Thursday, August 14, 2014

Robin Williams and Preventing Suicide

Five years ago this past week, my company Accolade first started helping people through the health care system by opening our Health Assistant Center.  This came only after spending two years developing the new profession of Health Assistant and the systems to support those Health Assistants.  A Health Assistant is a professional trained to form long term relationships in order to help people and their families through the health care decision making process, including  those decisions related to insurance coverage, physician selection, care options, personal health behaviors and all of the life issues which impact and are impacted by health, wellness and illness.  There were many surprises and lessons learned as we improved our ability to form human relationships with people as they were about to enter the health care system and help them along the way. 

One of the biggest surprises that first week was when our youngest Health Assistant, a very bright young woman who is now a leader in our company, took our first call from a person at risk for suicide.  The person was calling for a totally mundane reason, having to do with her benefits when she made a vague suicidal reference that upon assessment by our in house clinical psychologist, turned out to be hallucinations commanding her to kill herself.  This was a first psychotic break for this woman and for the next hour, we stayed on the phone with her, called the Emergency Medical Response team, contacted her sister to come and stay with her in person and had her evaluated and admitted to a hospital.  Following her hospitalization, that same young Health Assistant and our Clinical Psychologist helped that woman get the continuing care she needed.  Five years later, while our Health Assistant is now a leader in our company, she still maintains the relationship with that woman whose life she likely saved that day.  The person has had one relapse which did not need hospitalization and she continues to live a full life.

That was our first experience with helping prevent a potential suicide.  We have found this to be much more common than we would have predicted and now as we help about half a million people who have access to a Health Assistant, we speak with people on the verge of suicide on an average of once a day.  They often start with a benign call.  One stands out in my mind as we were helping a person through an open enrollment process.  Her boss had told her to call her Accolade Health Assistant because the open enrollment period was ending and it was required that she take part in that process.  On a Friday afternoon, this patient called and the Health Assistant first asked about what health care she might need the following year as that would help decide on the best plan for her.  The conversation continued with the person finally telling the Health Assistant that she was not sure that she would be around the following week let alone the following year!  She admitted to severe depression and told of her plan to kill herself.  Our mental health expert immediately joined the call.  On that Friday afternoon, the Health Assistant and our mental health expert stayed with her and made sure that she received the care she needed including admission to the right facility to start her therapy. 

I know that we are not always successful but we do know that suicide, if you are fortunate enough to catch someone at the right time and have the right skills to best assess and engage with these people, can be prevented.  The timing is key and while these telephone conversations cannot achieve 100% success, they are often our best hope.  The assessment often starts by simply listening to the person on the phone.  A clinical “pearl” I learned in medical school was that one should be suspicious of depression if, when you talk to someone, you start feeling depressed yourself.  While the natural reaction when a person feels depressed talking to another is to turn away, we know that is the precise time to stay with that person in need.  We do know that a phone call can be lifesaving when the professional on the phone recognizes the risk of a potential suicide and has the tools and skills needed to facilitate the right interventions. 

In some ways, as I reflect on our experience at Accolade and on the tragedy of a man who gave so much joy to so many deciding to take his own life, I realize that the challenges of treating that creative, quick mind of Mr. Williams may have been too much for any single phone call or any intervention to avoid the newspaper headlines we are now faced with.  I am also reminded of a senior psychiatrist who once told the story of a person he treated for twenty-five years who then committed suicide.  He asked the question of whether his treatment was a failure and answered that his assessment was that he helped that person avoid suicide for those twenty five years so the therapy, while incomplete, could not be called a failure.  I for one will not second guess the health professionals who, presumably, tried to help Robin Williams with his addiction and depression over the years.

But we always must try to intervene, and a simple phone call, as the suicide prevention hotlines around the country and we at Accolade have proved, can be successful in helping people through the depth of despair at the right point in time.  There is a country western song written by Matt Kennon (and I admit to believing that country songs have great truth embedded in them) that may best reflect the power of a phone call to avoid tragedy. 

Today was gonna be the day
He'd already wrote the note
And parked that Chevrolet
At the end of that dead end road
Had his finger on the trigger; just about to end everything
He was taking one last long breathe; when he heard his cell phone ring

And his best friends say man where you been?
We're headed down to the lake this weekend
You better not miss it 'cause buddy I swear
It won't be the same If you ain't there
And I told that girl that you like so much
You were coming along and her eyes lit up
I better let you go man I really hope I didn't catch you in the middle of anything

He said you kinda did but I don't mind at all
I'm glad you called


I have seen over and over, the right phone call at the right time prevent tragedy and I only hope and pray that all who are suffering and alone, make or receive that phone call at the right time to prevent the horror of suicide, for themselves of course but also for all those who care about them.