Preventing Suicides in the Health Care Workforce: Steps to Supporting Every Worker

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Tom Haederle
For health care workers, the threat from the pandemic has receded, but its effect on the workforce lingers on as they continue to report high levels of stress, burnout, depression and even suicidal thoughts. September is Suicide Prevention Awareness Month. What better time to take the advice of experts and get past any shame or reluctance to talk about this? Welcome to Advancing Health, a podcast from the American Hospital Association.

00;00;41;10 - 00;01;05;08
Tom Haederle
I'm Tom Haederle, with AHA Communications. The AHA’s Suicide Prevention Learning Collaborative was created to kick start a very important dialog among health care providers about the best ways to provide the behavioral health resources and support that so many health care workers say they want and need. Operating across 24 states, Chicago based CommonSpirit Health is a participant in the collaborative.

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Tom Haederle
In today's podcast, Paul Rains, senior vice president of Behavioral Health with CommonSpirit, joins Jordan Steiger, senior program manager of Clinical Affairs and Workforce with AHA to discuss best shared practices and the need to make sure every health care worker is supported no matter what job they hold. Says Rains, if you suspect somebody is hurting, ask, say something.

00;01;28;01 - 00;01;30;25
Tom Haederle
And with that, let's join Jordan and Paul.

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Jordan Steiger
Paul, thank you so much for being with us today. You have such a wide experience and breadth of knowledge on this topic, and I'm excited you're able to share it with our members today.

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Paul Rains
Thank you.

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Jordan Steiger
So before we get started and get into the content, could you just tell us a little bit about CommonSpirit health and your role as vice president of behavioral health for your system?

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Paul Rains
So CommonSpirit Health, as you probably know, is a very large organization in 24 states. It's a merger between Catholic Health Initiatives and Dignity Health. Was born in 2019. At the time, I was doing the behavioral health leadership role at Dignity Health, and after the merger, I have taken on a larger responsibility for that. My role as senior vice president for behavioral health certainly has evolved since that time.

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Jordan Steiger
And I think a lot of listeners might assume when they hear senior vice president of behavioral health that you would be focused mostly on patient care and relations behavioral health. But you joined our collaborative to help your health system better learn how to support your workforce. So could you tell us a little bit about how your role has evolved in that way.

00;02;34;01 - 00;03;08;07
Paul Rains
As a clinician, my role in behavioral health has always been public facing and trying to do everything we can to improve our services for the patients that we serve. But it's always been something that as a clinician, I feel like I have a responsibility to be aware and look out for the folks that I work with. It was the COVID pandemic really that heightened that awareness to the point where we knew that this was big and this was going to require a very substantial response and developed a support system across our system, even though we know that that is important in health care.

00;03;08;09 - 00;03;22;08
Paul Rains
It became exponentially more important. So I just kind of forced my way through the door of the conversation and took a seat at the table and started working with a great group of folks within CommonSpirit that were already working on a well-being initiative.

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Jordan Steiger
That's great, and I think a lot of listeners will probably resonate with having to make that pivot after COVID and really making sure their workforce was taken care of. But why do you think this should be a priority for all hospitals and health systems?

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Paul Rains
You know, one suicide in any context, in any population, for me is one too many. Certainly in our workforce where we expect health care clinicians and workers to be resilient. It's obvious that resilience is not something that is a, I guess, a common characteristic. And we're human, right? So we can only take so much. It's so important for us to be addressing this.

00;04;02;22 - 00;04;33;15
Paul Rains
I think that AHA's being a facilitator of this project, suicide prevention in the workplace, really makes our voice much larger, much bigger, and addresses something I don't think that we've really addressed is: what is best practice? What is evidence-based practice in this area? When we first started doing this work, we were reviewing research, looking at all the literature on trauma in populations and things, and certainly after natural disasters, things like that, that there were certain characteristics could be identified for things like post-traumatic stress disorder.

00;04;33;17 - 00;04;52;22
Paul Rains
But this was different. This was like going to war. I mean, like being drafted to go to war in a situation where folks that had no expectation of ever being put into the situation facing death day in and day out. Nope, that happens in health care. We faced that. But this was different. It was traumatic and it was hard to watch.

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Paul Rains
It was hard to not be a frontline nurse on the firing line where this was happening every day. But knowing that my colleagues and peers were having to deal with this and just it was something I could not stop thinking about.

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Jordan Steiger
I'm sure, especially as a nurse, it was hard for you to watch. And I think this is a great way that you've been able to contribute still, without being on the frontline. So you've mentioned the Suicide Prevention Learning Collaborative that we've been working on together. Could you just tell our listeners a little bit more about the collaborative and the work you've done at CommonSpirit through this participation?

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Paul Rains
Well, initially what I wanted to be able to offer our system was bringing in the concept of peer support. In my work, I've done a lot of work around peer support, especially in recovery, like recovery from substance abuse disorders. But knowing the value of what it is for someone that has been through it, to be able to have that ability to share and listen to someone else.

00;05;48;18 - 00;06;06;08
Paul Rains
There's a healing aspect of that. It's hard to measure that, and I don't know that there's a lot of research out there on that, but participating in this, I wanted to bring that component to the wellbeing initiative, and we first looked at models like the Mental Health First Aid Model, thought that was a really great model and kind of patterned what we did create

00;06;06;08 - 00;06;34;26
Paul Rains
after that. We really want to be able to have a level of saturation in our system so that no matter what shift someone was working in, no matter what environment they're in, whether they're in the OR up on a medical floor, working in our registration reception areas and or in emergency departments, that no matter where someone is, no matter who they are, no matter what role they play in our system, that there's going to be somebody they're around, that they can identify as someone that they can go talk to.

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Paul Rains
And often times these are people that they know anyway. Right? And likely and hopefully trust to be able to say, hey, I'm not doing so well, you know. Then conversely, these folks can also kind of spot their coworkers and say, hey, are you okay? You know, asking the question. Taking the time to care. We get these catch phrases, you know, like see something, say something.

00;06;57;03 - 00;07;03;04
Paul Rains
This is another one of those times when it's like if you suspect that somebody is hurting, ask, say something.

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Jordan Steiger
Absolutely. And I think oftentimes people are very scared to do that. So I think having a more formal process and approach throughout your system is very, very powerful for your workforce. I know people are often afraid to ask about somebody's mental health, about suicidal ideation, because they're afraid they're going to make it worse. We know that's not the case.

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Jordan Steiger
But I think just empowering people to know that it's okay to ask those questions is such a great thing that your system is doing. I want to ask, though, you exist in a huge health system across 24 states, lots and lots of employees. I know you just mentioned that you want this to touch every single person within the organization.

00;07;45;09 - 00;07;47;27
Jordan Steiger
How are you doing that in such a big organization?

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Paul Rains
That's a great question. I was just talking to one of your colleagues earlier about how communication, much like your organization, communication across many different departments, can be challenging. And so, you know, how do we make this work in a system that's in 24 states, 145 hospitals and 2200 other care sites? It is challenging, but we have a great group of people that have come together.

00;08;10;29 - 00;08;37;13
Paul Rains
You know, initially what we were faced with was different initiatives that were going on in different markets across our system. And we actively reached out to those markets to ask them, what are you doing and how is it working? Largely around the ERP process, things like that. And then as the word got out that we were doing this work, we had others contact us and say, Hey, I'm doing the stress first aid in our Midwest division or I'm doing the We Care program, or we have a program for physicians.

00;08;37;15 - 00;08;56;26
Paul Rains
And our response was, That's great. Let's put it all together. Let's create an eclectic program that honors what you're doing and the evidence that you've gathered. And let's bring it all under one umbrella and let's create it for the entire system, and then let's communicate it effectively through a mechanism so that we're not asking people to look in ten different places.

00;08;56;29 - 00;09;17;20
Paul Rains
We're giving them one place to go to be able to access - here's what you do for your wellness and then here's the connection. So having these what we call peer ambassadors out there, those are the folks are going to be educated not only in how to know how to ask those questions and approach folks, but also knowing about our program and being able to educate their peers and coworkers on this.

00;09;17;23 - 00;09;32;09
Jordan Steiger
Sounds like you're really breaking down some of those barriers to access, and I love that you're honoring all of the different approaches from your different hospitals across the system and bringing that together. I think getting that buy-in from the workforce is so important. And this work.

00;09;32;11 - 00;09;52;03
Paul Rains
This initiative that AHA is sponsoring, it has allowed us to share best practice across organizations because there are some topics that it's just it's not proprietary that, you know, it's not something that we need to keep to ourselves. Hey, we're doing it the best. This is an issue that affects us all and affects our communities. These are our brothers and our sisters, aunts and uncles.

00;09;52;03 - 00;10;17;13
Paul Rains
These are our family members. The health care world is a very large, very large world population of folks. But what AHA has done is brought us together so that we can compare. And I really appreciate the ability to validate what we have put together when we see other folks that have come to pretty much some of the same conclusions and said, Yeah, we've come to learn that this we feel like this is evidence-based and best practice and that's what we have arrived at as well.

00;10;17;15 - 00;10;20;01
Paul Rains
That's validation of what we're doing. We're on the right track.

00;10;20;02 - 00;10;40;08
Jordan Steiger
Absolutely. It makes you feel good about the support that you are giving to the people within CommonSpirit. I think that's great. So as we close here, we all know, I think that September is Suicide Prevention Month, as many of our listeners will observe this month at their own organizations. What do you think they really need to remember about this discussion?

00;10;40;11 - 00;10;59;25
Paul Rains
You know, mental health, the topic, the stigma. I mean, at some point we've got to get over ourselves. We're ashamed to talk about it, too. We're afraid of what's going to happen if somebody knows. We need leaders to step up and speak up. I mean, we need leaders to be able to say, yeah, I had those thoughts of I don't know whether it's worth going on or how much more I can take.

00;11;00;03 - 00;11;19;26
Paul Rains
Right. I think all of us have had thoughts of despair. At some point when those thoughts become, well, I don't see very many other options to stop this feeling that we just need to talk about it more. We need to be willing to come out and say, yeah, I've been there. I've been to that place where I wondered whether or not I should go on. I've personally been there more than once.

00;11;20;03 - 00;11;29;09
Paul Rains
Right? So there's something we need to remember. And for me, you know, September may be Suicide Prevention Month. For me, every day is suicide prevention. That's right.

00;11;29;10 - 00;11;54;09
Jordan Steiger
So I think that's a great takeaway and really getting that leadership buy in and that leadership support and speaking out I think is so powerful. And I appreciate you sharing that today. I think that maybe will encourage other leaders to do the same within their own systems. So, Paul, thank you so much for joining us today. If anybody is looking for additional resources about health care worker suicide prevention, please visit AHA.org/suicide prevention/health care workforce. Thank you.

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Paul Rains
Jordan, Thank you for having me.

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Jordan Steiger
Thank you.