In 1995, the very day I completed my masters in Community Agency Counseling, I returned home feeling like a “master clinician” only to immediately receive an imminently suicidal caller. My first thought was how I could possibly go through a 60-hour CACREP accredited program without a shred of preparedness! My balloon of confidence popped, and I spent the next 10 hours in a more important final exam.
|David W. Covington, L.P.C., M.B.A.|
Vice-President, Adult & Youth Services
Maricopa County Regional Behavioral Health Authority
Magellan Health Services
National Action Alliance Executive Committee Member
Fourteen years later, as Chief of Adult Services for Magellan of Arizona, our CEO Richard Clarke charged me with leading an initiative to end suicide for those enrolled in our care. We found thousands in our network’s workforce feeling similarly unprepared, as I had been years earlier. I have found the metaphor of the Golden Gate Bridge and the story of Kevin Hines extremely powerful in understanding our challenge and our opportunity.
Eighteen-year-old Kevin Hines was receiving usual and customary behavioral healthcare but was despondent over the challenges of his bipolar disorder. In September of 2000, he kissed his father goodbye and caught a municipal bus to the bridge where he hurled himself over the rail, a tragic scene that has been played out some 1,500 times over the last 80 years.
The railing is embarrassingly low at four feet. The rationale has been that people like Kevin would simply go somewhere else or do something different if the rail were higher. “You cannot stop someone from killing themselves if they really want to do it,” or so the saying goes.
In Phoenix, we have used the bridge to tell the story of the opportunity Community Behavioral Health has to challenge suicide directly and raise our own rail to stop these deaths.
Forbes magazine last October in “The Forgotten Patients” chastised the mental health industry for ignoring the 35,000 people who die by suicide each year. The Suicide Prevention Resource Center’s published report on progress since the 2001 National Strategy found little focus on improved training.
The core belief currently strongly ingrained among many healthcare professionals is that there are two distinct kinds of people who have very little to no overlap in terms of their experience – “Group A” are those who kill themselves, and “Group B” are those who talk about it. This is what we were taught.
Kevin did not just talk. He took an action that is lethal 98% of the time. He recounts vividly the last five seconds prior to jumping. One second he was so distraught he would do anything to end his pain, and the very next, there was no more grip on the bridge’s firm steel. Instantly, he realized he had made the worst mistake of his life and would do anything to undo what he had just done.
In 1975, Dr. David Rosen interviewed 7 of 10 known survivors with similar stories. Three years later, Dr. Richard Seiden interviewed 515 people who were taken off the bridge by law enforcement. The average length of time since their experience was 25 years. Yet, only 6% had gone on to kill themselves somewhere else and later on.
The same year that Kevin took the bus to the bridge, Don Berwick challenged the Henry Ford Health System (HFHS) in Detroit to improve its depression care. HFHS adopted what has become known as the “Perfect Depression Care” initiative. They raised their rail, and in 2010, they reported their tenth quarter without a suicide death.
In 2009, our Phoenix behavioral health collaborative determined to end the practice of suicide care as a specialty referral. We raised our rail and trained 2,000 in the core of the workforce in a two-day suicide prevention training. It has changed our culture and provided a level of skill, confidence, training, and support to effectively engage those at risk.
Kevin and others like him have taught me that suicide is always preventable and future deaths are avoidable. We have two powerful allies in suicide intervention, namely the mind and body of each person who struggles with intense emotional pain. They do not cooperate and continuously find ways to fight back.
Recently, 25-year-old Lashanda Armstrong drove a minivan off a dock and into the Hudson River. The only survivor was her 10-year-old son, who climbed out the window and swam to safety. Initially, his mom told him if she was going to die, he was going to die with her. But, as she plunged into the water, she desperately tried to put the car in reverse and repeated, “I made a mistake.”
We do not have to feel helpless or hopeless. We can make a difference. Mike Hogan is the Commissioner of Mental Health for New York State and my co-lead for the National Action Alliance Task Force on Clinical Care and Intervention. I believe we can do that best by dedicating ourselves to frank and open discussion of a higher rail and real solutions.
Question: Months after Kevin’s story was released in Eric Steel’s documentary, the bridge authority voted 15 to 1 to install a physical deterrent underneath the full span. What is the equivalent of the programmatic safety net we need in healthcare to render suicide a “never event?”