Suicide is one of the ten leading causes of death in the United States, taking the lives of more than 44,000 Americans every year. With increasing suicide rates, suicide prevention needs to be a top priority in healthcare. While prevention measures have increased, there are still many areas in which healthcare professionals can improve care for mental health.
According to the May 2015 issue of Medical Care, 38 percent of people who attempt suicide make a healthcare visit within one week before their attempt, and 64 percent make a visit within one month before their attempt. Making suicide prevention a top priority and assessing mental health at every opportunity could lead to lower suicide rates and improve care for mental health. One way to prioritize mental healthcare is to assign care managers to intervene, especially with chronic patients who may be more likely to suffer from depression or suicidal thoughts.
Most people are prescribed psychiatric medicine by their primary care physician (PCP) rather than a psychiatrist, because they often feel more comfortable with their “regular” doctor. Care managers are regularly seen as an extension of PCPs and are trusted by default. This trust allows patients to be more open with care managers. Care managers enhance coordination of care, help navigate the healthcare system, eliminate duplication, improve patient care, and head off or prevent the need for medical care by improving the health of the patient. There are different ways that they can build relationships and trust with patients to assess for depressive or suicidal thoughts.
Ways Care Managers can help:
1. Look into positive screening test results.
Follow up with any positive score of the Patient Health Questionnaire (PHQ-9), a screening tool used by primary care physicians to monitor patients for depression and treatment response. It is an opportunity to help the patient move the score to zero. As a care manager, one can provide resources and referrals, links to services, explain the healthcare system or provide the “hand-holding” that a physician cannot always do during their appointment. They can set up interventions at the visit to ensure safety. The care manager can also provide the education, support and follow-up needed to help the patient through the time of crisis.
2. Normalize psychiatric treatment.
The care manager can help adjust the patient to a routine of using psychiatric medications and/or attending therapy. They can also challenge a patient’s “I should” thinking, and help the patient realize they are not “abnormal” for being depressed and/or suicidal.
3. Follow up with additional support.
They should be persistent and follow through with the patient from the initial visit to provide further support if needed. Multiple studies of psychiatric hospital and emergency department discharges show that following up with a patient after a suicide attempt can reduce suicidal behavior post discharge. Care managers can check in with the patient and inquire how things are going. They can listen or provide additional referrals, education, or links if needed. Care managers can communicate with patients by phone call, postal letter, email, text or personal visit to ensure continuity of care, which is the most vital link to managing suicidal risk.
4. Bridge gaps in communication.
Care managers can play a vital role in keeping patients in communication with their physicians, as they can reach out to patients for follow-up care when the PCP may not have time. They also help bridge physical and mental care.
5. Lower costs.
The Suicide Prevention Center lists the average cost of one suicide at more than $1.3 million. “Every $1 spent on psychotherapeutic interventions and interventions that strengthened linkages among different care providers saved $2.50 in the cost of suicides,” (Suicide Prevention Resource Center). The goal of the care manager is to get more people linked to mental health treatment which can save their life, improve their mental health, and reduce costs.
While there is still a lot of work to be done in prioritizing mental healthcare and suicide prevention, assigning care managers to make this one of their main concerns is a step in the right direction. Learn more about Medical Advantage’s approach to in-practice interventions today.
