Putting Dignity First in Mental Health

Written and Reposted with permission by Guest Blogger: EDUARDO VEGA

Putting Dignity First

dignityandrecoverycenter.org

Many variables affect people in their ability to recover from mental illness and manage mental health conditions.  There is not one program, service, support or medication that will work for all, or that will work for many for an extended period of time. Intuitively we know this to be true, although many are still driven by the dream of a ‘silver bullet’, a perfect medication or treatment, or even an ideal array of services that could perfectly match all our communities needs.

We do not know if science will progress to the level of a ‘cure’ or prevention for mental illness— if it is even possible to so radically alter the biogenetic vulnerability factors that predispose some to mental illness as to significantly reduce its prevalence in the world.

We do not know if we can ever be free of the impacts of trauma, stigma, abuse, discrimination, poverty, and violence and all that they contribute to the manifestation of psychiatric symptoms in our communities, and the barriers they represent to recovery.

We do know a few things. We know that some things almost always make a difference to people living with mental health challenges. We know that hope is the greatest fuel for recovery, that without it the best services and supports in the world are futile. We know that people can accomplish almost anything with enough hope, and can achieve almost nothing without it.

But we have not talked enough about dignity in mental health. About its role in connection to recovery and resilience, about its centrality in the nexus of relationships that links every one of us to each other. About dignity as a human right that should be foremost in all our interactions with all people. Or about the many myriad of ways in which systems, public media and individual attitudes work to diminish the dignity of people affected by mental illnesses every day.

Some people grow up with a sense of purpose, with agency and confidence—perhaps because it was inculcated in them by great parents or their culture or faith. Some seem to gain dignity by association with status, position, class or wealth, which perhaps is false in some ways.

Some of us had to learn about dignity from others. Seeing it in their eyes or their actions when faced with insult and adversity.

I learned about dignity from friends struggling to put a few months of sobriety together, from hundreds of people who were homeless, from more than a few newly released convicts, and from the many I’ve known who continue to face down the pain, shame and stigma of mental illness to retain regain whole and meaningful lives.

I also learned about how people seek out dignity, and how they avoid its opposite at a profound and almost reflexive level. How the indignity that went along with things I was ‘giving’ to people ‘in need’ could more detrimental than I anything I could positively ‘provide.’ I learned from people who were in more desperate circumstances than I could ever imagine that honoring their personal dignity was much more important than ‘providing’ them a service.

You don’t have to spend time in a inpatient psychiatric ward to have a sense of how often one’s dignity can be undermined in services. But a few snapshots can help—

·                    You called for help because you were desperate and felt like dying and couldn’t be safe. When help came they pointed guns at you, put you in handcuffs, took you away in the back of the police car while all your neighbors watched.

·                   Perhaps you came in voluntarily, feeling completely anguished or out of control, then a few days later you find your status had been ‘switched’ to involuntary and that the papers you signed meant you had given up your rights to refuse medications you didn’t like.

·                   You’re in your room where there in no privacy from your roommate—multiple times of day staff, nurses, sometimes even students come in unannounced, begin asking you questions, often the same questions you’d already answered several times. 

·                    You go to “art group” in which the art activity consists of large nubby crayons and children’s coloring books even though its is an adult/geriatric ward and the average age is over fifty.

·                    You ask for a pen or pencil so you can write in your journal and are told you can only use them while someone watches you at the nurse’s station— and that they are too busy to do so.

·                    You find that your privileges for phone calls or cigarette breaks were removed because you failed to attend enough ‘groups’

·                    You ask where the policy for restoring privileges is and are informed that this is a ‘staff decision made at rounds’.

·                   You tell your prescriber about the debilitating side effects of the medications your taking. In response she rolls her eyes, saying ‘you’ll get used it’ or ‘nobody has all of those’.

Stigma? -yes. Discrimination? yes— but to most people these things that happen every day are just plain insults to a dignity they may be already struggling to maintain.

If we put Dignity First all these things things that drive people into despair, that magnify the fear shame and self-doubt that so often accompany mental illness, all these can be wiped away.

So people won’t seek death by suicide or painful isolation as more dignified than supports for their recovery.

When we put Dignity First we approach people as deserving and seeking more from us than ‘care’ or services. We recognize people are challenging us to respect them first and then to bolster their opportunities to respect themselves. By listening and engaging with the intention to understand what that would require, we challenge our assumptions and the power relationships inherent in health care that work against people’s dignity. And that, as a result, drive many people away. Putting Dignity First we understand that recovery needs to include recovering from the indignities that they’ve suffered as a result of their symptoms, their situations and the messages they’ve received from others and their society about what it means to have a mental health condition.

In putting Dignity First we know that honesty, hope and sincerity are our best resources for engaging people who so often have lost their dignity. We help by offering resources, skills and services that people want to use, rather than ‘providing’ them with the services we have and rejecting them if those do not fit.

Putting Dignity First is not just a crucial step towards systems in which recovery is realized, it is the mind-set, the approach we must take in relating to individuals with mental health conditions, and in reforming our world into one in which all people live in communities that truly support recovery and mental health for all.

The Paradox of Traumatic Grief

Take the light, and darken everything around me
Call the clouds and listen closely, I'm lost without you
Call your name every day when I feel so helpless
I'm fallin' down but I'll rise above this, rise above this

~“Rise Above This,” Seether

The lead singer for the rock band Seether wrote those lyrics in the aftermath of his brother’s suicide. The video for the song depicts what many people feel upon hearing the news that their loved one has died.  A mother, a father, a sister – all going about their normal daily lives -- are suddenly blown completely off their feet by an unseen force. 

The course of a complicated bereavement, like the process that often follows suicide, usually does not follow the straightforward path outlined by Elizabeth Kubler-Ross so many decades ago, but rather twists and turns and circles back on itself through mazes of denial, sadness, anger, shame, blame, and multiple physical reactions.  Several authors have described an “oscillating process” in complicated bereavement – a moving back and forth between loss-orientation and restoration orientation^[1], between growth and depreciation^[2]. In this oscillating process survivors of suicide loss can move closer to some people and further away from others. They may simultaneously experience increased symptoms of distress and feelings of adaptation as these states appear to be independent dimensions.

As survivors of suicide loss learn to adjust to the empty chair and redefine life without the physical presence of their loved ones, they can feel like they have lost a part of themselves.  Not everyone is debilitated by this loss, however, and the bereaved often fall into one of three clusters:

1. Quick recovery.  Those who recover quickly without assistance and can return to functioning as before.  Some of these people are not distressed because they had only superficial contact with the deceased, while others are often internalizing and suppressing pain, anger or guilt.  In the latter case, maladaptive strategies of coping may emerge such as substance abuse or other compulsive behaviors.
2. Modest support needed.  Most people who were functioning well before the suicide need only a modest level of support for anywhere from a month to a couple of years.  This level of support might include outpatient therapy or support groups.
3. Psychiatric disability. Some people may develop a mental disorder, such as post-traumatic stress disorder or depression, in reaction to the trauma and loss and may require extended or intensive treatment.

For the first couple of years after my brother Carson’s death, I moved in and out of these three states. Sometimes I would feel like I was functioning well, other days I would get through with a call to a friend or a visit to a support group, and some days I would be so consumed with the sadness of what had happened that I would benefit from periods of counseling.

In the aftermath of an unexpected death, especially suicide, traumatic grief is a common reaction.  When this occurs both trauma and grief reactions are experienced together, and elements of this combined level of psychological distress are often debilitating and complex. 

A number of circumstances about a suicide death may influence traumatic grief reactions^[3]:

• Suddenness or lack of anticipation.  The unexpected death offers no opportunity for goodbyes, unfinished business, resolution of conflict, or answers to questions.  Very often the bereaved are left with endless “whys” and “what ifs.”  When loved ones die from a prolonged illness, by contrast, we have time to prepare ourselves for their absence.
• Violence, mutilation, and destruction.  Deaths that involve suffering or extreme pain may cause horrifying traumatic imagery and intrusive thoughts – whether or not the bereaved actually witnessed the death or the body. If the death occurred in a familiar or personal space of the bereaved, that space will most likely continue to trigger traumatic reactions.
• Preventability or randomness of death. The randomness of such a loss can trigger a greater sense of vulnerability and anxiety. This is often the case when there were no apparent warning signs before the person died.
• Multiple deaths (bereavement overload) or multiple losses. In addition to the primary loss of the person, secondary losses may include loss of an income, loss of a home, or loss of all things familiar.  The resulting disorganization can strain the family and social system.
• Contact with first responders or the media. Sometimes the reactions of first responders – who need to rule out homicide in every suicide case – can increase confusion and distress among those bereaved. If the events surrounding the death were newsworthy, the bereaved may also be dealing with the intrusion of the media.

Trauma reactions and grief work are often at odds with each other. On one hand, the trauma experience leads to continual intrusion of the death event.  That is, survivors of suicide loss can’t stop thinking about the death scene (even when they are dreaming), and disturbing images may flash before the mind’s eye when they least expect it. The horror can be overwhelming and the natural impulse is to stay away from anything that reminds them of the trauma.  Sometimes survivors develop post-traumatic stress disorder (PTSD) in the aftermath of a violent or unexpected death. 

When I first started reading about trauma as a graduate student in the 1990s, I was moved by Ronnie Janoff-Bulman’s book Shattered Assumptions.^[4] Her basic premise is that traumatic events shatter three world views that all people tend to hold:

·         Benevolence of the world – people are generally good

·         Meaningfulness of the world – good things happen to good people

·         Self-worth – I am good and can keep myself and those who love me safe and healthy.

All three of these assumptions are usually deeply challenged, if not shattered, after a suicide death. The traumatic responses of re-experiencing intrusive thoughts through flashbacks and ruminations are the mind’s way of rebuilding new world views about the self and the world. When Randy and I were in Hawaii just months after Carson’s death, we were hiking along the Napali Coast – one of the most beautiful places on Earth – and I could not stop ruminating about the horror of my brother’s suicide. I remember saying to Randy, “In the last hour, I have imagined Carson’s final moments at least 40 times and have only thought of our children once. What is wrong with me?”

On the other hand, the grief experience works in phases as survivors of suicide loss come to accept the reality of the loss, and the tendency is to move toward things that remind them of the deceased. The intense sadness can feel like it will never go away; and I like to reframe this grief reaction as honoring our loved one. Kahlil Gibran once said, “When you are sorrowful look again in your heart, and you shall see that in truth you are weeping for that which has been your delight.” 

The alternating cycle of horror and loving memories, of avoiding and embracing things related to the loved one, makes traumatic grief complicated.  Not everyone is incapacitated, however, and many find unexpected twists in the journey can lead them to “rise above it” and integrate their experience into a deeper understanding of themselves, their purpose, and their world.

For more information on getting support in the aftermath of a suicide death, please visit: http://www.suicidology.org/suicide-survivors/suicide-loss-survivors

About the Author

Sally Spencer-Thomas, Psy.D., is CEO and co-founder of the Carson J Spencer Foundation, a Colorado-based nonprofit established after the suicide of her brother. The foundation is known for “sustaining a passion for life” by developing innovative and effective approaches to suicide prevention among working aged people, coaching youth social entrepreneurs to be the next generation of suicide prevention advocates, and supporting people bereaved by suicide. www.CarsonJSpencer.org

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[1] Stroebe, Margaret & Schut, Henk (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197-224.

[2] Baker, Jennifer, Kelly, Caroline, Calhoun, Lawrence, Cann, Arnie & Tedeschi, Richard (2008). An examination of posttraumatic growth and posttraumatic depreciation: Two exploratory studies. Journal of Loss and Trauma, 13, 450-465.

[3] Ambrose, J. T (n.d.) Traumatic grief: What we need to know as trauma responders. Retrieved October 30, 2005 from http://wwwctsn-rcst.ca/Traumaticgrief.html

[4] Jannoff-Bulman, R. (1992). Shattered Assumptions: Towards a New Psychology of Trauma. New York: Free Press.

Five Things Employers Need to Know about Workplace Mental Health and Suicide

Here is the bad news…

1.       Depression is a top driver of health care costs to employers.[1] [2] Depression represents employers' highest per capita medical spending (per-capita annual cost of depression is significantly more than that of hypertension or back problems, and comparable to that of diabetes or heart disease. People with depression also have more sick days than people suffering from other conditions)[3].

2.       If we take a snapshot of any workplace at any given point in time, at least one in five people will have a diagnosable mental health condition.[4] The most common among these are mood disorders like depression or substance abuse disorders like alcohol abuse.

3.       The majority of people who die by suicide are working aged people. While other groups’ suicide rates are holding steady or decreasing, the rates for men and women in the middle years has increased significantly over the last decade.

Here is the good news…

4.       Everyone on a workplace plays a role in mental health promotion and suicide prevention. By engaging in simple preventative steps (e.g., stress management, depression screenings, etc.) anyone can help maintain their own mental health and by learning practical tactics (e.g., becoming suicide prevention gatekeepers, referring coworkers to employee assistance services, etc.) employees help promote the mental health and safety of others.[5] [6]

5.       A comprehensive and evidence-based approach to suicide prevention and mental health promotion exists,[7] is cost-effective[8] and gives employers a clear guide on what to do. By being “visible, vocal and visionary” leaders, employers can set the expectation that a culture of health and safety is a priority and that mental health promotion and suicide prevention are a critical part of that priority.

For more information: www.WorkingMinds.org

About the author:

Sally Spencer-Thomas, Psy.D., is CEO and co-founder of the Carson J Spencer Foundation, a Colorado-based nonprofit established in 2005 after the suicide of her brother. The foundation is known for “sustaining a passion for living” through innovation in suicide prevention. Working Minds, a program of the Carson J Spencer Foundation, focuses on helping workplaces build capacity to promote mental health and prevent suicide. www.CarsonJSpencer.org.

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[1] Mental Health America (n.d.) Depression in the Workplace. Retrieved from http://www.mentalhealthamerica.net/index.cfm?objectid=C7DF951E-1372-4D20-C88B7DC5A2AE586D

[2] Witters, D. (2013, July 24). Depression Costs U.S. Workplaces $23 Billion in Absenteeism. Retrieved from http://www.gallup.com/poll/163619/depression-costs-workplaces-billion-absenteeism.aspx.

[3] Managed Care Magazine (2006, Spring) Depression in the Workplace Cost Employers Billions Each Year: Employers Take Lead in Fighting Depression. Retrieved from http://www.managedcaremag.com/sites/default/files/supplements/0603_depression_in_workplace/DepressionInWorkplace_Spr2006.pdf.

[4] Gray, T. (2004) ValueOptions Articles - Managers. Retrieved from http://www.valueoptions.com/suicide_prev/html%20pages/Mental%20Illness%20and%20the%20Workplace%20Lifting%20the%20Stigma.htm

[5] Paul, R. & Spencer-Thomas, S. (2012). Changing Workplace Culture to End the Suicide

Standstill. National Council Magazine. (2), 126-127.

[6] Spencer-Thomas, S. (2012). Developing a workplace suicide prevention program. Journal of

Employee Assistance, 42(1), 12-15.

[7] National Action Alliance for Suicide Prevention (2013) Comprehensive Blueprint for Workplace Suicide Prevention. Retrieved from http://actionallianceforsuicideprevention.org/task-force/workplace/cspp

[8] National Institute of Mental Health (2007, September) Workplace Depression Screening, Outreach and Enhanced Treatment Improves Productivity, Lowers Employer Costs. Retrieved from http://www.nimh.nih.gov/news/science-news/2007/workplace-depression-screening-outreach-and-enhanced-treatment-improves-productivity-lowers-employer-costs.shtml

COLLABORATIVE EFFORT PRODUCES MANAGER’S GUIDE TO HELP WORKPLACES WITH THE AFTERMATH OF SUICIDE

See guide at: http://carsonjspencer.org/ManagersGuidebook.pdf

Denver, CO – In the U.S., the majority of people who take their lives are working-aged people, and yet workplaces are often unprepared to deal with this crisis. Today the American Association of Suicidology (AAS) and the National Action Alliance for Suicide Prevention (Action Alliance) announce the launch of a collaborative publication, in partnership with Crisis Care Network (CCN), and the Carson J Spencer Foundation entitled A Manager’s Guide to Suicide Postvention in the Workplace: 10 Action Steps for Dealing with the Aftermath of Suicide.

For every suicide death, an estimated minimum of six people are affected, resulting in approximately six million American “survivors of suicide” in the last 25 years. The creation of the guide came as a logical step for the collaborators. “The demographics of suicide inform us that the working-age individual, in particular working-age male, is most at risk for suicide,” explained Dr. Alan Berman, Executive Director for the AAS. “A sizeable proportion of these deaths by suicide occur on the worksite, or otherwise affect the worksite, pointing to an increased need for postvention in the working population. These guidelines are most important for systems of employment, in the worst case possibility that such a tragedy occurs.”

The guide provides clear steps for postvention, giving leadership a sense of how to immediately respond to the traumatic event, have a plan in the short-term for recovery, and consider long-term strategies for helping employees cope down the line. Dr. Sally Spencer-Thomas, CEO & Co-Founder of the Carson J Spencer Foundation, explained: “We collaborated to create succinct procedures with checklists and flow charts to be a go-to guide for people dealing with the crisis of suicide. Our goal is to help to reduce the impact of the suicide event by offering a blueprint to handling these challenging situations. The guidebook allows for immediate access to clear steps to take for moving forward, and helps workplaces plan to move from a solely reactive position on these issues into policy development and trainings.”

“In many postvention responses we saw business leaders forced to operate well outside of their training and expertise, grappling with unanswered and unanswerable questions,” said Bob VandePol, President of CCN. “When there is a death by suicide, all eyes turn to leadership and people take their cues based upon how leadership responds. It’s also true that people under the influence of traumatic stress look to leadership and make assumptions about their own personal worth within the company, so there is tremendous power in a calm, compassionate presence by management during this time.”

The collaborators worked to create a set of guidelines that are useful across varied types of workplaces, and they expect a range of individuals within these organizations and companies to find the information immediately helpful. “This guide can be useful to managers at all levels–from the CEO of a large business to a front-line supervisor of a small organization,” asserted Action Alliance Executive Secretary, Dr. David Litts. The Action Alliance played a key role in bringing these groups together to develop this resource.

To download your own copy of these guidelines and to review others, please go to http://carsonjspencer.org/ManagersGuidebook.pdf.

American Association of Suicidology

Founded in 1968, AAS is a membership organization for all those involved in suicide prevention and intervention, or touched by suicide. AAS leads the advancement of scientific and programmatic efforts in suicide prevention through research, education and training, the development of standards and resources, and survivor support services.

Contact: Alan L. Berman, PhD, ABPP, Executive Director, 202-237-2280, berman@suicidology.org

National Action Alliance for Suicide Prevention

The National Action Alliance for Suicide Prevention, a public-private coalition, works to advance the National Strategy for Suicide Prevention by championing suicide prevention as a national priority, catalyzing efforts to implement high priority objectives of the National Strategy, and cultivating the resources needed to sustain progress. Launched in 2010 by Health and Human Services Secretary Kathleen Sebelius and former Defense Secretary Robert Gates, the Action Alliance envisions a nation free from the tragic event of suicide. For more information, see www.actionallianceforsuicideprevention.org.

Contact: Katie Deal, Deputy Secretary, 202-572-3722, kdeal@edc.org

The Carson J Spencer Foundation (www.CarsonJSpencer.org) is a Colorado nonprofit, established in 2005. We envision a world where leaders and communities are committed to sustaining a passion for living. We sustain a passion for living by

·         Delivering innovative and effective suicide prevention programs for working-aged   people.

·         Coaching young leaders to develop social enterprises for mental health promotion and suicide prevention.

·         Supporting people bereaved by suicide.

Contact: Sally Spencer-Thomas, PsyD, CEO & Co-Founder, 720-244-6535, sally@carsonjspencer.org

Crisis Care Network

Founded in 1997, Crisis Care Network (CCN) is the EAP industry’s premier provider of Critical Incident Response for the workplace. CCN helps individuals and organizations return to work, life, and productivity following critical incidents. We mitigate the human and financial costs of workplace tragedy such as workers' compensation claims, low morale, employee attrition, and litigation. CCN has established the nation's largest network of master’s- and doctoral-level clinicians trained as Critical Incident Response Specialists, responding more than 1,000 times per month to workplace incidents for EAP’s, insurers, and employers in communities throughout the United States and Canada.

Contact: Judy Beahan, MSW, Clinical Manager, 888-736-0911, Judy.Beahan@crisiscare.com

How Mentally Healthy is Your Workplace?

photo credit: Nelson Webb @Flickr

By Sally Spencer Thomas, Psy.D

It’s not an easy topic to discuss. Suicide, that is. There is a lot of fear based on misperceptions about it. While pamphlets can disseminate information, they are usually not effective enough to shift attitudes or prompt discussion or even help people.  The fact is, the majority of people who die by suicide are working-aged people, and yet most of the suicide prevention efforts target youth. By training workplaces to be better able to identify people at risk, early in the progression of a mental health disorder, more people will get help.

Employers and managers are leaders who can champion a mentally resilient and thriving workplace. They do this by understanding that mental health issues are like other health issues and advocate for promoting protective factors, minimizing risk factors and giving access to quality care. When people are in crisis, these leaders can offer guidance on how to navigate the balance of workplace functioning and individual well-being.

How do you get there?

A great place to start is to take the online assessment.  Part organizational review and part environmental scan, the questionnaire is designed to get workplaces thinking about the many ways they could promote mental health in the workplace. The assessment is helpful, but it is really just the foundation, and one page from the Suicide Prevention Toolkit, which is a Working Minds Program and part of the Carson J. Spencer Foundation.  But the results from the questionnaire will help set the stage for the workshop that follows.

Utilizing the Suicide Prevention Toolkit, employee assistant or human resources personnel, will be able to lead between 25-35 people through the program. The program is practical, user-friendly and seen as highly effective tool for suicide prevention education in the workplace. . One of the main teaching tools is the DVD, which creates a forum for dialogue and critical thinking about workplace mental health challenges. Designed to be implemented over the lunch hour or as a half-day session, the workshop opens the lines of communication and lets employees learn and practice new skills, including help-seeking and help-giving skills.   

Just the employer is encouraged to take the organizational assessment; there is research that supports the use of anonymous online screenings for employees. Through WorkplaceResponse, a program of Screening for Mental Health, employers have a unique opportunity to offer a customized online screening tool that will let employees determine if their symptoms are characteristic of various mood and anxiety disorders and alcohol problems. 

Both programs are about preventing crises through a proactive approach. Both programs are low cost, high impact approaches that empower workplaces to help their vulnerable employees move from distress to coping, communicating that the workplace cares about the well-being of their workers, not just their immediate performance. Both programs have the potential benefit beyond the workplace. In other words, the skills/information acquired in these programs can be applied to family members, neighbors and more. This positions the workplace as responsible corporate citizen and this holistic approach can increase morale.

Click here to take the employer assessment. 

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