Dear _______:
It has been some time since you were here at the hospital, and we hope things are going well for you. If you wish to drop us a note we would be glad to hear from you.
What would happen if that simple letter was mailed on a regular basis—say, every few months—to people who had been hospitalized for depression or suicidality and had declined mental healthcare following discharge? Would this letter—in generic type, somewhat personalized—change anything? Would it decrease the likelihood that the recipient of the letter would die from suicide? Or would this intervention simply be a waste of time, trees, and money? Is the note potentially therapeutic, or is it a piece of junk mail?
The data—from a randomized, controlled study—suggests that people who received these modest notes have a statistically significant reduction in suicide rates for at least two years compared to people who do not receive these letters!
Let me emphasize that point: People are less likely to die from suicide if they receive occasional well-wishing letters from mental health providers. I’d like to think that this means the recipients are less likely to attempt suicide as a result of receiving these letters, but that is not a conclusion we can confidently state from the data.
I know I still think about many of the patients I have met in the past. Have I written them any letters? Nope. Heck, how often do I send notes to my friends through the postal mail to say hello? Not very often.
Why is it so difficult for us to show we care?
19 Jul 2007 |
What a simple concept. Connection makes a difference. I know that some of our clients who see the doctor only every 12 weeks for a “med review” feel the need to call me (the social worker) much more frequently, just to “check in”. They often have no need of my services, only my ears. They just like knowing that someone is on the other end of the line who cares.
Comment by donnalee | 20 Jul 2007 @ 5:29am
This is cynical of me, perhaps, but wouldn’t there need to be a billing code?
Comment by Bardiac | 20 Jul 2007 @ 6:15am
They might be less likely to kill themselves if they received similar letters or even face-to-face visits from their own family members.
My guess is that one could find an analogous situation if one also did this with people with COPD, or diabetes, or heart disease.
Indeed, one could probably find a similar effect as Al-Anon if it were staffed and run by health professionals. But obviously there’s nothing magical about health professionals doing it, which means it’s a task that can be done as well and more efficiently by nonprofessionals.
Comment by Greg P | 20 Jul 2007 @ 10:17am
Good God. I’d be highly affronted by receiving such a letter, and even *less* inclined to trust the institutional senders thereof than I already am. What an intrusion.
Comment by Baba Yaga | 20 Jul 2007 @ 4:51pm
Depends on how its done.
(ahem)
Dear Maria:
We here at Amalgamated MedsNBeds are hoping you are well. Remember all the time you spent here with us, working on getting better? Well, its up to you now to keep it up, and we hope you will.
Sincerely,
Your Pals at AMB
or
Dear Maria:
We hope you’re well. Remember, we’re always here if you need us… even if all you want to do is chat.
Sincerely,
Your Pals at AMB, Fourth Floor
Which is better?
Comment by bill | 20 Jul 2007 @ 5:47pm
Baba Yaga — I agree that it could be intrusive and obnoxious, however beautifully phrased, depending on my feelings about who sent it. For me, psychiatric hospitalization itself was traumatic, and I have no warm fuzzy feelings for the doctor who administered trice-weekly ECT to me. If it came addressed from him, it would just bring up anger and bad memories.
Comment by LadyGrey | 20 Jul 2007 @ 7:53pm
I don’t know. I find it somewhat inappropriate, almost reductive, to homogenize a group of patients who suffer from depression by sending out generic letters to them. Of course I’m not a psychiatrist but isn’t it true that even with depression, individual personalities still exert a living influence over sufferers and, while some, or maybe even a majority, may be positively affected by the initiative, there may be a proportion who takes umbrage at such corporate gestures. I guess what I’m saying is that while the idea on paper sounds revolutionary, implementing it may not be as straightforward as we would like and in some cases a more personal approach may be necessary.
But the idea is great. I hope someone follows through on it.
Comment by karrvakarela | 20 Jul 2007 @ 7:53pm
I don’t know about getting a letter like that…maybe it would help, maybe it wouldn’t.
For Greg P…Perhaps some people would be less likely to kill themselves after receiving a letter or face-to-face visit from family members…and many would be more likely.
Comment by Fallen Angels | 20 Jul 2007 @ 7:53pm
Here’s an analogous thing — what do you do when you happen to see someone out in public you have cared for or a family member? I think it’s important to acknowledge that person, say hi, maybe even exchange a few words if they start a brief conversation. Usually they don’t mention anything medical, other than maybe telling the person they’re with that you are/were their doctor. But they seem very appreciative for the acknowledgment, something like a validation of them as a person, not just a patient/client/customer.
Oddly, there are many doctors I know, not necessarily closely, but see them frequently at the hospital, who don’t even seem to acknowledge my existence when I see them in public. I doubt they have any sense of how that makes them appear in my eyes, perhaps they don’t care, which is exactly what I’m thinking — here is a doctor who doesn’t care.
Comment by Greg P | 21 Jul 2007 @ 6:42am
In response to Greg P’s comment:
We are taught as mental health professionals that for confidentialities sake we are to essentially ignore our clients. I did this for the most part while practicing as a social worker.
Now as a much more enlightened mental health consumer I see that this is an ignorant stance to take. I never did run into any of my personal mental health providers while I worked as one so I did not know how insulting it is to be ignored.
I finally was very rudely ignored by my psychiatrist. After that incident I told him that I wished to be acknowledged in the future and that it was humiliating to wave to him only to see him turn his head. I have since told all my providers that I wish to be acknowledged and (now that I live in a small community) I’ve run into both my therapist and psychiatrist since I’ve told them this. We’ve had very pleasant exchanges that appeared to be comfortable for all of us.
My suggestion to mental health providers at this point is to have a conversation with every single one of your patients about how they would like to be treated if encountered in public. Some people very well may prefer being ignored and that should certainly be respected exactly for the reason we are taught to do so. Patient confidentiality is important. However, most clients don’t know of this policy and even if they do, as I did, will find their care providers ignoring them offensive.
Comment by Gianna | 22 Jul 2007 @ 1:07pm