Meeting Workplaces Where They Are: Crisis Response, Safety Planning and Cost-Savings

By Sally Spencer-Thomas

Parts of this blog republished in the International Association of Suicide Prevention’s Newsletter

While most of us in the field of Suicidology can see the great benefits of enlisting employers to implement comprehensive approaches to suicide, most employers are not quite ready. They are unfamiliar with the idea of their role in suicide prevention and often find it initially daunting and significantly out of their usual business endeavors. For these reasons, we need to listen well, move slowly and let them lead.

Many well-meaning suicide prevention advocates jump into the work of fixing something before they understand what the obstacles to change are.  The “Stages of Change” model^[1] developed by Prochaska and DiClemente, informs us that in order to be effective, we need to craft our strategy of change to the readiness of the people or systems needing change.^[2] If the problem is not in awareness, they will not be motivated to take action. If the problem is in their awareness but brings with it some big perceived obstacles to change, they will not be motivated to take action. It’s only when the perceived benefits of change outweigh the consequences of staying the same that change happens. You know you are moving too fast in championing change, when you get a lot of “yes, but” responses such as, “Yes, there may be mental health issues at work, but no one has time/money/expertise (fill in the blank) to deal with it.”

For these reasons, suicide prevention advocates need to take time to listen to workplaces and find out how they are being affected by suicidal behavior, before we prescribe a comprehensive blueprint for change. Those of us interested in of suicide prevention in the workplace have noticed three main areas where workplaces have concerns about suicidal behavior:

1)    After death or a serious attempt has already occurred:  Unfortunately, most workplaces dealing with this issue are doing so in a reactive mode – wondering what warning signs were missed and how best to support their grieving and traumatized staff. To help workplaces in these situations, one goal of the workplace suicide prevention advocates is to provide succinct guidelines on how best to handle the crisis and suggested best practices on how to support bereaved employees.

2)    As they relate to healthcare costs and lost productivity costs: Most for-profit organizations make decisions based on how the choice will impact their bottom line. For this reason, suicide prevention advocates will continue to gather data to make a strong business case for suicide prevention. In other words, we need to demonstrate that engaging in suicide prevention will save the company money.

3)    As they relate to workplace safety: with suicide-homicide cases capturing the attention of employers for decades, much concern exists on how dangerous suicidal people are to others. In order to alleviate this worry, suicide prevention advocates can help link workplaces to policy, protocol and training that allows them to implement “early warning” systems and a process for linking at-risk people quickly to qualified care.

Thus, our general approach is to meet workplaces where they are – crisis support, cost-savings, safety protocol, or whatever other need they have. In order to better serve their needs we need to listen well to their concerns about suicidal behavior as well as their perceived barriers to doing something different. By aligning employers’ goals with the goals of suicide prevention, we will have a much greater chance of successful larger-scale change, as one step can often lead to another.

Contact the Carson J Spencer Foundation for more information about up-coming training on suicide prevention in the workplace and our Working Minds Toolkit (www.WorkingMinds.org).

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[1] Prochaska, James, DiClimente, Carlo, Norcross, John (1993). In search of how people change: Applications to addictive behaviors. Journal of Addictions Nursing, 5(1) 2-16.

[2] Edwards, Ruth, Jumper-Thurman, Pamela, Plested, Barbara, Oetting, E. & Louis, Swanson (2000). Community readiness: Research to practice. Journal of Community Psychology, 28(3), 291-307.

Prescription Drug Abuse at Work

Written by Sally Spencer-Thomas

What is the most concerning substance abuse trend facing workplaces today? Is it meth? Heroin? Cocaine? When we look at who is showing up in our emergency rooms after overdosing and who is showing up at addiction treatment centers, the drugs that are affecting the working aged population most are the drugs we usually get with a prescription.

What is prescription drug abuse? Prescription drug abuse is the non-medical use of prescription medications. Prescription medications are only safe for the prescribed patient, for the prescribed reason, for a prescribed time. After they have been used for their intended purpose, they should be safely discarded, and yet many stockpile and share these potentially deadly and addicting medications, leaving them readily accessible for abusive purposes.

For example, OxyContin, which is essentially the same drug as heroin, is often prescribed for pain relief after major surgery. This toxicity of this medication is perceived quite differently when it comes in a prescription pill bottle from the medicine cabinet, and yet the body doesn’t know the difference between this pill and its illicit cousin heroin. The common perception is that these prescription drugs are safe because they come from a doctor rather than off the street. Yet, the consequences of abuse can be just as deadly.  When we look at national overdose deaths, we find that prescription drug abuse deaths are:[1]

·      Four to five times higher than those of black tar heroin in the 1970s

·      Twice as high as the peak years of crack cocaine in the 1990s

More people are dying each year from prescription drug overdoses than from heroin and cocaine overdoses combined.  In 2005 there were 22,400 prescription drug overdose deaths in the United States versus 17,000 homicides.

 The alarming trend in prescription drug abuse poses a dilemma for doctors. Chronic and severe pain is often best managed with narcotic based medicine until the source of the pain has healed. Very often drug-seeking patients will show up at their primary care clinic complaining of dental or injury pain and will claim they “just need something to get them through the weekend.” Since pain is so subjective, prescribing healthcare providers are often unsure about how to handle such situations and may err on the side of relieving the symptoms the best way they know how.

Sometimes workers who had legitimate pain medication prescriptions find themselves hooked and will “doctor shop” to get additional refills to support their addiction. Other overwhelmed overachievers may turn to prescription drugs for an edge in our highly competitive society. It is not uncommon for Mom or Dad to sneak stimulant pills prescribed for their teen’s Attention Deficit Disorder so that the parent can work longer hours.

The impact of prescription drug abuse on the workplace is evident. Because these pills are usually paid for through insurance, the healthcare costs for workplaces are affected when the drugs are being abused. Performance is impacted when workers are operating under the influence of narcotics, but unlike the abuse of other substances, prescription drug abuse often leaves little evidence: no smell, no paraphernalia, and no visible marks on the skin. Workers can abuse the drugs right at their desks without others noticing.

With all these pills around, the opportunities for intentional and unintentional overdoses increase significantly. Emergency room monitoring shows an upward trend of people experiencing medical crises from these effects.[1] Given these health risks and workplace implications what can employers do?

Like other health issues, the best intervention is early detection. Thus, workplaces can raise awareness by educating employees about the dangers of prescription drug abuse and offer screening to identify those at risk for abuse. Workplaces can help promote events like the Colorado Department of Public Health’s “Take Back” challenges where people can bring in unused prescription medications and dispose of them safely. When writing policies regarding substance abuse, prescription drug abuse should be included. Whatever the approach, workplaces that acknowledge the potential risks of prescription drug abuse will be better able to proactively work to reduce its impact.

Acknowledgement

I would like to thank Beverly Gmerek from Peer Assistance for her leadership in the area of prescription drug abuse prevention and for the information presented at the May 14^th, 2010 Colorado EAPA meeting which was used for the basis of this article.

About the Author

As a psychologist and the survivor of her brother’s suicide, Dr. Sally Spencer-Thomas addresses the issue of suicide prevention, intervention and postvention from many angles.  Currently she is the Executive Director for the Carson J Spencer Foundation (www.CarsonJSpencer.org), a Colorado-based (USA) nonprofit that is dedicated to “sustaining a passion for life” through suicide prevention, social enterprise and support for emerging leaders.” In 2009, the Carson J Spencer Foundation launched the Working Minds Program (www.WorkingMinds.org), a comprehensive suicide prevention initiative for workplaces.  As a professional speaker, she frequently presents keynotes and trainings for workplaces, campuses, and conferences around the world. In addition, she is the Executive Secretary for the National Action Alliance for Suicide Prevention, the public-private partnership advancing the Surgeon General’s National Strategy for Suicide Prevention. Finally, she is the Division Chair for Survivors of Suicide Loss for the American Association of Suicidology.  

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[1] Gmerek, Beverly (2010, May 14). Prescription Drug Abuse. Presentation at the Colorado EAP Meeting. Denver, Colorado

[2] Gmerek, Beverly (2010, May 14). Prescription Drug Abuse. Presentation at the Colorado EAP Meeting. Denver, Colorado

Preparing for the Worst: Protocols for Community Postvention

Postvention is a difficult topic, and like many other topics that make us uncomfortable, we tend to avoid it. We want to believe our prevention and intervention efforts will be successful. But the truth is, sometimes, just like with cancer, we can do all the right things to try to save someone life and death still results. Postvention should be a part of every comprehensive approach, and predetermined protocols could link back to overall goals of prevention.

Like all guidelines, postvention protocols are living documents that help us think through tough situations but are adaptable to specific circumstances. While adopting other community protocols may be tempting, this can be tricky: many cultural sensitivities exist in each community and a one-size-fits-all approach is bound to be less than ideal.

Active Postvention, as developed by Frank Campbell and his LOSS team in Louisiana,  means that the people in charge of the critical aftermath needs are trained and ready to conduct outreach in response to any traumatic event on campus. People are well-versed in standard operating procedures for trauma, especially as it relates to suicide death.

“Community” can be defined in many ways – a school community, a workplace community, a faith community, or a local community.

When developing a postvention policy, stakeholders or coalition members should examine some critical questions:

·      Will the community be notified after a death? How will they be notified? Within what timeframe?

·      What support services will be needed? What support will be active and what should be passive?

·      How will we identify vulnerable individuals who might be prone to copycat?

·      How can we partner with the media and other messaging outlets to help ensure responsible reporting?

·      How can we honor the life of this person without putting others at risk?

·      Who are the first responders and how can we coordinate their efforts? Who is the main point person for this effort?

One of the biggest questions that communities have when developing a protocol for suicide postvention is how to manage memorialization practices. Leaders of these efforts may find themselves immobilized by the fear of copycat suicides on one hand and overwhelmed by the outpouring of grief by the survivors on the other hand. The suicide prevention field currently is in a heated debate over the best way to handle this balance. The most sensible stance I have found is to treat suicide memorials in the same way you treat other traumatic deaths in the community: one bereavement policy regardless of the cause of death. That way, when someone dies we just turn to the policy and say, “This is what we do.” When suicides are treated differently, the death is either marginalized or glamourized. When families of people who die by suicide ask to have a bench erected or a tree planted and then are told they can’t because that would be glorifying the death, they are often shocked and think, “I can’t believe you think I am trying to do that – I just want to remember my son.” With a proactive policy in place, we can just turn to the policy and say, “This is how we treat all deaths here. We don’t establish permanent markers, but rather we do X, Y, and Z to honor the deceased.”

If communities try to suppress the memorialization of people who die by suicide, the plan often backfires. Shutting down channels for grief is a bad idea. A rejecting message goes out, and the bereaved can get very vocal. They will find their own ways to memorialize their friends and family members, and their choices may be much less safe than those supported by knowledgeable suicide prevention folks. Communities often don’t realize the message they are sending when they try to squelch the memorialization efforts of the bereaved. In these circumstances, survivors of loss are likely to feel that their community doesn’t care.

“If you tell people to put their candles out, they will get angry on top of their grief,” says Frank Campbell. “They will find ways to honor their friend and the community just looks embarrassed. I ask community leaders, ‘What would you do after a car accident? Let’s start there.’”

So we have to learn to balance the safety of the community with the needs of the bereaved. This situation is not an either/or proposition. With creative thinking and careful planning, both needs can be met. To do this, several key questions should be explored:

·      What does the family want?

·      Where are the natural support groups in this community? How many social networks have been affected?

·      What is the appropriate timing for a memorial service?

·      What is a good way for the community to express grief and say goodbye that can safely be replicated for many types of death?

·      Who will attend memorialization events from community and what message will it send? Will someone from the our community speak on behalf of the deceased?

Rather than have an individual memorial service for each person who dies, some larger communities hold annual memorial services for all of these at one time. While this may seem like a reasonable idea, I don’t think it will meet the needs of people in the immediate aftermath of their loss. If their friend dies in September, they want to honor her then and not wait until a group service in April. The important thing is to be consistent. Don’t offer memorials for suicide deaths if you don’t offer them for other types of deaths on campus. If you do decide to hold a memorial service, make sure that all people who speak understand the safe messaging guidelines and the reasons why they exist.

Generally speaking, a public and permanent memorial is probably not a good idea. For one thing, it can often become a shrine that ends up inadvertently glorifying the death. Better ideas for memorial practices are to channel the grief towards something life-giving. For example, we can suggest that rather than pile flowers and cards at the deceased’s death site, we can collect pictures of and letters about the person who died to give to the family. We can make a community quilt. We can develop an awareness walk or lecture series in honor of the person’s memory. Or we can start a fund and donate it to a cause that the deceased supported.

                  Community practices for suicide postvention are a critical part of suicide prevention. When done well the bereaved feel supported and are better able to move through their grieving process and the impact of suicide is minimized for all.

Lights in the Darkness and the Symbol of the Star

Just weeks after my brother died in 2004, our family and his friends from across his lifespan started holding conference calls as we brainstormed our vision for the Carson J Spencer Foundation. The calls were as therapeutic as they were productive. While all of those participating loved him, not all of the friends knew each other at the beginning of our planning since they were acquainted with my brother at difference ages and places in his life. As we shared stories and ideas, we came together in our grief and our shared mission.

One of the early tasks of the group was to come up with a logo for the organization. Because Carson was such a prominent business man in Denver, the Rocky Mountain News, one of Denver’s main papers, interviewed several family members for a featured obituary following his death. The article closed with a quote from Carson’s mother-in-law, “he was a star who shone so brightly that he just burned out too quickly."

[Photo courtesy of bm01 via Flickr]

Indeed, my brother was a star in many ways. A shooting star who rose quickly as an entrepreneur in his industry and gained the admiration of many. He also had the ability to light up any room with his charming smile and pee-in-your-pants humor. His spirit was brilliant. And when stars die, their light shines on in the darkness.

One Yale professor once speculated, “…starlight, traveling in space forever, could be interpreted as an expression of immortality….long after stars have ‘died,’ photons of their energy – i.e., their light – continue to exist….It has been said that humans are made of the same stuff as stars – and we share the same energies.” --Schwartz, Garry (2002). The Afterlife Experiments. New York: Simon & Schuster, Inc.

We wanted the Carson J Spencer Foundation to be the light of his legacy, carrying on his goodness and his spirit. Carson’s expressed legacy before he died was to help young emerging entrepreneurs get to college, so we started the Rising Star Scholarship to honor that wish. As we also acknowledged his gift of helping others and our desire to prevent what happened to him from happening to others, we began a number of programs in a social entrepreneurial spirit that are designed to prevent suicide, promote mental health, and assist those bereaved in our community. His light shines on.

The idea of stars in the dark is also the message we are trying to extend to those suffering in silence. Many have told me that being depressed feels like being trapped in a dark place with no way out. Loving, caring people can provide those inspiring points of light in the dark by offering connection and support as they hold the hope for the hopeless. Sometimes, those who are suffering can’t feel the warmth of the glow of these supporters initially, but they can be reassured by their presence and the realization that others care.

For these reasons, we have called our annual gala “Shining Lights of Hope” and we aim to recognize those individuals and organizations in our community who support the work of suicide prevention and provide compassionate assistance to those in pain. Each year we award those who have stood above the others as stars. The “Shining Lights of Hope” award goes to an individual or group that has been bereaved by suicide or who has experienced a mental health crisis and has turned that suffering into a passion to make a difference. The “Shooting Star” award goes to a organization that has selflessly gone out of their way to help our cause. Our “Volunteer of the Year” award celebrates the volunteer who has contributed significantly to moving us forward, and of course, our “Rising Star Scholar” is our chosen high school entrepreneur who receives our scholarship to help with four years of college tuition.

It’s been five years since Carson’s death, and many of us still feel the pain of his loss on a daily basis. We are comforted in part, knowing that we are living in the light of his legacy and that we are bringing forward a galaxy of stars who shine their light in the darkness for others.

…and lights shine on.

Working Minds Contest -- Celebrating Mentally Healthy Workplaces in Colorado

With so much focus on toxic workplaces and the stress of the economy on the employee, the Carson J Spencer Foundation decided to do something a little bit different: focus on the workplaces that are getting it right. While we know many workplaces are suffering under intense pressure resulting in bullying, depression, and dissatisfaction among the ranks, other workplaces have found ways to not only survive this rough spot, but to help their staff thrive. In recognition of this, the Carson J Spencer Foundation is hosting a contest to acknowledge mentally healthy workplaces, application due date is July 22, 2010.

Criteria:

• Must be a Colorado workplace (nonprofit, for-profit or governmental)
• Innovative and effective approaches that promote mental health at work
• New and creative methods
• Positive outcomes

Contest Guidelines: Submit 500-word essay that answers the question: How is mental health promoted at your workplace? What do you do and how do you know that the strategies are effective (case studies and statistics are both welcome as evidence)? Consider the following questions:

• How do you educate your workforce about mental health as part of overall wellness?
• What are the practices and policies that minimize distress at work?
• How does the workplace support those who are experiencing mental illness, trauma or bereavement?
• How does the workplace promotes a sense of purpose and belonging?

Awards:
First, second and third place awards given. Recognition at our Shining Lights of Hope Benefit Auction Evening on August 28th at LeMay Auto Museum. Awards include: complementary seats at our event, one year membership to the Working Mind Network, a free Working Minds Toolkit and training, and recognition as a "mentally healthy workplace" in local media outlets and on the Working Minds website.

Applications:
Applications should be sent electronically to Sally Spencer-Thomas: Sally@CarsonJSpencer.org. For more information or to get an application call 720-244-6535.









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Working Minds: Gaining Momentum for Suicide Prevention in the Workplace

“The workplace is the last crucible of sustained human contact for many of the 30,000 people who kill themselves each year in the U.S. A co-worker’s suicide has a deep, disturbing impact on work mates. For managers, such tragedies pose challenges no one covered in management school.”

Shellenbarger – Wall Street Journal

In the suicide prevention field a gap exists: the majority of people who die by suicide are men of working age, and yet very little prevention work is targeting this demographic. While 85% of middle managers believe part of their responsibility is to identify and help employees with depression, only 18% of those managers had received training that would prepare them to do so. Since we noticed this gap, the Carson J Spencer Foundation has been on a mission, and in 2010 our vision is quickly gaining momentum.

When we formed the Carson J Spencer Foundation in 2005, our goals were two-fold, to honor the life of the man who was the foundation’s namesake and to help prevent others from going through the unimaginable mental anguish he faced as he battled a mental illness that ultimately proved fatal. When we spent 18 months or so examining the needs of the field and our unique position to fulfill them, we discovered a much-needed niche to be filled: suicide prevention in the workplace. We then spent the next couple of years developing the “Working Minds” program – a multifaceted suicide prevention program for employers. And now, as we face our 5th year anniversary, the program is gaining momentum at every turn.

The goals of the Working Minds program are three-fold:

1. to increase awareness that suicide is a public health issue that is preventable and that workplaces have a responsibility to respond and a vested interest in prevention and mental health promotion
2. to increase skills related to suicide prevention, intervention and postvention in the workplace
3. to offer models of recovery at the individual level and mental health promotion at the organizational level

The program components include an interactive website (www.WorkingMinds.org), a toolkit for managers, and a network of organizations that are focused on promoting mental health at work. The Working Minds Toolkit, a cornerstone of the program, offers employers an off-the-shelf curriculum to begin to change the conversation workplaces are having about mental health and suicide. The toolkit, published in November 2009, is available on Amazon and through the Working Minds website.

In 2010, we continue to see the momentum for the Working Minds Program build:

• The Anschutz Family Foundation funds the Working Minds Program implementation among organizations that serve homeless populations.
• Mountain States Employer’s Council, the go-to organization for HR training in the Rocky Mountain Region, agrees to offer Working Minds training to its members.
• The Working Minds Toolkit is accepted to the Best Practice Registry after being reviewed by national experts who determine that it adheres to standards of care
• Presentations are made at the Navy’s Suicide Prevention Conference and other national and regional conferences touching leaders in the military, risk management and suicide prevention fields.

With the increasing strain of economic hardship and the challenges of reintegrating returning military from active combat into a civilian workforce, mental health concerns will continue to confront employers in many ways. The Working Minds Toolkit helps give them skills to proactively address these problems rather than just react to them.


How is your company promoting mental health and preventing suicide?

Suicide Prevention in Colorado – Together We Are Better

Suicide Prevention in Colorado – Together We Are Better


When suicide makes the news, many of us cringe because the coverage – often sensationalized and overly simplistic – can increase the risk that vulnerable people may act on suicidal thoughts as a result.

Today was different.

Today was a milestone day for the suicide prevention movement in Colorado – our story made the front page of the Denver Post’s Sunday edition, complete with pictures and graphs that demonstrated both the deep need in our state and the exceptional efforts being made to save lives.

Like many of the Rocky Mountain states, Colorado’s suicide rate continues to be high despite the dedicated efforts of many suicide prevention organizations. Kevin Simpson, the Denver Post reporter, spent more than a month collecting information for this article. In this article he highlights the fact that while many are fighting this war against suicide, our resources are continually stripped, making this challenging work even more difficult. By interviewing so many of us who consider ourselves foot soldiers in this battle, he did another important thing – he helped to show how our field is becoming united in our efforts.

As competition for scarce resources increases the risk for internal conflict, suicide prevention groups in Colorado are finding creative ways to collaborate because we know that “together we are better.”

In many ways, Colorado is seen as a leading state in the effort of suicide prevention. Thanks to pioneers like Deanna Rice and others who testified before the state legislature in the 1990s and helped create our Office of Suicide Prevention, we became one of the first states to have an official state strategy for suicide prevention. Other pioneers like LaRita Archibald (founder of HEARTBEAT support groups) and Vivian Epstein (founder of Parents Surviving Suicide) started support groups for families bereaved by suicide long before most people realized the unique challenges of suicide grief. Hotline support has evolved through the steadfast dedication of Eleanor Hamm and others out of our crisis center for decades. And of course, there is the far-reaching work of the Emme family and the Yellow Ribbon Suicide Prevention Program, whose message lets youth know that “it’s okay to ask for help.”

More recently, we have seen the explosion of the incredibly effective work of Jeff Lamontagne and The Second Wind Fund, who are helping uninsured and underinsured youth at-risk for suicide link to qualified help. Sheila Linwood in Mesa County, Ronna Autrey in Routt County, Dana Lindsay in Larimer County, Nancy Harris in Otero County, Susan Marine in Boulder County and many more – are all finding ways to learn from each other to save lives in Colorado.

"Long's Peak from North, Rocky Mountain National Park," Colorado.

From: U.S. National Archives’ Local Identifier: 79-AA-M16

Photographer: Adams, Ansel, 1902-1984

The reorganization of the Suicide Prevention Coalition of Colorado is another piece of evidence of our pulling together. Knowing that our rural communities need as much (perhaps even more) support than the Denver metro efforts, we now use audio and video conferencing technology to engage communities statewide. When we have better knowledge of the strengths of each organization we are much less likely to duplicate efforts.

The 3rd annual Bridging the Divide Suicide Awareness and Prevention Summit (May 20 & 21, 2010 at Colorado State University) is still another example of successful collaboration. For this conference, clinicians, researchers, advocates and those impacted by suicide share knowledge and resources.

The impact of suicide often remains hidden to the world. The fact that we have such few resources to deal with this profound public health tragedy is a moral outrage. Kevin’s article helped shed some light on the deep need in our state and the potential for a different future.

Help those in a position of creating change pay attention – spread the word.

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Please take a moment to thank Kevin for his coverage by writing him a note: ksimpson@denverpost.com.

To join the Suicide Prevention Coalition of Colorado – CLICK HERE

To register for the “Bridging the Divide Suicide Prevention Summit” – CLICK HERE