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Handwritten notes show results in preventing suicide

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Suicide prevention is a complex and challenging problem that health care systems must address. If a patient is admitted to a hospital or behavioral health clinic, they can be well looked after for the time being, but studies show that the first days and weeks after they are discharged from the hospital are the most dangerous times for those who have suicidal thoughts.

Sanford Health has launched a pilot program called Caring Contacts, which is designed to help patients after they leave the building. The idea is surprisingly simple: send a handwritten letter to each patient informing them of its importance.

The idea behind care communications

“We know that suicide is closely related to feelings of loneliness and isolation,” said Jeff Lechter, PhD, principal officer of behavioral health integration at Sanford Health. “It’s sometimes called the ‘death of despair’ because people at their worst moments often feel like no one cares.”

“When we communicate in a person-to-person way, not a form letter, not an email, it’s something people realize was created by someone interested. It doesn’t matter.”

Dr. Lichter explained that the idea of ​​”care communications” goes back nearly 50 years, when the first letters of care were sent to Vietnam veterans who were being treated for suicidal thoughts or attempted suicide. Messages are not asking for anything, not a phone call or asking for any follow-up. They are simply sent with a message of care and thought.

“The messages are encouraging and supportive, and when you consider receiving mail, it’s something we don’t get anymore,” said Larissa Marsh, an integrative therapist and licensed clinical social worker at Sanford Health in Fargo, North Dakota. “The goal and theory is that once the cards are received, people will feel more socially connected and therefore will have less suicidal propensity.”

Marsh writes program messages by hand in Fargo. It followed 19 patients as part of the pilot, and sent letters to high-risk patients who agreed to participate. The first card is sent two to three days after they leave Sanford. Additional messages are sent at regular intervals for an entire year. So far the results have been incredibly encouraging.

“We use the social connectedness scale, and people’s scores go up, and they go up, and they go up,” Marsh said. “And a lot of the feedback was positive.”

Then she underwent some patient responses, which read:

  • “That’s cool. I love them.”
  • “The cards really light up my day.”
  • “When I go to the mailbox and see the cards, things get better.”
  • “I saved them all, go back and read them.”
  • “I feel much better than I did six months ago.”

Arlene’s story

Arlene Wilken works with Marsh and Dr. Leichter to craft messages that are sent to patients in Fargo. But unlike her pilot program colleagues, she has a non-clinical background. She has a personal relationship to suicide.

Her husband, Mark Wilkin, suffered severe depressive episodes. Twenty years ago he stopped working after his employer closed his doors. He was 44, and Arlene said to Mark, “It’s just time.”

“He lost a lot of self-respect and self-esteem. He lost where he was going. He lost interest in his hobbies. He just kept spinning down and down,” she said.

She encouraged her husband to seek advice, but said it was “not something he was willing, willing or comfortable to do.”

In 2014, at the age of 56, Mark committed suicide.

“Not a day goes by that I don’t think about it,” Arlene said. “He was in a hole so deep that he didn’t know how to climb it. He didn’t know how to help himself.”

Arlene has now thrown herself into suicide prevention, to help people she doesn’t know and whom she doesn’t often meet. For Caring Contacts, they are adamant that every letter contains the correct message.

It can’t be nonsense. It can’t be playful. It has to come from the heart without sounding insincere and flowing. It’s a bold statement to say, ‘You deserve it. We care. We’re here for you,’ she said.

And it’s the feedback she receives that lets her know that the software is making a difference.

“People who are locked in themselves don’t usually come forward and say positive things,” Arlene said. “But when you hear people say, ‘This makes a difference, I appreciate your card,’ I think it definitely does. It gives me pride.”

Positive results

For the people working on this early stage project, there is universal agreement: their time is well spent, the cost and effort is minimal, and the benefits to patients are clear.

“This is not a treatment per se, but it is a very simple way to supplement the care they are receiving,” Dr. Lichter said. “We’re looking at the feedback we got from patients who participated, and some of them are quite moving.”

“It personalizes the care. To me it feels like an extension of it. You have an appointment and can feel very infertile,” Marsh said. “I don’t want to oversimplify it, but it shows that you are more than just a patient. Your life matters, even when you walk out the door. We care while you’re here and we care when you’re not here.”

For Arlene Wilken, the last word comes as easy as writing a letter. This is what you would say to anyone experiencing suicidal thoughts. And she still wanted to tell her husband Mark all these years after that:

“You deserve everything who you are. You are needed and appreciated, whether you see it or not. There are so many people who love you and want you around and you have so much to offer,” Arlene said. “Wait another day. And if that day wasn’t better, the next day after that. Life is worth living.”

Whether you’re experiencing suicidal thoughts yourself, or are in love with someone, get help now by calling any of the following:

Visit to find resources, risk factors, warning signs, and steps you can take to help your loved one.

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Published in Behavioral Health, Fargo