaska and Alaska 211 have 800-numbers listed online and offer texting. Like 911, these helplines are staffed by Alaskans.
“We’re grateful to hear from someone before they’re deep in the weeds,” says Marchuk. “Maybe then they never get to thoughts of suicide.”
Careline enables callers to find a listening ear, gives them space to share what hurts and bothers them the most, and empowers them to identify resources. Together, the caller and counselor develop post-call strategies, like who to confide in, how to decompress and stabilize, or where to pursue higher levels of care, such as therapy or residential treatment.
“The person asking for support drives the call,” Marchuk emphasizes. “They help us know where to go with the conversation.” Simple questions make talking easier for the caller, help ground them, and reveal circumstances contributing to their feelings, like if they’ve gotten enough sleep and food.
“When you really focus on understanding what’s going on in someone’s world, it’s life changing,” says Marchuk. “It helps them move away from what is painful or sticky.”
Careline only dispatches on about 1 percent of calls—up to half of which occur with the caller’s consent. Dispatched helpers are often mobile crisis teams (MCT), which use trauma-informed, person-centered, culturally responsible approaches. They help people receive treatment instead of being sent to jails or hospitals.
In Fairbanks, ABH runs the MCT. “We’re on standby 365 days a year, 24 hours a day,” Arvidson says. It responds about fifty times per month. Arrests or hospital stays have plummeted, he adds, occurring in less than 2 percent of cases.
“Our Fairbanks clinic has walk-in,” says Arvidson, “so often the people the MCT helps are seen the next morning, if not that night.” People are realizing they won’t face personal or legal outcomes for requesting mental health aid, which increases their likelihood of calling.
When dispatched, Pierce assesses suicide risks and provides brief therapeutic intervention. The focus is on people’s strengths and protective factors. “I want them to see what skills they have,” she says, “so they have a safety plan in place in case there’s a next time.”
Anchorage’s MCT averages twelve calls a day, a steady increase since its start in 2021. “Right now, the team has three calls in the queue,” Pierce says during the interview.
When a request for the MCT comes in, the call center asks questions to dispatch the right resources. The team comprises a mental health clinician and a firefighter EMT/paramedic and goes to workplaces, private residences, parks and street corners, hotels and shelters—basically everywhere.
“We make sure the help we are providing is what the person wants and agrees to, which looks different for everyone,” says Pierce. She’s responded to calls that take five minutes to facilitate self-advocacy or up to three hours.
“We take all calls one at a time to focus on the individual and remain present,” she adds.
The right level of care varies, but it’s always the MCT’s priority. “The mind and body are connected,” says Pierce, which is why sometimes mental health symptoms mask physical ones. “I’ve had to convince people, ‘No, you are experiencing a medical emergency. We need to get you support right now.’”
The MCT can transport people to outpatient clinics or detox centers. For 10 percent of responses, help involves a hospital, requiring an ambulance. “A clinician rides with them to offer continuity of care,” she says. A warm handoff with a medically accurate report means the patient is more likely to receive the right services.
Pierce likens herself and other MCT members who provide therapeutic intervention to “Swiss Army knives.” They can address everything from suicide, depression, and panic attacks to substance abuse and dementia, regardless of age or background.
“We help, but we can only do so much,” she says, carrying the analogy further. “That’s when people must rely on a full toolbox.”
“We can train most anyone,” Ramsey says. “We also offer ASIST [applied suicide intervention skills training], an intensive suicide prevention course.”
“Anyone” includes workplaces that can secure certifications for wellness programs that help mitigate mental health issues.
More than 18,000 Alaskans have received their certifications. Ramsey has traveled to thirty-five communities in the state to lead trainings. From law enforcement and educational institutions to nonprofits and businesses, workplaces are a necessary part of suicide prevention and intervention—especially considering most suicides in Alaska occur between the ages of 15 to 45, which covers students and employees.
“No matter a person’s affiliation, we can schedule trainings with their organizations,” Ramsey says, stressing that, although there are costs, she can find ways to train even if funds are limited or nonexistent. “I do make deals, and we work it out so cost isn’t a barrier.” Grants can offset expenses, in some cases.
“Many folks come to me after they’ve lost someone, which is such a sad situation,” she says, but she cautions that people need not worry over what they could’ve done yesterday. “We do the best we can with what we know.”
Training helps her clients know more next time. “You can learn suicide warning signs and become familiar with local resources,” Ramsey says. “With standard first aid, you learn how to perform CPR, not heart surgery, and stabilize someone until help arrives. Mental Health First Aid uses those principles.”
The first step is accepting that everyone struggles, which can normalize seeking help. “No passerby ignores someone dealing with a life-threatening issue,” says Ramsey, “and mental health shouldn’t have different standards.”
Ramsey cites a finding that one in nine people thinks about suicide at any given time. “You can’t fix their mental health problem,” she says, “but if we don’t do anything, we know what can happen.”
“If nothing else, workplaces must prioritize the safety and sustainability of their workforce—wherever it comes from,” Ramsey says, “though I hope it stems from compassion.”
Making mental well-being part of the workday empowers people to ask for help. They cease fearing they’ll be written up or fired. Ramsey tells people in trainings:
- Call or text someone when you’re concerned. Do it even if it means annoying them.
- Err on the side of caring. You won’t regret acting.
- Ask for help. Embarrassment is better than what you’re feeling or, worse, dying.
A study conducted at Columbia University, which inspired a 2006 documentary titled The Bridge, found that 100 percent of sampled people who attempted suicide regret it. They didn’t want to die. They didn’t want pain either. However, in those moments, they couldn’t see beyond pain.
I believe my best friend would have had this perspective, too, had he survived.
Suicide ideation can be a temporary crisis. If we do nothing, it can become a forever consequence. Together, we can prevent people from isolating, which increases their self-harm and suicide risk. I know now, firsthand and devastatingly, that I’d rather have someone upset with me and alive.
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