Wednesday, September 24, 2014

Suffering In Silence: Why We Should Talk About Suicide

I can remember it so clearly. It was just a few hours before the clock struck twelve and it would be my husband’s birthday. He loves presents, but always makes it difficult for me to get the right thing. He acts as if his birthday doesn’t matter to him, but I do think he likes a bit of a fuss.

The message on my phone wasn't very clear. There was a great deal of background noise. I could hardly hear him say, “Call me now, it’s an emergency!” I tried calling several times, but he wasn’t answering. Finally, I called my father-in-law and I could have never predicted what would come next. His voice was different; it was slow and soft as he calmly explained to me that my husband’s brother had just killed himself. He was 26 years old. It was incomprehensible. I couldn't make sense of it. Even after years of working in mental health, I could not even begin to grasp what I was hearing.

There isn’t a day that goes by that I don’t think of him. He and my husband were best friends. Al was always there. He did everything with us. I remember he would come out on the boat with us. He never got out on the ski or wake board. He never drove either. He just liked to come along for the ride. He liked to spend time with his brother. The feeling was mutual. They were very close. Where you found one, you would very likely find the other.

It only takes a momentary glance to see the sadness in my husband’s eyes. I have come to know this silent sorrow all too well, because it dwells in our family. I have experienced other family members dying. I have talked about my father's death, which had a profound effect on me but this is different; there is a silence that accompanies suicide. The silence is deafening. Each December we are quiet, our conversation subdued, as his birthday passes and the holidays come and go. Then there is there is the day Alfred ended his life - the eve of my husband’s birthday. Even though we rarely speak of the night he killed himself, we are all thinking about it. I don’t really know how to say it other than directly. I miss Alfred. I really miss him. There is so much silence. I wish we could talk about him more.

A few years ago I decided I would give my husband a different kind of gift for his birthday and joined thousands of people in Chicago on a 20-mile walk into the dawn as part of the American Foundation for Suicide Prevention's, Out of the Darkness Overnight Walk. Two years later, when he was ready, my husband joined my on the journey Overnight in San Francisco and we walked Out of the Darkness together. Since then, we spend each day combating the silence and stigma that too often accompanies suicide.

Help end the silence and erase the stigma surrounding suicide and its causes. Encourage those suffering from mental illness to seek treatment. Show support to the families and friends of the 36,000 Americans who die by suicide each year. Suicide is the third leading cause of death among teens and young adults and the second leading cause of death for college students. Every 40 seconds someone dies by suicide in the world.

Please approach those suffering with compassion and remember that “many people who are experiencing suicidal thoughts don’t want to die; they want the pain to go away.” Take the warning signs seriously. You can find them on the Contra Costa Health Services website here. I encourage you to reach out and offer support to families who are devastated from losing a loved one. They will be grateful to know you are there. You can make a difference by ending the silence.

You can find more information on the Contra Costa Health Crisis Service page. Or in other communities you can check your local crisis resources or the resource page here at the American Foundation for Suicide Prevention.

So many lost, so many left behind and all preventable.


Wednesday, September 17, 2014

CCRMC and HC Rapid Improvement in the Health Homes: Kaizen Report Out

Over the last year we have been actively redesigning our ambulatory health system, pushing ourselves to build a stronger patient-centered, team-based system of care.  Last week a multidisciplinary team came together to work on optimizing the roles of each member of our health home teams.  The improvement team set out to better define the connections between team members in pursuit of meeting patient’s needs in a more timely manner.  The team was supported in their work by one of our patient partners, Nancy, who directly participated to help design and carry out the tests of change throughout the week. 
The Kaizen team focused their energy on two roles; the Care Coordinator and the Health Home Coordinator.  Our Care Coordinators assist patients with system navigation and specialty referral management, among other tasks.  While our Health Home Coordinators have a nursing clinical background that supports patients with health education and chronic disease management.  The team felt that by improving the connections and clarity between the two roles teamwork could be improved.  Over the course of the week the team defined processes for reporting laboratory results, reception and processing of any incoming patient calls, and initiation of durable medical equipment (DME) requests.  One example of the improvement work, involved utilization of online tools that staff will now use to streamline DME processing.  This new process was able to reduce initial processing cycle times by 20%.  The team will continue to monitor the changes over the next three months, with a continued emphasis on adjusting and learning from their experiments. I have included the slides from the report out above.

Two overarching themes that continue to rise to the top are centering all we do on meeting the patients expressed needs and creation of standard, predictable roles so we can work seamlessly as a team to meet our patients needs. I hope you take the time to review the visibility boards in your work areas which display our current work and progress towards our goals.
More very soon,


Many thanks to Miles Kotchevar and the Health Home Kaizen team for your contributions to this post. Keep an eye out for the Kaizen Team Postcard!