Handwritten notes show results in suicide prevention

Suicide prevention is a complex and difficult problem for health systems to solve. If a patient is admitted to a hospital or behavioral health clinic, they may be well taken care of in the moment, but studies show that the first days and weeks after discharge are the most dangerous times for those with 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 to let them know they matter.

Idea behind Caring Contacts

“We know that suicide is strongly correlated with feelings of loneliness and isolation,” said Jeff Leichter, Ph.D., senior administrator for behavioral health integration at Sanford Health. “It’s sometimes called a ‘death of despair’ because people in their worst moments often feel like nobody cares.”

“When we reach out from person to person, not a form letter, not an email, it’s something that people recognize as being generated by a caring person. It matters.”

Dr. Leichter explained that the idea of ​​Caring Contacts dates back almost 50 years, when the first caring letters were sent to Vietnam veterans who had been treated for suicidal thoughts or had attempted suicide. The letters don’t ask for anything, not a phone call or a follow-up request. They are simply sent with a message of care and consideration.

“The messages are uplifting and encouraging, and when you think about getting mail, it’s something we don’t really get anymore,” said Larissa Marsh, integrated health therapist and licensed clinical social worker at Sanford Health in Fargo, in North Dakota. “The goal and theory is that simply by receiving the cards, people will feel more socially connected and have less suicidality.”

Marsh handwrites the letters from the program to Fargo. She followed 19 patients in the pilot project, 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. The results so far have been incredibly encouraging.

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

She then went through some of the patient responses, which read:

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

Arlene’s story

Arlene Wilken works with Marsh and Dr. Leichter to craft the messages that are sent to Fargo patients. But unlike her colleagues in the pilot program, her training is not clinical. She has a personal connection to suicide.

Her husband, Mark Wilken, suffered from severe bouts of depression. Twenty years ago, he quit working after his employer closed down. He was 44, and Arlene said of Mark, “time just dragged on.”

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

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

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

“Not a day goes by that I don’t think of him,” 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 has now taken up suicide prevention, helping people she doesn’t know and often has never met. For the Caring Contacts program, she wants every letter to contain the right message.

“It can’t be flippant. It can’t be light. It must come from the heart without appearing hypocritical and gushing. It’s a bold statement to say, “You are worth it. We care. We are here for you,” she said.

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

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

Positive results

For those 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.

“It’s not a treatment per se, but it’s a very simple way to complement the care they’re getting,” Dr. Leichter said. “We are reviewing the feedback we have received from patients who have been involved, and some of it is quite emotional.”

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

For Arlene Wilken, the last word comes as easily as writing a letter. That’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 later:

“You are worth everything you are. You are needed and you are appreciated, whether you see it or not. There are so many people who love you and want you and you have so much to offer,” Arlene said. “Wait one more day. And if that day isn’t better, the day after tomorrow will be. Life is worth living.”

Whether you are struggling with suicidal thoughts yourself or love someone who is, get help now by contacting one 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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Posted in Behavioral Health, Fargo, Here for All. Here for good.