The Care Stack Layer 3: Acute Care
As more companies take action to support the mental health of their employees, HR and benefits leaders are doing what they can to cover services like virtual therapy and wellness practices, but what happens when an employee experiences an extreme mental health crisis at work? These events will require more immediate action and support by team leaders, managers, and coworkers.
At Mentera’s recent Care Stack Summit, panelists presented perspectives on a range of mental health programs available to employers. Day three of the summit covered the subject of how to support an individual in an acute mental health crisis. Panelist Kelly Clarke, Assistant Vice President, 988 Network Engagement at Vibrant Emotional Health, discussed the history, vision, and promising results from the launch of the national 988 Suicide & Crisis Lifeline this past July. She summarized two key takeaways from her work with this national network of crisis responders that employers can apply to acute mental health crises in the workplace:
- All employees have a role to play when it comes to addressing a mental health crisis of a coworker.
- Educational resources are available to equip both employers and coworkers with basic skills to assist an employee in crisis.
Suicide On the Rise
Acute mental health crises were on the rise even before the onset of the COVID pandemic. According to the CDC, between 2000 and 2018 the suicide rate in the US rose 36%. The same CDC report also states that in 2020, 12.2 million adults seriously thought about suicide and that nearly 46,000 died by suicide.
Clarke explains that although the number of deaths is concerning, these statistics tell a story that has a positive lesson. While 46,000 is the number that often catches attention in the press, the fact that 12.2 million people survived suicidal ideation points to the powerful role others can play to help individuals experiencing a crisis.
“What we don’t hear are stories of resilience, stories of hope, of individuals with that lived experience being able to share what it was that was helpful for them to move through those feelings, what it was like for them to be able to access care and support.”
The 988 Lifeline is a continuation of the National Suicide Prevention Lifeline, which was started in 2005. The line connects callers to local crisis centers based on the area code they call from. There are currently over 200 local crisis centers in the network. The network has been building capacity since 2020 when Congress approved the 988 designation along with additional funding. Clarke says that between 2020 and 2021, the network was able to process an increase of 150,000 calls. This increase in capacity, combined with a nationwide media campaign leading up to the launch of the three-digit number in July, has helped raise awareness of the service for those in need.
“For every person who dies by suicide annually, there are another 316 people who have thought seriously about suicide who don’t kill themselves, and nearly 60 who have survived a suicide attempt. The overwhelming majority of these individuals will go on to live out their lives. These untold stories of hope and recovery are the stories of suicide prevention.”
Breaking the Stigma Around Suicide
Although the national spotlight on suicide prevention has helped advance the conversation about mental health and severe mental health crises, a significant stigma still exists around talking about suicide, especially in the workplace. The stigma remains not only for those experiencing suicidal ideation, but also for those who may want to help but are unsure how to ask for fear they may make things worse. Clarke says one of the important services of the 988 Lifeline is that in addition to being a resource for individuals in crisis, it also offers help to those who are trying to assist someone at risk of suicide.
How to Identify a Person in an Acute Mental Health Crisis
Clarke says that there are several evidence-based resources offering guidance for individuals and companies that want to address acute mental health crises in the workplace. While she advises companies to have individuals trained in crisis response, it is important to remember that anyone can make a difference by offering help with the right approach. Identifying behaviors that may be signs of mental health crisis or suicidal ideation is a first step. According to SAMHSA’s Suicide Prevention Resource Center, some behaviors that might indicate a person is at immediate risk for suicide include:
- Talking about wanting to die or to kill oneself
- Looking for a way to kill oneself, such as searching for ways to obtain a gun
- Expressing feelings of hopelessness or having no reason to live
Other behaviors that may be warning signs of serious imminent risk include:
- Expressing feelings of being trapped or in unbearable pain
- Talking about being a burden to others
- Increased use of alcohol or drugs
- Reckless behavior or acting overly anxious
- Irregular sleeping patterns (too little or too much)
- Giving away meaningful possessions
- Feeling isolated or withdrawing from social activity
- Expressing rage or a desire to seek revenge
- Extreme mood swings
How to Help an Individual in Crisis
If you do suspect a person is dealing with suicidal ideation, Clarke recommends following the five steps that are outlined in the #BeThe1To protocol:
- Ask: Asking the question “Are you thinking about suicide?” communicates that you are open to speaking about suicide in a non-judgmental and supportive way. Asking doesn’t increase the risk of suicide. Ask confidently and be direct.
- Be There: Once you ask, then you must be willing to listen to what they are going through. This could mean being physically present or speaking with them on the phone. Make sure to let them know you are there to listen and willing to stay with them.
- Keep Them Safe: Make sure the individual is safe. Do they have a plan? Do they have access to what they would need to carry out that plan? How would you help to take away some of those things to keep them safe?
- Help Them Connect: Connect the individual to care. Encourage them to call 988 or see if they are comfortable with you calling first and then handing them the phone. Alternatively, help them contact someone that they know and feel connected to, like a family member, friend, or trusted medical professional.
- Follow Up: Stay connected. Once the crises situation has been brought under control, check back in with the person to let them know the crisis has not changed the way you feel about them. This is an important step that shows them that someone cares and that they are not alone.
Overcoming Fear When Offering Help
Even with the evidence that these steps can support individuals in mental health crisis, it can be difficult to break through the stigma of talking about it. What if you’re afraid to offend someone who may be hurting but not actually having suicidal thoughts? Clarke says that as a therapist herself, she had to realize that any fears of offending someone were more about her than about the person needing help. Once she realized that, she understood that the alternatives were clear:
“Worst-case scenario was that I was going to offend an individual, but best-case scenario was that I was going to save a life.”
How to Develop Mental Health Crisis Preparedness at Work
Clarke suggests employers begin by building suicide and mental health crisis preparedness in the workplace. She recommends providing training for managers and leaders as well as all employees. Employees with more confidence in helping others deal with mental health challenges at work or in other areas of their lives (families, relationships, communities, schools) will help decrease the stigma around mental health and provide more connection and engagement in the workplace. Here are a few resources that offer training programs:
Building a Robust Care Stack
Clarke is encouraged by the impact the new 988 Lifeline has made so far and the role it is playing to increase awareness about suicide prevention. With the knowledge and learning from services like the 988 Lifeline and other crisis support programs, employers have many options available to support employees who may be experiencing an acute mental health crisis. Engaging employees in actively supporting each other and being aware of all levels of mental health needs can help build a stronger, more resilient, workforce. With this knowledge and support, your employees can become an essential component of your company’s mental health Care Stack.
To learn more about Mentera’s Care Stack framework, check out the other presentations from our Care Stack Summit. To see how the Care Stack can help your organization to support the mental health of your team, download our Care Stack Playbook.