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 can be well taken care of in the moment, but studies show that the early days and weeks after their discharge is the most dangerous time for those with suicidal ideation.
Sanford Health 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 highly correlated with a sense of loneliness and isolation,” said Jeff Leichter, Ph.D., lead administrator for behavioral health integration at Sanford Health. “It’s sometimes called a ‘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 that people recognize as being generated by a caring person. It matters.”
Dr. Leichter explained that the idea for Caring Contacts stretches back almost 50 years, when the first caring letters were sent out to Vietnam veterans who had been treated for suicidal thoughts or had made attempts on their own lives. The letters don’t ask for anything, not a phone call or a request for any follow-up. They are simply sent with a message of care and thoughtfulness.
“The messages are encouraging and supportive, and when you think about receiving mail, that’s something we don’t really get anymore,” said Larissa Marsh, an integrated health therapist and licensed clinical social worker at Sanford Health in Fargo, North Dakota. “The goal and the theory is that simply by receiving the cards, people will feel more socially connected and in turn have less suicidality.”
Marsh handwrites the letters for the program in Fargo. She has followed up with 19 patients as part of the pilot, sending letters to high-risk patients who have agreed to take part. The first card is sent two to three days after they leave Sanford. Additional letters are sent at regular intervals for one full year. So far the results have been incredibly encouraging.
“We’re using a social connectedness scale, and people’s scores are going up, up, up,” said Marsh. “And a lot of the feedback has been positive.”
She then went through a few of the patient responses, which read:
- “This is wonderful. I love them.”
- “The cards really do brighten my day.”
- “When I go to the mailbox and see the cards, things get better.”
- “I’ve saved them all, and go back and read them.”
- “I feel a lot better than I did six months ago.”
Arlene Wilken works with Marsh and Dr. Leichter to craft the messages that are sent to the patients in Fargo. But unlike her colleagues in the pilot program, she has a background that is not a clinical one. She has a personal connection with 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 for Mark, “the 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 hobbies. He just kept spiraling down and down,” she said.
She encouraged her husband to seek counseling, but said that “wasn’t 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 of him,” said Arlene. “He was in such a deep hole that he didn’t know how to climb out. He didn’t know how to help himself.”
Arlene has now thrown herself into suicide prevention, helping people she doesn’t know and often has never met. For the Caring Contacts program, she is adamant that each letter have the right message.
“It can’t be flippant. It can’t be lighthearted. It needs to come from the heart without seeming insincere and gushy. It’s a bold statement to say, ‘You’re worth it. We care. We’re here for you,’” she said.
And it’s the feedback that she receives that lets her know the program is making a difference.
“People locked into themselves don’t usually come forward and say positive things,” said Arlene. “But when you hear people saying, ‘This makes a difference, I appreciate your card,’ I believe it certainly does. It gives me pride.”
For the people working on this project in its early stages, there is universal agreement: Their time is well spent, the cost and effort involved is minimal, and the benefits to the patients are clear.
“This isn’t a treatment all by itself, but it’s a very simple way to supplement that care they’re receiving,” said Dr. Leichter. “We’re looking at the comments we’ve gotten from patients who’ve been involved, and some of them are quite moving.”
“It personalizes care. To me it feels like an extension of it. You have an appointment and it can feel very sterile,” said Marsh. “I don’t want to oversimplify it, but this shows that you’re 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 final 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 later:
“You are every bit worth who you are. You’re needed and you’re valued, whether or not you see it. There are so many people that love you and want you around and you have so much to offer,” said Arlene. “Hold on one more day. And if that day isn’t better, the next day after that will be. Life is worth living.”
Whether you’re struggling with suicidal thoughts yourself, or love someone who is, get help now by contacting any of the following:
- SAMHSA National Helpline: (800) 662-HELP (4357)
- Suicide & Crisis Lifeline: 988 or (800) 273-TALK (8255)
- Crisis Text Line: Text HOME to 741741
- SAMHSA Disaster Distress Helpline: (800) 985-5990
Visit sanfordhealth.org to find resources, risk factors, warning signs and steps you can take to help a loved one.
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