Right by You

Dear friends -

It's been a busy fall and I'm finally getting to a place where I'm ready to take the time to write to you again. In the next few weeks I would like to tell you about the Canadian Association for Suicide Prevention conference last October, about Andrew's and my experience hosting a Survivors of Suicide event on November 23, the networking connections we've made, and about the work our Washington friends at Forefront are doing.

In the moment, though, I want to forward you an appeal for action by Partners for Mental Health, a new organization that is taking a very active role in advocating for much-needed strides forward in mental health care and suicide prevention. Please see their president Jeff Moat's email below.

Lynn


From: Partners for Mental Health
Date: December 10, 2013 11:05:54 AM PST
Subject: Your action is needed now

Right By You - Partners for Mental Health

Dear Lynn,

We’ve come to a crucial point in our Right By You campaign in support of greater funding for youth mental health and suicide prevention.

Action is needed now. Every day, we lose 2 young Canadians to suicide. Almost 90% of people who die by suicide have a mental illness, yet the majority of children and youth – 3 out of 4 – who have a mental health problem or illness won’t get the treatment they need. And the average wait time before children with diagnosed mental health issues receive treatment is 12 months. This is unacceptable, and we need to work together to fix this.

In order to drive real change, we must show the government that this is an issue that matters to all Canadians. Local politicians need to hear directly from the people they represent – people like you.

It’s time to raise our voices with government. And we’ve got the tools and resources to easily help you get started.

First, sign the Right By You petition to show your support.

Then, contact your local politician using our toolkit to further amplify your voice and put pressure on our elected officials to act.

Specifically, we are calling on:

Federal government – to create a $100 million national suicide prevention fund.

Provincial and territorial governments – to provide access to mental health services, treatment and support to all children and youth when they need it, no matter their ability to pay.

These changes can happen but we need your help today.


Thank you,
Jeff Moat
President, Partners for Mental Health

Psychological Safety in the Workplace

Dear friends -

After Cliff died, I was furious at the leaders and managers at his workplace for the role I perceive them to have played in his death. Because I had worked for the same organization and with many of the same people, I had my own experience and perspective of what he was dealing with.

Cliff's experience

The extreme anxiety and major depression that took Cliff's life were precipitated and aggravated by events in his workplace. The anxiety began after he learned that his employer's contract for IT services would not be renewed by BC Hydro, which put his job in jeopardy. Other aspects of the situation added to the stress and pressure:

• Management of Cliff's team had changed frequently, especially in the past two years. The current manager seemed inexperienced, awkward, and unaware of his impact on the team. He was focused on pleasing his superiors rather than taking care of his employees. Some of the decisions he made and the way those were implemented caused Cliff to feel ostracized, scrutinized, or embarrassed, and Cliff did not trust him.
  
• Contract workers from India, paid at a much lower rate, had been brought to B.C. to do work closely related to that of Cliff's team. The employer made no attempt to educate the Canadian team members about working cross-culturally, and there were many communication challenges. The use of contract workers was perceived by Cliff and some of his colleagues as a threat to their employment.
• Some team members were already leaving to work for other employers, meaning the team was losing knowledge, skill, resources, and established relationships. This increased pressure on the remaining team members.
• Cliff's team was responsible for maintaining the integrity of an enterprise IT system, SAP, through which all of BC Hydro's customer, human resources, and financial information is managed. Despite the team being under-resourced and dealing with news about the impending end of the contract, they were still required to take on a project to integrate customer payments into SAP -- further increasing the profile and risk of the system, and the pressure on the team. The suicide attempt that led to Cliff's hospitalization in December occurred immediately after he finished work on this project.

Strategy #3: Psychological safety in the workplace

There were other factors that made Cliff vulnerable to these events -- just as there are factors that heighten people's risk of cancer, broken bones, and other illnesses and injuries. That doesn't negate the effect that workplaces have on people's lives, or the responsibility that we each have as employers, managers, and workers to take reasonable steps to promote the physical and psychological safety of our employees, our colleagues, and ourselves.

Risk stimulates us, challenges us, makes life more interesting. Workplace safety isn't about eliminating risk or not engaging in risky activities; it's about recognizing risk and taking appropriate precautions so that at the end of the day workers return home with their health and safety uncompromised. In North America, we've been protecting worker's physical safety for years. Only now are we recognizing we also need to attend to workers' psychological safety.

Initial steps towards regulating psychological safety

Last June, British Columbia passed Bill 14, legislation that expands eligibility for compensable psychological workplace injuries. (Because mental stress and injury due to management behaviours and decisions are explicitly excluded from coverage, someone in Cliff's position would still not be eligible for compensation.) This legislation paves the way for Workers' Compensation Boards and other provincial health and safety regulators to begin playing a role in developing and enforcing psychological safety regulations.

An important factor in that will be defining the standards which employers are required to meet. This month, the Canadian Standards Association is certifying a new voluntary standard for psychological health and safety in the workplace.

Neither Bill 14 nor the voluntary standard for psychological health and safety are yet enough to prevent deaths like Cliff's, but they are significant changes in how we hold ourselves responsible for workplace mental health. Mental illness and injury are not just individual weaknesses or problems, they are societal, cultural, and economic issues that affect more of us than we may believe; that really do debilitate people and threaten their lives; and that are often caused, triggered, or worsened by outside events.

Where I'm at with this

While I still believe Cliff's workplace conditions played a pivotal role in his death, I haven't found a way to influence significant change in this area. I tried to meet and talk with managers and leaders in Cliffs organization soon after his death, and met with resistance, fearfulness, and stonewalling. The most positive thing I was able to achieve was a brief email exchange with his immediate manager, who refused to meet in person. With the end of the contract with BC Hydro, that area of the organization is folding up shop. Many of the things Cliff was afraid would happen in that process have happened.

On a much more positive side, people like Martin Shain, founder of Neighbour at Work; Great West Life, commissioners of Guarding Minds at Work; and Bill Wilkerson, co-founder and CEO of the Global Business and Economic Roundtable on Addiction and Mental Health have already been doing impressive work in this area for many years, work that is paying off in new standards and changes in legislation.

Psychological workplace safety remains a concern for me. For now I am putting my efforts into other areas where change seems possible and much needed.

Family Involvement in Patient Care

Dear friends -

I really appreciate your responses to the initial update I sent last week. From the comments and from re-reading it myself, I realize there's more to say about Strategy #1 before I move to the next one.

First, there was a request for clarification of the recommendations we had for the hospital and doctors.

Referrals for someone who has accompanied a person to hospital because of a suicide attempt
Most of us know little about suicide assessment and intervention, yet need that information when someone close to us is suicidal. When someone is admitted to hospital due to suicidal behaviour or risk, there is an opportunity to provide education and support to the person or people accompanying them. In my experience and the experience of others with whom I've spoken, this opportunity has been missed.

The practice of referring accompanying people to agencies that specialize in suicide prevention and counselling services, such as SAFER, could strengthen the network of care for people at risk. The vast majority of counselors and mental health professionals in B.C. have little or no training in suicide assessment and intervention, and are therefore unable to provide effective support in that area to either the person who is suicidal or the people who love them. (More on that in a future update.)

Provision of basic information to visitors taking a patient out on a pass
Patients in the psychiatric unit are permitted to leave the hospital for progressively longer periods of time, provided they are with a visitor. This implies that the visitor has some responsibility for the patient, yet visitors receive no information on what to do or where to call if something goes wrong. Providing visitors with phone numbers for the hospital ward, mental health police unit, and 911 would at least give them a range of resources to call on if concerns arise.

Assessing opportunities for family involvement in patient care
At Vancouver General Hospital (VGH), where Cliff was a patient, spouses and family members are not invited to participate in meetings with the treating physician, social worker, community mental health worker, or other professionals involved in the care of a suicidal patient. In contrast, family members of patients with diabetes are encouraged to attend appointments and are invited to participate in Diabetes School with the patient. VGH purports to promote family involvement in patient care, yet in the case of suicidal patients this involvement rarely if ever happens. We recommend that treating physicians regularly assess the opportunity to involve, educate, and consult with family members.

If a suicidal patient opposes the involvement of a family member when it is apparent that there is a supportive and loving relationship, this should be taken as cause for concern and inform decisions such as whether the patient is well enough to be discharged.

Family involvement in discharge and transition
I am still shocked at how informal Cliff's discharge process was when later we learned that only the day before he had been assessed by a community mental health worker as highly suicidal. I have since heard of similarly casual discharges for patients who died shortly after. Although patients who have been hospitalized due to suicide risk are at high risk of dying within 48 hours after discharge, there are no provisions for informing family members that a patient is about to be discharged; for discharging the patient into anyone's care; for informing that person of the heightened risk following discharge; for involving family members in safety or transition plans; or for providing the person into whose care the patient is discharged with any information about the patient's risk assessment, what to watch for, or what to do if there are any concerns. Family members of patients at risk of a heart attack or stroke are much more likely to get that type of information and support.

My last email takes an optimistic tone that may belie my anger, frustration and distrust. We've tried to take a non-litigious and collaborative approach to generating change within the hospital system. Although the doctors have been receptive, the response to date hasn't convinced us that this approach will be effective. It may be time to re-examine other avenues.

I welcome your responses, experiences, and suggestions.