Let’s treat suicide like a public health crisis and set some audacious goals to end it
The growing list of high-profile celebrity suicides in 2018 is as heartbreaking as it is puzzling. Even with access to the nation’s top behavioral health services, why are those with seemingly unlimited resources still at risk? It only points to a much broader crisis.
New data from the Centers for Disease Control and Prevention show that suicide rates have jumped 30% in the U.S. since 1999. As suicide reaches crisis-level proportions in our nation, it’s time to treat suicide like the public health crisis that it is, and healthcare leaders and executives play a critical role.
We must lead the charge—drawing in other key stakeholders like providers, lawmakers, teachers and family members to support efforts to increase access to behavioral healthcare and reduce the stigma of mental illness. This requires investing in a community approach to education, surveillance and capacity-building to enable early detection and intervention.
One important place to start is by increasing education and awareness. And these efforts need to be sustained. Creating a communitywide or statewide education program focused on an audacious goal, such as a commitment to zero suicides, fosters the sense of urgency needed to drive broadbased buy-in. Keeping the message top of mind also is critical. Consider producing public service announcements that share the impact of suicide on real families and individuals.
Second, we must work to break the stigma around mental health disorders—and normalize the need for care. Equipping providers with the tools for early detection of mental health disorders and suicide risk is necessary to making an impact. Train providers, community members and peers in “safeTalk.” This training is offered by LivingWorks, a social enterprise com- pany focused on suicide intervention. SafeTalk has been used in over 20 countries since its development in 2006, preparing anyone 15 or older to become “suicide-alert helpers” and learn the skills needed to save a life.
Investing in suicide training for family members and peers of those with mental health conditions also is critical. Such training fosters early detection and, in the case of peer support, provides a common frame of reference, making individuals more likely to engage.
Finally, improved access to care is critical to reducing the risk of suicide. Ensuring that everyone, regardless of economic status or background, has access to behavioral health services is one solution, but finding specialists who are skilled in suicidology isn’t easy. One study in Maricopa County, Ariz., determined that only 30% of behavioral health professionals in the county believed they had the necessary skills and support to treat at-risk patients.
Our healthcare system must look for ways to support early detection by making depression screenings part of every primary-care visit, such as during the registration process via digital tools. As many as 38% of people making a suicide attempt did so within a week of a healthcare visit. Increased funding for suicide training among medical professionals—with a focus on training for providers serving minorities or underserved populations—will ensure access to appropriate care for patients of all economic and cultural backgrounds.
Digital solutions for mental health treatment also have the potential to make a profound impact in reducing suicide rates by improving outreach and connectivity.
Recent studies have shown that suicides are more likely to happen after midnight. If an individual who is wrestling with depression and insomnia is up all night and isolated, that individual is more likely to commit suicide. We’ve found that digital solutions for treating insomnia can improve the ability to sleep, reducing the severity of depression by more than 50%. These solutions provide relief that could save lives.
The path to zero suicides requires that healthcare leaders—and the nation as a whole—treat suicide as a public health issue and that we normalize discussion around mental health, suicide and treatment. Let’s all commit to strategies that involve entire communities in suicide prevention and draw upon multiple resources for continuous education and access to treatment. ●
Level of integration key to supply-chain savings from mergers
Regarding the article “Mergers yield minimal supply-chain savings” (ModernHealthcare.com, Sept. 21), my supply chain consulting work with more than 1,700 hospitals (which includes over 180 integrated delivery networks) corroborates the key points made.
What is not said in the article, at least not directly, is that corporate culture is a huge factor in how much integration can even potentially be achieved. Merging hospitals and IDNs have a very broad spectrum of philosophies about how much corporate centralization and/or consolidation will be accommodated, how much standardization can be achieved, and therefore, the subsequent savings that are likely to be achieved.
Until the merging or acquiring parties address that 800-pound gorilla, financial results via supply chain will continue to be limited and far from optimal.
Jamie Kowalski Founder, CEO Jamie C. Kowalski Consulting Whitefish Bay, Wis.
‘ Choose Medicare’ option would promote competition
Regarding the recent op-ed by Sen. Chris Murphy of Connecticut (“‘Choose Medicare’ should be an option for all Americans, to ensure coverage and boost competition,” The 115th Congress on the State of Healthcare special supplement, Sept. 24), finally, here’s a solution. Many of us in the business of healthcare see the benefits of offering Medicare as an option, not a requirement. I believe this would promote competition across the health insurance industry and provide another option for employers and consumers.
Rich D’Amaro CEO Schumacher Clinical Partners Lafayette, La.
Create payment models that fairly reward primary-care providers
Regarding the article “Azar: Expect ‘bold’ risk-based Medicare payment models” (ModernHealthcare.com, Sept. 6), the movement toward “value-based care” may have some unintended consequences—the extinction of independent primarycare providers. Stakeholders apparently have different definitions of “value.” Payers and policymakers seem to equate “value” with “risk.” The recent article on the Medicare Shared Services Program highlighted the CMS’ desire to accelerate risk for ACOs, thus threatening the demise of the independent primary-care providers.
The current system is full of waste generated by unnecessary, duplicative and excessive medical treatments. “Risk” should be reserved for those that created the waste. Don’t reward inherently inefficient groups while penalizing those with an established record of high efficiency.
The CMS recently acknowledged that primary-care providers are “critical” because of their comprehensive care management. The literature continues to show that independent primary-care providers, or PCPs, are more efficient than their employed counterparts, but they are being forced to take risk in both commercial and government models. Without proper benefit design funneling patients to the providers and giving patients incentives to become more healthy, independent PCPs will have limited impact and most likely fail.
With the proper benefit design, efficient, independent PCPs can directly and indirectly control more than 80% of medical costs, but they’re currently compensated at a fraction of these total costs. In “risk” models, payers want to further erode a PCP’s anemic compensation but not provide a reasonable mechanism to control it.
If we truly want to preserve the most precious resource in the healthcare system to ensure successful reform, we must realize the true “value” of independent PCPs in “value-based” care. We need to compensate them accordingly for their abilities to manage complex patients efficiently through models that reward them appropriately for their work that results in higher-quality, more costeffective care.
Dr. Robert Resnik Cary (N.C.) Adult Medicine