Suicide prevention is a complex and difficult problem for health care systems to address. If a patient is admitted to a hospital or behavioral health clinic, they may be well cared for for the time being, but studies show that the first few days and weeks after discharge are the most dangerous time for those with suicidal ideation.
Sanford Health launched a pilot program, called Care Contacts, which is designed to help patients after they leave the building. The idea is surprisingly simple: send a handwritten letter to each patient to let them know they matter.
The idea behind care contacts
“We know that suicide is strongly associated with feelings of loneliness and isolation,” said Jeff Leichter, Ph.D., chief administrator for 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 reach out in a human-to-human way, not a form letter, not an email, that’s something people recognize as being created by a caring person. It matters.”
Dr. Leichter explained that the idea for Care Contacts stretches back almost 50 years, when the first care letters were sent to Vietnam veterans who had been treated for suicidal thoughts or had attempted to take their own lives. The letters do not require anything, not even a phone call or request for any follow-up. They are simply sent with a message of care and caution.
“The messages are encouraging and supportive, and when you think about getting the mail, that’s something we don’t really get anymore,” said Larissa Marsh, an integrative health therapist and licensed clinical social worker at Sanford Health in Fargo, North Dakota. “The goal and the theory is that just by getting the cards, people will feel more socially connected and in turn will be less suicidal.”
Marsh writes the letters for the program in Fargo. She followed 19 patients as part of the pilot, sending letters to high-risk patients who agreed to participate. The first card is sent two to three days after they leave Sanford. Additional letters are sent at regular intervals for a full year. So far the results have been very encouraging.
“We’re using a social connection scale and people’s scores are going up, up, up,” Marsh said. “And a lot of the feedback has been positive.”
She then went through some of the patient’s responses, which read:
- “This is great. I love them.”
- “Cards really brighten my day.”
- “When I go to the mailbox and see the cards, things get better.”
- “I saved them all, and 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 create messages that are sent to patients in Fargo. But unlike her colleagues in the pilot program, she has a background that is not clinical. She has a personal connection to suicide.
Her husband, Mark Wilken, suffered from severe bouts of depression. Twenty years ago he stopped working after his employer closed its doors. He was 44, and Arlene said of Mark, “time just dragged on.”
“He lost a lot of self-respect and self-esteem. He lost where he was going. He lost interest in his hobby. It just kept rolling down and down,” she said.
She encouraged her husband to seek counseling, but said it was “not something he was ready, willing or comfortable doing.”
In 2014, at the age of 56, Mark took his own life.
“There’s not a day that goes by that I don’t think about it,” Arlene said. “He was in such a deep hole that he didn’t know how to get out. He didn’t know how to help himself.”
Arlene is now involved in suicide prevention, helping people she doesn’t know and often has never met. For the Caring Contacts program, she is convinced that every letter has the right message.
“It cannot be in vain. It can’t be easy. It should come from the heart without coming across as insincere and cocky. It’s a bold statement to say, ‘It’s worth it. We care. We are here for you,” she said.
And it’s the feedback she gets that lets her know the program is making a difference.
“Introverted people usually don’t come forward and say positive things,” Arlene said. “But when you hear people say, ‘It makes a difference, I appreciate your card,’ I believe it certainly does. It makes me proud.”
Positive results
For people working on this project in its early stages, there is universal agreement: their time is well spent, the cost and effort involved are minimal, and the benefits to patients are clear.
“This is not a treatment in itself, but it is a very simple way to supplement the care they are receiving,” said Dr. Leichter. “We’re looking at the feedback we’ve received from patients who have been involved, and some of it is quite exciting.”
“It personalizes care. To me it feels like an extension of her. You have a meeting and it can feel very sterile,” Marsh said. “I don’t want to oversimplify it, but it shows that you are more than a patient. Your life matters, even when you walk out the door. We care when you’re here and we care when you’re not here.”
For Arlene Wilken, the last word comes as easily as writing a letter. It’s what she would say to anyone struggling with suicidal thoughts. And what she still wants to say to her husband Mark all these years:
“You deserve everyone who you are. You are needed and valued, 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,” said Arlene. “Wait one more day. And if that day isn’t better, tomorrow will be. Life is worth living.”
If you are struggling with suicidal thoughts yourself, or you love someone who is, get help now by contacting any of the following:
Visit sanfordhealth.org to find resources, risk factors, warning signs, and steps you can take to help a loved one.
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Behavioral health, Fargo
