The United States (US) Food and Drug Administration (FDA) recently authorized the Pfizer-BioNTech COVID-19 vaccine for children ages 5 to 11 years old. The Centers for Disease Control and Prevention (CDC) also recommended the vaccine in this age group. There are 28 million children in the US ages 5 to 11 years old. This age group makes up 39% of COVID-19 cases in those under the age of 18 years. While children are less likely to develop severe COVID-19 than adults, severe illness, hospitalization, and death have occurred in younger ages. Now that there is a COVID-19 vaccine option for ages 5 to 11 years, here are answers to vaccine questions that are top of mind for many parents.

1. How effective is Pfizer’s vaccine in children ages 5 to 11 years?

• According to results from the ongoing study in ages 5 to 11 years, the vaccine has been 90.7% effective in preventing COVID-19 measured 7 days after the second dose. The study has been going on with delta as the prevalent strain.
• Immune responses in this age group were comparable to 16 to 25-year-olds.

2. What are the common side effects?

• The most common side effect was injection site pain (sore arm). Some of the other common side effects include fatigue, headache, redness and swelling, fever, chills, and muscle pain.
• Side effects were generally more common after the second dose. Side effects were mostly mild to moderate, started within 2 days of the second dose, and resolved within 1 or 2 days.
• There have been no cases of myocarditis (heart inflammation) reported in this age group.
• The study is ongoing, and the FDA and CDC will continue to monitor for vaccine safety and look for rare or serious side effects.
• The vaccine should not be given to anyone who has a history of anaphylaxis (severe allergic reaction) to any part of Pfizer’s vaccine.

3. How is Pfizer’s vaccine dosed in ages 5 to 11 years? What type of vaccine is it?

• The dose for 5 to 11-year-olds is a two-dose regimen of 10 mcg given 21 days apart.
• It is a messenger RNA (mRNA) vaccine, but the dose is one-third of the adolescent and adult doses (30 mcg).

4. Can the flu and COVID-19 shots be given at the same visit?

• COVID-19 vaccine can be given at the same visit as routine childhood immunizations, including flu.

5. Where is Pfizer’s vaccine available?

• Pfizer’s vaccine for ages 5 to 11 years is available in pediatrician offices, pharmacies, health departments, hospitals, and other sites.  Vaccines.gov lists vaccine availability at different locations.

Disclaimer: The content in this blog article is NOT a substitute for professional medical advice. For questions regarding COVID-19 vaccines, any medical condition, or if you are in need of medical advice, please contact your healthcare provider. Given the fluid nature of the pandemic, information in this article is subject to change and may not be current.

Sources

• VRBPAC FDA Briefing Document. October 26, 2021. https://www.fda.gov/media/153447/download
• Pfizer EUA Press Release. October 29, 2021. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-receive-first-us-fda-emergency-use-0.
• FDA Press Release. October 29, 2021. https://www.fda.gov/news-events/press-announcements/fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use-children-5-through-11-years-age
• CDC Interim Clinical Considerations. November 3, 2021. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#children
• Pfizer EUA Fact Sheet. Revised October 29, 2021. https://www.fda.gov/media/153714/download
• AAP Policy Statement. November 2, 2021. https://www.aap.org/en/pages/covid-19-vaccines-in-children-and-adolescents-policy/
• Vaccines.gov.

Meredith Delk, general manager of the government markets division within Magellan Rx Management

What is the government markets division within Magellan Rx?

We are the largest pharmacy benefit administrator across 27 states and Washington D.C. working with Medicaid and public health agencies. We partner with states across the country to ensure that their Medicaid or AIDS Drug Assistance Program (ADAP) enrollees, depending on the state, have access to the drugs they need at the right time and at the right place. Additionally, we process approximately $18 Billion in rebate dollars on behalf of 20 states annually.

How does your work in the government markets division align with Magellan’s mission of leading humanity to healthy vibrant lives?

Our work is focused on people living in poverty across the United States. So, irrespective of the state and specific program, everyone we serve within the government markets division is affected by poverty and our commitment is to provide our customers (government agencies) and the consumers they serve with best-in-class service to access medications, therefore positively impacting their quality of life. We have about 1,000 employees on any given day who are dedicated across 27 states to ensure that the individuals we serve have a role in accessing their drugs and that they understand that their voices matter.

Further, we are deeply committed to our work across the country administering ADAP, thru our ADAP Center of Excellence. This is a federally funded program benefiting those who are affected by HIV and AIDS. As a result, these members are able to receive their life changing and lifesaving medications. In addition, there are wraparound services and other support services for people living with HIV and AIDS who do not have commercial healthcare and are not on Medicaid. The Ryan White program created a solution to ensure that, regardless of your socioeconomic status, if you are affected by HIV or AIDS, you will have access to medications. It is a fantastic program and one we are honored to be a part of here at Magellan.

Given everything that’s happening in healthcare right now with the pandemic, how does Magellan’s mission and improving customer service relate to the work you’re doing?

In many respects, the work we are doing in the government markets division supports the fabric of the safety net for millions of Americans. We know that through this pandemic unemployment has been on the rise, which means Medicaid enrollment has been on the rise, throughout the country. We also know that mental health issues have increased, creating additional challenges related to overall physical health and access to behavioral health services and medications. Within Magellan Rx and the government markets division, we’re on the front lines with our customers.

We partner with public health agencies to provide them real time solutions beyond our core POS work, for example. Right after the COVID vaccine was made available a Governor in a state where we have business announced during a press conference, that Magellan’s call center would be the vaccine hotline for every person in that state, regardless of their type of insurance. Almost overnight, we stood up a call center to support that state in improving their vaccination rates. We’re listening to and keeping a close eye on new and innovative challenges that Governors and Medicaid regulators have experienced during this pandemic.

How does your background in social work influence the work you’re doing and your leadership style?

I’m a trained clinical social worker and I also have a PhD in counseling. I have spent quite a bit of time while working on the PhD focused on people living in poverty who were also affected by a mental health issue and more specifically families who had a family member affected by severe mental illness. Additionally, I worked on the streets of Washington DC with people who were homeless and seriously affected by poverty, who also suffered from serious mental health issues. That’s really where I grew up in my 20’s, focused on people living in poverty and their access to mental health care. I worked at a lockdown stabilization unit for people who were suicidal and homicidal. It was a 7 p.m. to 7 a.m. shift on Friday and Saturday nights at the lockdown unit. That’s how I put myself through graduate school. I have seen firsthand the effects that mental illness and poverty combined have on people, families, and communities. In many respects, that is what created the foundation of my career. It helped establish the first pillar of my leadership style which is focus on your people first.

What is your strategy for keeping your team on mission and integrating them into the broader Magellan culture?

Every business leader and CEO rightfully would answer that question by talking about being best-in-class and supporting those we serve. I think the difference between us at Magellan and many other teams is the drive it takes to do that every single day. We are very disciplined about the data and metrics that bring to light how well we are doing on behalf of our associates, customers, and members.

I’m a former Amerigroup executive and Jim Carlson was the CEO when I went to work for them after spending a few years in state government. At AmeriGroup, I was very young and very green. I had the benefit of working under an extraordinary executive team led by Jim. Jim used to say, ‘don’t confuse effort with results.’  This aphorism has defined much of my career. To this end, we focus a great deal on the results we achieve with our customers, associates, and other key stakeholders.

The true measure of how well we are doing includes metrics like winning new business, bringing on new customers and retaining existing customers. In 2020, the government markets division earned a 100% customer satisfaction results. We surveyed all our government customers who are Medicaid regulators, and achieved 100% satisfaction, which is extraordinary and a direct result of the terrific work that our team does day in and day out.

Additionally, we have among the highest associate engagement scores on our internal customer service surveys. There are 28 people on my leadership team who bring 369 years of experience in our fee for service PBA (pharmacy benefit administration) business. On this team, 20 of those individuals have more than 10 years of experience with Magellan and eight of those individuals have more than 20 years. Three people have over 30 years of experience and the longest serving person on the team has 39 years of experience with Magellan. So, when you think about that, you know the turnover among leaders and subject matter experts is very low. This team is fundamentally about the people who come to work every day – they are truly focused on getting good work done, they like one another, they want to be here, they enjoy the work they’re doing and feel respected and valued for it.

What is exciting you about where we’re going, in terms of both Medi-Cal and Magellan Health as a broader company?

It is an exciting time for us in the government markets division. Medi-Cal is an extraordinary project, and it has been a true testament to the commitment and leadership brought by hundreds of people across the company and an exceptional California-based team led by Billy Thomas. They have shown up every day for the last year and a half, even during the pandemic, and are a team that’s so deeply committed to this work, and we will go live with Medi-Cal on January 1, 2022. The Medi-Cal project is transformative for the government markets division.

Additionally, we’re very excited about the work within the ADAP business. We’ve recently piloted our Navigate Whole Health program with our ADAP members. Results so far have shown us that very simple and straightforward clinical interventions with our providers and prescribers can really move the needle on quality and general efficacy of treatment modalities for HIV and AIDS medication. For example, we developed a regimen for one patient who didn’t want to take medications at work. As a result, the patient will be more compliant with the regimen. I believe it’s about adding more value and being a smart and sophisticated partner to these government entities and the people they serve.

Our national footprint allows us to be big thinkers. We can be more thoughtful and add more value because we are in 27 states across the country and every state is a little different. We also have the ability to leverage expertise, technology, infrastructure and innovation across the country.

Are you currently hiring for the Medi-Cal team?

Yes, we are. It’s a truly extraordinary project and an opportunity to be part of a team like no other in the country. There’s no state that has done quite what California has done with their Medi-Cal pharmacy benefit. This is a full drug carve out for all 14 million Medi-Cal enrollees.  It’s an opportunity to join a team led by Billy Thomas and his leadership team who are the best in the business. I also think it’s an opportunity to join a team where growth and development is a big part of the culture. We’re just very proud of the work that we have done with the state of California so far and are excited about serving them in a meaningful way. Anyone who’s interested in being part of that team should find out more. It’s a great team and it’s important work.

Learn more about joining the Medi-Cal team here.

The COVID-19 pandemic has had a profound affect on everyone, particularly children with emotional health concerns. Many support structures in place prior to the pandemic to help children thrive have disappeared or been changed significantly, resulting in increased pressure on caretakers and overwhelming stress for children. New and innovative solutions are needed to meet these challenges. Magellan Healthcare’s Emotional Health for Kids by Mightier is a clinically proven video game solution that helps children build emotion regulation skills through play and caregivers build emotionally healthy homes.

Developed at Boston Children’s Hospital and Harvard Medical School, Mightier helps children ages 6 to 14 who are struggling with emotional health concerns, such as irritability, aggression, and anger, as well as children diagnosed with oppositional defiant disorder, attention deficit-hyperactivity disorder, autism spectrum disorder (ASD) and general anxiety disorder.

Mightier’s impact on children’s emotional health

In a pilot program, Magellan provided members access to the Mightier program for a period of twelve weeks during the COVID-19 pandemic. Families were recruited and randomized into a group that received Mightier in addition to applied behavior analysis (ABA), or a group that received only ABA as a control.

• Children engaged with Mightier at a high rate. On average, Mightier families played for 30.4 minutes above the 30 minutes per week recommended to see clinical change.
• Clinical symptoms improved. Eighty percent of children with ASD who used Mightier showed an improvement on primary symptoms, compared to only 50% in the control group.
• Children showed twice as much decrease in aggressive behaviors. Adding Mightier to ABA resulted in a reduction in aggressive behavior in children with autism by twice as much compared to ABA alone.
• Families reported a less stressful and more supportive environment. Families using Mightier showed 50% improvement in family stress, 114% improvement in parent confidence, and 114% improvement in access to resources relative to control.

Visit  Magellanhealthcare.com/kids-emotions-mightier/ to learn more about the pilot and how Mightier helps children build self-regulation skills and supports caregivers in building emotionally healthy homes.

Among those who experience a mental health illness, more than half do not receive treatment.[1] The 2019 National Survey on Drug Use and Health reveals no treatment was received by:

• 90% of the 20.4 million individuals aged 12+ who have a substance use disorder (SUD)
• 55% of the 51.5 million individuals aged 18+ who have any mental illness (AMI)
• 35% of the 13.1 million individuals aged 18+ who have a serious mental illness
• 90% of the 9.5 million individuals aged 18+ who have a co-occurring SUD and AMI
• 57% of the 3.8 million individuals aged 12-17 who have had a major depressive episode

In fact, what we’ve seen in our data is that 60% of patients who are admitted to inpatient care were first seen in a primary care setting within 6-12 months of the admission and the mental health condition was either missed or not addressed.

Through effective screening for mental health conditions on your own or through a physician or mental health professional, it is possible to identify problem areas and get help, so you can live a happier and healthier life.

Mental health self-screening tools

Magellan Healthcare provides links to reputable, free self-assessments of behavioral/mental health, substance use and more.* Once you complete an assessment, be sure to review your results and any recommendations with your doctor.

• Addiction(CAGE-AID)
• Alcohol consumption (AUDIT-10)
• Anxiety (GAD-7)
• Bipolar disorder
• Child depression (CES-DC)
• Child trauma (CTS)
• Depression (PHQ-8)
• Drug abuse (DAST-10)
• Eating disorder (SWED)
• Insomnia (ISI-7)
• Obsessive compulsive disorder (OCD) (Y-BOCS)
• Pain (PEG-3)
• Parent mental health
• Postpartum depression
• Post traumatic stress disorder (PTSD) (PC-PTSD)
• Psychosis (PQ-B)
• Youth mental health

*Note these are links to outside websites that are not monitored by or affiliated with Magellan Healthcare. If your screening results indicate you are at high risk, call 911 or go to the emergency room immediately.

We encourage you to watch a recording of our webinar, “Depression is more than just a rough patch,” and find additional resources addressing depression at MagellanHealthcare.com/Mental-Health.

[1] https://www.samhsa.gov/data/sites/default/files/reports/rpt29392/Assistant-Secretary-nsduh2019_presentation/Assistant-Secretary-nsduh2019_presentation.pdf

Even before the COVID-19 pandemic entered our world, the prevalence of mental illness and suicidal ideation in the US was increasing. In 2019, 61.2 million American adults (24%) had a mental illness and/or substance use disorder, an increase of 5.9% over 2018.[1] Depression – a sad mood that lasts for a long time and interferes with normal, everyday functioning – for those under age 50 increased steadily from 2016 to 2019:[1]

• 6% increase among those aged 12-17
• 1% increase among those aged 18-25
• 6% increase among those aged 26-49

From 2009 to 2019, suicidal thoughts, plans and attempts increased among:[1]

• Young adults aged 18-25, 95%, 98.8% and 62.4%, respectively
• Adults aged 26-49, 23.3%, 50% and 24.5%, respectively

Increased stressors brought about by the pandemic – grief and loss, social isolation, financial instability, fear, etc. – have exacerbated the state of mental health in the US. More people from January – September 2020, compared to all of 2019, sought help for anxiety (93% increase) and depression (62% increase).[2] Since COVID-19 began, suicidal ideation in the US has more than doubled, with younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers experiencing disproportionately worse effects.[3]

Recognizing the symptoms of depression

Depression can have different symptoms depending on the person, but in most people, a depressive disorder changes how they function day-to-day, and usually for more than two weeks.

Learn the FACTS:

• Feelings: Being extremely sad and hopeless, losing interest or enjoyment from most daily activities
• Actions: Exhibiting restlessness or feeling that moving takes great effort, having difficulty focusing, concentrating on things, or making decisions
• Changes: Gaining or losing weight due to changes in appetite, changing sleep patterns, experiencing body aches, pain, or stomach problems
• Threats: Talking about death or suicide, attempting suicide or self-harm
• Situations: Experiencing traumatic events or major life changes, having a medical problem or family history of depression

A serious symptom of depression is thinking about death or suicide. If you are in crisis or considering suicide, or if someone you know is currently in danger, please dial 911 immediately.

We encourage you to watch a recording of our webinar, “Depression is more than just a rough patch,” and find additional resources addressing depression at MagellanHealthcare.com/Mental-Health.

Jamie Hanna, MD, serves as the medical director for the Magellan of Louisiana Coordinated System of Care (CSoC) program. She is board certified in Psychiatry and Child and Adolescent Psychiatry. Prior to joining Magellan in 2020, Dr. Hanna served as an assistant professor and assistant training director with Louisiana State University School of Medicine, working with the acute behavioral health unit, and leading the psychiatric consultation-liaison service and emergency psychiatric services at Children’s Hospital of New Orleans. Dr. Hanna completed medical school at the University of Alabama School of Medicine and a subsequent internship in Pediatrics, residency in General Psychiatry, fellowship in Child and Adolescent psychiatry, and fellowship in Infant Mental Health with Louisiana State University in New Orleans.

[1] https://www.samhsa.gov/data/sites/default/files/reports/rpt29392/Assistant-Secretary-nsduh2019_presentation/Assistant-Secretary-nsduh2019_presentation.pdf

[2] https://mhanational.org/issues/state-mental-health-america

[3] https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm

October is Breast Cancer Awareness Month, which focuses on increasing awareness and highlighting the importance of early detection. Although there has been a significant increase in awareness over the years, there is still a great deal of information about the disease that can cause some confusion.

Here is a look at three common myths about breast cancer and the truth behind them.

Myth: Finding a lump in your breast means you have breast cancer.
The Truth:  Only a small percentage of breast lumps turn out to be cancer. If you find a lump in your breast or notice changes in tissue, it is very important that you see a physician for a clinical breast exam or imaging.

Take charge of your health. Perform routine breast self-exams, establish ongoing communication with your doctor, get an annual clinical breast exam, and schedule your regular screening mammograms.

Myth: Men do not get breast cancer; it affects women only.
The Truth:  Quite the contrary. Annually, approximately 2,190 men¹ will be diagnosed with breast cancer, and 410 will die each year. While this percentage is small, men should also periodically do a breast self-exam while in the shower and report changes to their physicians.

Breast cancer in men is usually found as a hard lump underneath the nipple and areola. Men carry a higher mortality than women do, primarily because awareness among men is less. Men are less likely to assume a lump is breast cancer, which can cause a delay in seeking treatment.

Myth: You are not likely to develop breast cancer if you do not have a family history of breast cancer.
The Truth:  Women who have a family history of breast cancer are in a higher risk group. However, most women who have breast cancer have no family history. Statistically, only about 10% of individuals¹ diagnosed with breast cancer have a family history of this disease.

• A first-degree relative with breast cancer: If you have a mother, daughter, or sister who developed breast cancer below the age of 50, you should consider regular diagnostic breast imaging starting ten years before the age of your relative’s diagnosis.
• A second-degree relative with breast cancer: If you have had a grandmother or aunt who was diagnosed with breast cancer, your risk increases slightly. It is not at the same risk as those with a first-degree relative with breast cancer.
• Multiple generations diagnosed with breast cancer: If there are several family members diagnosed under age 50, the probability increases that there is a breast cancer gene contributing to the cause of this familial history.

When breast cancer is detected early, in the localized stage, the 5-year survival rate is 98%.³

Knowledge is power, it is vital to learn the facts about the disease. The more you learn about this disease, the better equipped you will be to make decisions about annual exams, screenings, risk reduction, and treatment options. Work with your provider to better understand your risk, and the steps you can take to be in charge of your breast health.

1. https://seer.cancer.gov/statfacts/html/breast.html
2. https://www.cancer.gov/about-cancer/causes-prevention/risk/myths/antiperspirants-fact-sheet
3. https://www.nationalbreastcancer.org/breast-cancer-stage-0-and-stage-1

Swarna Ramachandran is bringing a new digital experience to the world of behavioral health. As vice president of digital and contact center solutions for Magellan Healthcare, Ramachandran is leading a team that is redesigning the online digital experience for members, making it more intuitive when finding the necessary resources. Digital transformation, including technology, experience and Contact Center modernization, has been core to where she is today, and navigating the whole realm delivery & PMO come natural to her, says Ramachandran. Keep reading to learn how Ramachandran and her team are creating a new digital experience for Magellan Health members.

Q: What kind of projects are you working on right now?

A: Digital transformation is a key area of focus for Magellan Health. Engaging and enabling members digitally for care and self-service, helping reduce the stigma around mental health, and enabling self-service for providers and clients digitally are some of our key transformation goals.

The COVID-19 global pandemic has increased awareness and need for mental and behavioral health care for all of us. Several products have been released in the market that are either point solutions or solves for a couple areas of mental health, leaving the member with a myriad of apps and tools, leading to a dissatisfied member. One of Magellan Health’s core strengths is mental and behavioral health and with our diverse population of members across our products, we are in a unique position to provide our members with a guided approach to accessing care and address issues at their root by understanding the stressors, specific resources and community support.

Our vision is a holistic approach to member wellbeing and care. Our approach starts with member engagement and navigation to help remove the stigma towards mental health by helping the member to approach mental health and wellbeing as part of their whole health. We do this by promoting annual digital wellbeing checks in a self-service mode.

Q: How did you and your team come up with this idea? Why is Magellan Health the best place to work on this project?

A: Digital is everywhere and in everyone’s hand today in the form of mobile apps, websites and internet.  Ideas are plenty but solving for the real need is key. We conducted various design thinking sessions with members and studied the need thoroughly from the member perspective.

Magellan Health’s core strength is mental and behavioral healthcare, and we have a significant population of behavioral health members. We have members from our other products like Employer solutions, State and Federal, which puts us in a unique position to capitalize on our strengths and serve this large group of members at their doorstep and to get them healthy mentally and physically.

Learn more about the digital experience here.

By Dr. Beall-Wilkins and Dr. Jamie Hanna

Magellan Health hosted a free webinar for September Suicide Prevention Awareness Month. If your question wasn’t answered during the webinar, or if you would just like to learn more about suicide prevention, read on for information shared by our webinar presenters, Dr. Rakel Beall-Wilkins, MD, MPH, and Dr. Jamie Hanna, MD. For more information and resources addressing suicide prevention, and to watch the recording of this webinar, visit MagellanHealthcare.com/Suicide-Prevention.

Question: Please say more about the interplay between chronic pain and suicide risk.

Dr. Beall-Wilkins: It is estimated that the prevalence of suicidal ideation is roughly three times greater in people living with chronic pain compared to those who do not have chronic pain, and chronic pain is linked to higher rates of not only suicidal ideation but also suicide attempts and completed suicides.[1] When coupled with impaired functionality and disability, chronic pain can result in socioeconomic hardships and limitations in access to care that further exacerbate both physical and mental health symptoms. Chronic pain and depression often go hand-in-hand, and clinical studies have shown that upwards of 85% of people with chronic pain have experienced severe depression.[2] It is essential that patients with chronic pain be routinely screened for psychiatric symptoms and acute safety concerns, and that they be referred to treatment if issues arise.

Question: Is a person really considered suicidal if they have considered it a lot but have never acted on their thoughts? What measures can we put in place for individuals with a baseline of passive suicidal ideation who are in outpatient therapy?

Dr. Hanna: Understanding the risk factors that can lead to suicidal behavior provides an opportunity to identify and support people at risk for suicide. Risk factors include a previous suicide attempt, diagnosis of mental illness/substance use, isolation, social/legal problems, trauma in childhood, a family history of suicide, recent stressors and access to lethal means. Learn more about suicide risk and protective factors from the American Foundation for Suicide Prevention and the Centers for Disease Control and Prevention. Suicidal ideation – or thoughts about suicide – is also an important risk factor and can be a warning sign of imminent suicidal behavior. There is greater risk when suicidal thoughts occur more often, over greater time periods or are more challenging to control; there are fewer barriers to acting on the thoughts; and the reason for the suicidal thoughts is to stop the pain. Identifying suicidal ideation and implementing treatment strategies are critical in preventing suicide.

It is always the goal to treat suicidality in the least restrictive setting and subsequently, treatment of suicidal ideation often occurs in the outpatient setting. There are a variety of measures that can be put in place to assess and treat suicidal thoughts in the outpatient setting. Some of these include screening, crisis intervention, and evidence-based and research-informed interventions.

One example of a screening tool is the Columbia-Suicide Severity Rating Scale (C-SSRS). This scale focuses on evidence-based metrics to assess the severity of suicidal ideation and behavior. Items on the scale also serve to differentiate between suicidal and non-suicidal self-injurious behavior.

Crisis intervention assistance is typically provided by connecting a person in crisis to trained staff for support and referral to additional services. The goal is to impact key risk factors for suicide, including depression and hopelessness, increase future mental healthcare access, and put space and time in between suicidal thoughts and action. Examples of crisis intervention services include the National Suicide Prevention Lifeline (1-800-273-8255) and Crisis Text Line (text HOME to 741741).

There are only a small number of evidence-based treatment interventions directly targeting suicide risk. These include cognitive behavioral therapy for suicide prevention (CBT-SP), dialectical behavior therapy (DBT) and Collaborative Assessment and Management of Suicidality (CAMS). Additional research-informed interventions include collaborative safety planning and reducing access to lethal means. These interventions are emphasized in both the CDC suicide prevention strategy and the Zero Suicide approach to suicide prevention.

Question: What do you say to someone who says they want to die and that life is torture, and asks why they were born? What types of things can you tell the person going through this, and how do you do it without sounding judgmental?

Dr. Beall-Wilkins: Feelings of despair, hopelessness, worthlessness and helplessness are commonly experienced by people who are in the midst of a mental health crisis. During episodes of emotional distress, it can be very difficult for some people to think positively or constructively, and this can manifest itself in the form of self-deprecating statements and thoughts of self-harm. When someone is feeling this way, it can be helpful to reassure them that things can get better, and that comprehensive treatment can improve how they feel. It’s also very important to assess their safety, inquire about any thoughts they may be having of hurting themselves or someone else, and encourage them to seek immediate professional help if they’re feeling unsafe.

Question: I had a family member take her life on 9/7. She went about her day as normal, and then chose to take her life that evening after placing her kids down for the night. As a family member, we are still trying to figure out why. Is this a normal feeling? Similarly, for people attempting to support those with suicidal thoughts, or who have tried to support someone who died by suicide, what suggestions do you have to help them find the balance between supporting the suicidal individual and feeling overly responsible for the suicidal individual’s choices, behaviors, etc.?

Dr. Hanna: When a loved one dies by suicide, intense emotions – such as disbelief, anger, guilt, isolation and despair – can become overwhelming, and there is no right or wrong way to feel. Many people will feel confused as they try to understand why their loved one chose suicide. And it is likely there will always be unanswered questions. The events which lead to suicide are often complex and most commonly there are many factors that contribute to a person ending their life.

The feeling of guilt can lead suicide survivors to blame themselves for the death of their loved one. It is critical that survivors do not blame themselves, and that they seek support and engage in self-care. Support and self-care can include reaching out to community members, such as friends, family, co-workers and mental health providers. Both in-person and online support groups are available specifically for suicide survivors. The American Foundation for Suicide Prevention provides resources to find a support group. It can also be beneficial to seek professional help with a licensed therapist or psychiatrist, especially for symptoms of depression and thoughts of suicide.

Question: The hardest part about helping someone who is suicidal is the concern that the police will be called, and the person will end up in handcuffs. How can we change this?

Dr. Beall-Wilkins: It is often the case that family and friends of those who are experiencing acute mental health crises face the prospect of summoning law enforcement to assist in maintaining safety and facilitating transportation to care. This can be a very daunting prospect and a growing movement of advocates, policymakers and mental health providers are now pushing for reforms that would reduce the likelihood of adverse outcomes in these circumstances.[3] One such reform involves greater collaboration between police departments and mental health clinicians, including training, education and joint response to crisis calls. Preliminary data indicate this approach can be a very effective means of reducing adverse outcomes, increasing public safety and strengthening trust within communities.[4]

Question: Is being suicidal hereditary? Are the mental/emotional issues that caused a previous suicide in a family hereditary?

Dr. Hanna: There is clear evidence that suicide can run in families, and family history of suicide has been identified as a significant risk factor for suicide. Studies show that individuals who have a parent or sibling die by suicide are two and a half times more likely to die by suicide than those without a family history of suicide. Research has identified a number of genes that appear to be associated with suicide risk. Psychiatric illness has also been shown to run in families and is a risk factor for suicide. Depression plays a role in over half of all suicide attempts. Children of parents with depression are three times as likely to develop major depression, anxiety disorders and substance use – all of which increase the risk of suicide.

While family history of suicide and psychiatric illness are important risk factors of suicide, other risk factors include previous suicide attempts, depression, substance use, stressful life events, physical illness and access to lethal means, among others. Suicide occurs as a result of many interacting genetic and environmental factors. Family members share genes, and they often share experiences – they eat together, live together and face economic stressors and loss together. These shared experiences may combine with genetics to increase an individual’s vulnerability to suicide. This does not mean that everyone with a family history and increased risk of suicide will have suicidal behavior, but that they could be more vulnerable and should take steps to reduce their risk. These may include early evaluation and treatment of mental illness and building protective factors to buffer against suicidal behavior.

Question: Could you speak to the legalities of those who need help but are past the age of responsibility, and family members and friends are told there is nothing they can do if the person refuses the help or that we can’t keep them somewhere against their will?

Dr. Beall-Wilkins: In most jurisdictions, the ability to commit an individual to treatment against their will is typically conferred by the courts based upon three guiding principles: harm to self, harm to others and evidence of significant mental deterioration that renders an individual unable to practice self-care in their own best interest. If an adult person is explicitly stating an intention to hurt themselves or others, or exhibiting grave mental disability, they can be involuntarily committed for observation, evaluation and acute stabilization.

Rakel Beall-Wilkins, MD, MPH, served as a medical director for Magellan Healthcare. Prior to joining Magellan in 2018, Dr. Beall-Wilkins assisted in the launch of an addiction psychiatry clinic embedded within Harris Health System’s Healthcare for the Homeless Program, to combat local impacts of the nationwide opioid and synthetic cannabinoid (“K2”) epidemics. Dr. Beall-Wilkins also served as a member of the Baylor College of Medicine faculty with clinical duties at both the Ben Taub General Hospital Psychiatric Emergency Center and the Thomas Street Health Center. There she helped to expand behavioral health services by launching a neurocognitive clinic collaborative to better screen, diagnose and treat individuals with HIV/AIDS-associated neurocognitive disorder and psychiatric comorbidities. She is a graduate of the University of Texas at Austin and the Johns Hopkins School of Public Health, where she obtained a Master of Public Health degree. She obtained her medical degree from Baylor College of Medicine. 

Jamie Hanna, MD, serves as the medical director for the Magellan of Louisiana Coordinated System of Care (CSoC) program. She is board certified in Psychiatry and Child and Adolescent Psychiatry. Prior to joining Magellan in 2020, Dr. Hanna served as an assistant professor and assistant training director with Louisiana State University School of Medicine, working with the acute behavioral health unit, and leading the psychiatric consultation liaison service and emergency psychiatric services at Children’s Hospital of New Orleans. Dr. Hanna completed medical school at the University of Alabama School of Medicine and a subsequent internship in Pediatrics, residency in General Psychiatry, fellowship in Child and Adolescent psychiatry, and fellowship in Infant Mental Health with Louisiana State University in New Orleans.

For more information and resources addressing suicide prevention, and to watch the recording of this webinar, visit MagellanHealthcare.com/Suicide-Prevention.

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[2] Sheng, J., Liu, S., Wang, Y., Cui, R., & Zhang, X. (2017). The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural plasticity, 2017, 9724371. https://doi.org/10.1155/2017/9724371

[3] https://www.npr.org/2020/09/18/913229469/mental-health-and-police-violence-how-crisis-intervention-teams-are-failing

[4] https://www.apa.org/monitor/2021/07/emergency-responses