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.
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| 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?”
4 comments:
To me the programmatic safety net in healthcare includes: 1) health care providers screening for depression and if warning signs are present, suicide risk; 2) health care professionals who are comfortable asking and talking about suicide; 3) quality and timely mental health referrals, and; 4) follow up
My son committed suicide in April. He had never shown signs of depression or spoke of suicide before. I requested his medical record. He had been seen by three different physicians during the past year. Each questioned him on his mental status including suicide. He denied having any problems. After he was dead, I found a picture up in his closet he had drawn about 5 years ago of himself with a gun pointed at his head. He was 26 years old. I had NO CLUE he had such thoughts. He was a good guy, 4.0 student. If they don't want to tell you, they will not.
My middle son died by suicide. While on suicide watch, in a hospital. He had the courage and encouragement of family and friends to self admit. HE did not want to die. He could not stop the compulsion, he asked for protection... it was not forth coming. So, while we can reduce stigma, encourage help seeking behavior, if the safety that is promised is not there and the services and supports are less than helpful...? The hospital unit he was on met the lowest critera of standards so were not "liable" for his actions. Fifteen minute bed checks, not line of sight. Until we change safety standards, we have to arm ourselves with knowledge to ask the critical questions and not assume that the MH professionals are always in the best position. I have worked dilegently with accrediation bodies when I discovered how many "sentinel" events take place in supposed safe environments. While significant progress has been made with in residential care settings,progresss in hospital setings has not been as significant. There is a gold standard... it should be met, every time!
My daughter died on 4/29/12 of an Unintentional Accidental overdose. She died because Magellan in Phoenix, had rubber stamped her as an addict, and had never in 5 years of treatment done a simple MRI or ordered one. In those years she worsened, became psychotic, complained of depression and suicidal ideation, and had her Dr's blame her for not getting better, yet, when she was in a coma, a simple MRI showed that her brain was so damaged by drugs she had used previously to being in the system, that she shouldn't have been able to walk or even communicate. And yes, she had told them she had been a Meth addict. If you want to end suicide, which my child did not commit, intentionally (she wanted to die but wouldn't take her life because she also wanted to live), then perhaps if someone is not responding to treatment they shouldn't be blamed, but they should be tested for all possible reasons. 3 weeks before her death, she seriously burned herself, was taken to ER, where she was put in a barcolounger since the ward was full. No one woke her to speak to a Dr. Her case manager, one that knew nothing about her, brought her to me, where I told them she needed to be inpatient. I was told the Dr would decide. He did. He told her he didn't know why he bothered to treat her anymore as she wasn't getting better. I live with guilt that I told her to take all the meds, so many and so many changes, to be honest and I believed Dr's that had case loads of unbelievable numbers. How can anyone be helped in a system that is motivated by time and money? One more death, yet, now she's not costing them any of their valuable time or wasting their valuable resources. Someone needs to step back and make sure that people who can't take care of themselves, are actually treated with the same methods and courtesy as those who can pay and who can fight back. They didn't believe her, so how effective can treatment be when the employees, only care about getting it all over with?
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