As a Primary Care Provider and Dad who lost his youngest son to suicide, I know the value of helping a person examine their life and feelings and make adjustments in relationships and circumstance. These are the “Determinants of Health (Quality of Life).” Folks, screening works, but only if we DO SOMETHING with the information! Screening for depression and then determining the person is not at risk for actively trying to kill themselves that night DOES NOTHING! You have to put an intervention in place and then stay with the person until their circumstance improves, or you’ve done nothing. The reason many of my former colleagues continue to believe screening, by itself, should be continued, is “cognitive dissonance.” We aren’t willing, able, to put resources behind practicing true Primary Care Prevention, but we will screen and then say “We are trying to help and doing something.” My son answered “Yes” to all the screening questions, was put on anti-depressant meds without proper close follow-up and caring, personal, intervention, and died ten days later. To say this means “screening doesn’t work” is simply not accurate. It means we do not listen to the person and appropriately respond to the data with meaningful short and long-term intervention. Period.
Stephen,
I hear you and agree with the multiple comments made in this blog that what ‘we’ have been doing to supposedly help folks with their (mental) health care have not been working, and in fact, have been, too often, detrimental. Glad you were helped by these two people. Compassion and seeking to understand is what’s needed. I encourage all to go back and read my comment above. I get it. The medical community needs to listen and provide person-centered health care delivery to and for the person we have pledged to serve, and include whoever they consider “family” to assist allow us to help others achieve their life’s objectives, rather than what we think they need.
Oldhead,
Yes, it is about our society, and culture, and attitude(s). A ‘healthy’ society would not ostracize and alienate those struggling with thoughts of being a burden or discriminate against them because they are in pain, whether physical or mental. We will never get to the solution (or vaccine) for this if we keep saying “you just can’t stop some people from killing themselves.” Actually, we can. Our society must change, and its citizens must begin to value and clamor for health. The sub-populations of our society where it has happened have been led by local medical and community leaders who establish compassionate health teams basing services on a person-centered, family-driven way to achieve ‘zero-suicides.’ (The current term for this is “Patient-Centered Medical Home” or PCMH.) These clinics and communities, ‘cultures,’ have arrived at zero-suicides against all odds (see The Henry Ford Health System in Detroit who went 6 quarters without a single suicide once they decided it was possible and focused their approach to what the ‘client’ wanted and needed, not what they were currently able to provide). When our citizens recognize this is possible and start clamoring for more providers and clinics like these, we will begin to do something about suicide as an all-too-common event in our society. When we value the ostracized “guru” as legitimate health care delivers, not pie-in-the-sky outliers, we will begin to address these issues. There are many of us out here, but you are right, not enough. (Note: Just because a clinic puts up a shingle saying “Patient-Centered” doesn’t mean they are…most are still driven by the productivity business office outcomes rather than health.)
Sorry you had this response from your “friends” (or lack of a response – depends how you look at it). As a distraught Primary Care Doctor and Patient-Person Advocate I want to apologize for our broken medical system and the abuse you were subjected to, as well. I sincerely hope, over time, you have developed healthy relationships with true friends and maybe even a trusted healthcare provider who knows they work for you, not the other way around. Glad to hear you got things ironed out and are still with us, contributing to the discussion, Julie.
Rachel, I DO know where the vaccine should be given – it’s with our Community Primary Care system. As a Pediatrician for 30 years and Family-Person Advocate my entire life, it seems, as well as a suicide loss survivor (my son at 20 yo), I am convinced everyone needs, and deserves, to have access to a primary care provider they trust to bring up all issues of health – physical, emotional, and ideally, spiritual. This provider needs to be trained in mental health issues, especially suicidal ideation and depression. The work-up and possible treatment plan is not the end of this concern, but the beginning, and the plan should ALWAYS include “family.” Every person should sign an ‘informed consent release of information” form with their primary care team listing who their trusted “family-friends” are to call if they should not be able to make life-sustaining decisions for themselves. (We were not called when our son make it known to an acute care clinician he was suicidal.) The time to discuss this is on first meeting when the person is hopeful they can BE healthy, in mind and body, NOT when in crisis and pain. Our current approach excludes families out of some displaced fear that healthcare needs to be ‘protected’ and ‘private.’ As mentioned in this blog, health results from belonging and being able to participate and contribute to society. Let’s fix our ‘sick-care’ system and give a ‘shot’ to rebuild a “Health Care System!” I’ve already been given the ‘vaccine’ by losing my son, and too many others, to suicide. I’m on board. When do we meet, where, people?
Musing over whether ADHD is a bona-fide DSM condition, genetic or environmental in origin, misses the point. There are people whose distractibility, impulsivity, and inattention, interfere with the ability to learn. (Hyperactivity is less of a concern, being more a problem for the teacher than the child.) The truth is these people don’t fit into our current hyper-productivity culture, which can’t/won’t adapt to the learner. It is a real condition impacting current and future success in their world. We should put our energies into helping the child, and adult, to understand their behaviors and learning styles rather than insisting the condition doesn’t exist. Cognitive Behavioral (Developmental) Therapy, with or without assistance of medication for more difficult cases, is needed. If we don’t “call it what it is,” we won’t do what’s needed to help the child become a successful adult understanding what makes them unique, with special skills they can call on to succeed in the future.
All providers of mental health services, and that includes Primary Care, need to establish an “air of acceptance and safety.” That “trust does not come easily. It has to be earned and tested…. the path always leads back to one’s Authentic Being. Love is the sustenance, and authenticity is the fountain of our aliveness.” Absolutely. And what’s missing in our sick-care system of care in the USA is a lack of continuity and integration of primary care with behavioral health. The client should be encouraged to trust the team, who collaborate to form a safety net around them, when they are sinking into depression, until we can give them back their voice and ability to navigate the world on their own again. To make this happen, we must being trusting each other, rather than operate within our ‘silos’ to protect our incomes. Do you teach this concept at Harvard, Dr. Berezin? I suspect we are soul-mates and would make a great team by being Patient-centered and Family-focused.
As a Primary Care Provider and Dad who lost his youngest son to suicide, I know the value of helping a person examine their life and feelings and make adjustments in relationships and circumstance. These are the “Determinants of Health (Quality of Life).” Folks, screening works, but only if we DO SOMETHING with the information! Screening for depression and then determining the person is not at risk for actively trying to kill themselves that night DOES NOTHING! You have to put an intervention in place and then stay with the person until their circumstance improves, or you’ve done nothing. The reason many of my former colleagues continue to believe screening, by itself, should be continued, is “cognitive dissonance.” We aren’t willing, able, to put resources behind practicing true Primary Care Prevention, but we will screen and then say “We are trying to help and doing something.” My son answered “Yes” to all the screening questions, was put on anti-depressant meds without proper close follow-up and caring, personal, intervention, and died ten days later. To say this means “screening doesn’t work” is simply not accurate. It means we do not listen to the person and appropriately respond to the data with meaningful short and long-term intervention. Period.
Stephen,
I hear you and agree with the multiple comments made in this blog that what ‘we’ have been doing to supposedly help folks with their (mental) health care have not been working, and in fact, have been, too often, detrimental. Glad you were helped by these two people. Compassion and seeking to understand is what’s needed. I encourage all to go back and read my comment above. I get it. The medical community needs to listen and provide person-centered health care delivery to and for the person we have pledged to serve, and include whoever they consider “family” to assist allow us to help others achieve their life’s objectives, rather than what we think they need.
Oldhead,
Yes, it is about our society, and culture, and attitude(s). A ‘healthy’ society would not ostracize and alienate those struggling with thoughts of being a burden or discriminate against them because they are in pain, whether physical or mental. We will never get to the solution (or vaccine) for this if we keep saying “you just can’t stop some people from killing themselves.” Actually, we can. Our society must change, and its citizens must begin to value and clamor for health. The sub-populations of our society where it has happened have been led by local medical and community leaders who establish compassionate health teams basing services on a person-centered, family-driven way to achieve ‘zero-suicides.’ (The current term for this is “Patient-Centered Medical Home” or PCMH.) These clinics and communities, ‘cultures,’ have arrived at zero-suicides against all odds (see The Henry Ford Health System in Detroit who went 6 quarters without a single suicide once they decided it was possible and focused their approach to what the ‘client’ wanted and needed, not what they were currently able to provide). When our citizens recognize this is possible and start clamoring for more providers and clinics like these, we will begin to do something about suicide as an all-too-common event in our society. When we value the ostracized “guru” as legitimate health care delivers, not pie-in-the-sky outliers, we will begin to address these issues. There are many of us out here, but you are right, not enough. (Note: Just because a clinic puts up a shingle saying “Patient-Centered” doesn’t mean they are…most are still driven by the productivity business office outcomes rather than health.)
Sorry you had this response from your “friends” (or lack of a response – depends how you look at it). As a distraught Primary Care Doctor and Patient-Person Advocate I want to apologize for our broken medical system and the abuse you were subjected to, as well. I sincerely hope, over time, you have developed healthy relationships with true friends and maybe even a trusted healthcare provider who knows they work for you, not the other way around. Glad to hear you got things ironed out and are still with us, contributing to the discussion, Julie.
Rachel, I DO know where the vaccine should be given – it’s with our Community Primary Care system. As a Pediatrician for 30 years and Family-Person Advocate my entire life, it seems, as well as a suicide loss survivor (my son at 20 yo), I am convinced everyone needs, and deserves, to have access to a primary care provider they trust to bring up all issues of health – physical, emotional, and ideally, spiritual. This provider needs to be trained in mental health issues, especially suicidal ideation and depression. The work-up and possible treatment plan is not the end of this concern, but the beginning, and the plan should ALWAYS include “family.” Every person should sign an ‘informed consent release of information” form with their primary care team listing who their trusted “family-friends” are to call if they should not be able to make life-sustaining decisions for themselves. (We were not called when our son make it known to an acute care clinician he was suicidal.) The time to discuss this is on first meeting when the person is hopeful they can BE healthy, in mind and body, NOT when in crisis and pain. Our current approach excludes families out of some displaced fear that healthcare needs to be ‘protected’ and ‘private.’ As mentioned in this blog, health results from belonging and being able to participate and contribute to society. Let’s fix our ‘sick-care’ system and give a ‘shot’ to rebuild a “Health Care System!” I’ve already been given the ‘vaccine’ by losing my son, and too many others, to suicide. I’m on board. When do we meet, where, people?
Musing over whether ADHD is a bona-fide DSM condition, genetic or environmental in origin, misses the point. There are people whose distractibility, impulsivity, and inattention, interfere with the ability to learn. (Hyperactivity is less of a concern, being more a problem for the teacher than the child.) The truth is these people don’t fit into our current hyper-productivity culture, which can’t/won’t adapt to the learner. It is a real condition impacting current and future success in their world. We should put our energies into helping the child, and adult, to understand their behaviors and learning styles rather than insisting the condition doesn’t exist. Cognitive Behavioral (Developmental) Therapy, with or without assistance of medication for more difficult cases, is needed. If we don’t “call it what it is,” we won’t do what’s needed to help the child become a successful adult understanding what makes them unique, with special skills they can call on to succeed in the future.
All providers of mental health services, and that includes Primary Care, need to establish an “air of acceptance and safety.” That “trust does not come easily. It has to be earned and tested…. the path always leads back to one’s Authentic Being. Love is the sustenance, and authenticity is the fountain of our aliveness.” Absolutely. And what’s missing in our sick-care system of care in the USA is a lack of continuity and integration of primary care with behavioral health. The client should be encouraged to trust the team, who collaborate to form a safety net around them, when they are sinking into depression, until we can give them back their voice and ability to navigate the world on their own again. To make this happen, we must being trusting each other, rather than operate within our ‘silos’ to protect our incomes. Do you teach this concept at Harvard, Dr. Berezin? I suspect we are soul-mates and would make a great team by being Patient-centered and Family-focused.