Preventing suicides in workforces and families

We typically use the term “heroic measures” when first responders and health professionals use emergency medicine such as CPR and defibrillation to resuscitate a patient or keep someone alive. Film and television productions often dramatize these rescues that professional emergency, surgical and critical care personnel undertake as routine parts of their work.

But ordinary people can save lives by doing things as simple as reaching out to someone who is struggling and letting them know they matter. The ways we can help people who are thinking about suicide don’t have to be dramatic to be heroic.

That’s a philosophy the behavioral health team at Arkansas Blue Cross and Blue Shield has taken to heart. This specialty care management team receives referrals for members facing challenges with their mental health or substance use. They contact the member who needs help, then assess their needs and risks. Once the behavioral health team understands the member’s specific needs, they connect them to behavioral health providers and resources near them for follow-up care.

Hope for the hurting

Chad Sievers helps lead the Arkansas Blue Cross behavioral health team. He said death by suicide is a tragic outcome to a personal mental health crisis, particularly because people in such pain often can be helped.

“Everyone has a role to play in saving lives,” said Sievers. “Only a small percentage of people with suicidal thoughts die by suicide, but many more think about it. Over 12 million adults seriously consider suicide each year. Of those, 3.5 million make a plan, and 2 million attempt it. Sadly, 48,000 die by suicide. This presents a significant opportunity for intervention.”

In 2021, suicide was the 11th leading cause of death in the U.S., with 78% of those deaths occurring among people of working age (16 to 64).

That Arkansas Blue Cross has a dedicated behavioral health team for specialized case management of mental health and substance use disorders is a key distinguisher for the organization. Such a team is rare in the insurance industry. The team receives referrals from many sources including claims data, other case managers and social workers, providers and facilities, and self-referrals from members seeking help.

Sievers said one of the best practices the team is implementing is screening every referral they get for suicidal thoughts and plans. “It’s just a few important questions, but they’re questions that often no one has asked them before. By asking everyone these questions, we can identify more people we can help.”

Caring Contacts: a low-key, personal touch

One initiative Sievers said has been particularly successful is Caring Contacts, an outreach program for members who have tried to end their life. After the team contacts the member and connects them to care, the behavioral case manager regularly over the course of the year sends them a hand-signed greeting card in the mail.

“I think a key reason Caring Contacts is effective is that we don’t ask anything of them. We don’t put any expectations on them,” he said. “We don’t use these cards to remind them of appointments or check that they’re going to therapy. It is just a bit of human connection to say, ‘Hey, man. I’m thinking about you and hope you’re doing okay.’ They’ve been through tough times. It lets them know that someone cares about how they’re doing with no strings attached. We’re also consistent—over the course of 12 months they receive at least 10 cards in the mail letting them know they are not alone, we are here for them, and we care about them.”

Caring Contacts is a strategy first developed by psychiatrist and World War II veteran Jerome Motto. While serving in the war, Motto received supportive cards, which sparked the initial idea for the approach. Later as a practicing psychiatrist, in the 1960s, he began sending letters to patients struggling with suicidal thoughts, particularly those he wasn’t having much success reaching through traditional methods. This simple, consistent outreach became the foundation of the Caring Contacts strategy. Sievers said that while such programs are becoming more common, it is unusual for an insurance company to do the member outreach.

Beyond being a compassionate thing to do, Sievers said that as a strategy, Caring Contacts has shown significant success helping reduce emergency visits and future inpatient admissions for Arkansas Blue Cross members who receive the cards. In May, Sievers and Martye Nelson, manager for behavioral health case management, presented their findings at the American Suicidology Association conference in Las Vegas. At Arkansas Blue Cross, 2023 claims data revealed 2,976 members had a primary diagnosis of a suicide attempt or ideation. But Sievers said the claims showed the program helped break patterns, reducing emergency visits by 60% over a year and inpatient admissions by 70%.

“The program works, and I’m proud of our results. Across our enterprise, increasing access to behavioral health is a strategic priority,” Sievers said. “Our members are healthier, and our groups can better contain costs and enjoy more productive workforces when our members can access care for their mental health and substance use recovery. At Arkansas Blue Cross, we truly prioritize behavioral health.”

Learning to listen

Sievers said that anyone can learn to detect the warning signs of suicidal thoughts and help people struggling with thoughts of self-harm find appropriate care. “In most cases, when friends, loved ones, colleagues and others notice the warning signs and take action to reach out to the person who is suffering and contemplating suicide, they can help avert suicide attempts,” he said. “Knowing someone cares about them and is paying attention to their suffering can make such a difference.”

It’s also important to take care of our own mental health. Ask for help if you need it. Your health plan may have an Employee Assistance Plan you can contact for help handling stress, anxiety, depression and other problems.

Take time for yourself. If your schedule is too busy with other people’s priorities, block your “me time” on your calendar so that it becomes a priority, too.

Suicide risk factors and warning signs

Understanding the risk factors for suicide helps us recognize them in others, or in ourselves. Risk factors cited by the American Foundation for Suicide Prevention include:

• Mood disorders
• Serious physical health conditions including pain
• Stressful life events such as rejection, divorce, financial crisis or other life transitions or loss
• Prolonged stress, such as harassment, bullying, relationship problems or unemployment
• Traumatic brain injury
• Having access to lethal means including firearms and drugs
• Family history of suicide
• Childhood abuse, neglect or trauma
• Prior suicide attempt

Understanding the risk factors, then watching for warning signs in people you know closely can make a difference, Sievers said. “It’s helpful to know the person closely to gauge what’s normal for them and what’s not. To know whether they’re saying they’d be better off dead because they are in a bad mood or because they believe that. Sometimes people get agitated and angry really quickly; an unusually short fuse can also be a warning sign.”

Other warning signs someone may be considering suicide include:

• Increased alcohol or drug use
• Not taking pleasure in everyday things
• Isolating from social activities, friends and family
• Major changes in mood
• Giving away possessions
• Threatening to hurt or kill oneself

Being (and sharing) a lifeline

Sievers said the time to have a conversation with someone about their possible suicidal thoughts is when you first start noticing warning signs. “Find a private time and place, then ask them directly if they have thoughts of wanting to die,” he said. “It can feel awkward, but it helps to be direct and nonjudgmental. I promise you aren’t going to put the idea into their head. Just let them know you’ve noticed a difference and that you care. Ask them if they want to talk.”

Once a person who is having suicidal thoughts opens up to you, it’s important to listen well. It’s not your responsibility to fix it. Just listen to their story, be present with them as they share. If it’s truly an emergency, encourage them to seek help, starting with calling or texting 988. They can call and someone qualified will be on the other end, ready to connect them to help.

Sievers said that awareness of the role each person can play in helping reduce suicide attempts has been growing, particularly with the 988 Suicide and Crisis Hotline that became operational nationally in 2023. “The hotline saves lives,” Sievers said. “It’s active 24 hours a day, seven days a week, and 988 is an easy number to remember to call or even text. You don’t have to be suicidal to call, and you can call on behalf of someone else you hope to help.”

To connect with the Arkansas Blue Cross behavioral health team, locate suicide prevention resources or find education on coping and problem-solving skills, visit mymindhelp.com.