Untreated mental illness costs the United States up to $300 billion every year.[1] It is the leading cause of disability and the third most expensive medical condition in terms of total health spending, behind cancer and traumatic injury.

Given that one in five Americans suffers from a mental illness in a given year[3], and that the average delay between the onset of mental illness symptoms and treatment is 11 years[4], mental health screening should be considered just as important as regular medical exams.

Many physicians integrate screening to diagnose mental health conditions as part of primary care. It gives a PCP a picture of the patient’s emotional state and helps determine if symptoms they are experiencing are an indication of a mental health condition or an underlying physical health condition. Magellan Healthcare supports primary care screening and treatment with our Behavioral Health Toolkit at MagellanPCPtoolkit.com

Online screening and digital screening are two of the quickest and easiest ways to determine if a patient is experiencing symptoms of a mental health condition. A PCP may ask a patient to complete a questionnaire online before a visit, or a PCP may ask a patient to answer a few questions on a tablet or form while you they are at the office.

Based on the results, the PCP can recommend treatment options, such as digital or in-person therapy, a referral to a psychiatrist or psychologist, or a referral to the patient’s health plan’s case management team.

Early identification and intervention lead to better outcomes and can reduce long-term disabilities and prevent years of suffering.

To learn more, visit magellanhealthcare.com/mental-health. You’ll find information about mental health conditions and links to evidence-based screening tools you can do yourself. If any screener indicates a problem, consult a healthcare professional immediately.

[1] National Alliance on Mental Illness. (n.d.) FY 2018 Funding for mental health. Retrieved October 7, 2020 from https://www.nami.org/getattachment/Get-Involved/NAMI-National-Convention/Convention-Program-Schedule/Hill-Day-2017/FINAL-Hill-Day-17-Leave-Behind-Appropriations.pdf

[2] Soni, A. (2015). Top five most cCostly conditions among adults age 18 and older, 2012: Estimates for the U.S. civilian noninstitutionalized population. Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. Retrieved September 18, 2020 from https://meps.ahrq.gov/data_files/publications/st471/stat471.shtml.

[3] Centers for Disease Control and Prevention (2018). Learn about mental health. Retrieved September 18, 2020 from https://www.cdc.gov/mentalhealth/learn/index.htm.

[4] National Alliance on Mental Illness. Mental health by the numbers. (2019, September). Retrieved September 22, 2020 from https://www.nami.org/mhstats.

The U.S. Preventive Services Task Force recommends that all people, starting at age 12, be screened for depression. Screening for depression helps find depression early. And early treatment may help you get better faster.

Depression is a disease. It’s not caused by personal weakness and is not a character flaw. When you have depression, chemicals in your brain called neurotransmitters are out of balance.

Depression causes adults and children to feel sad or hopeless much of the time. It’s different from normal feelings of sadness, grief, or low energy. Always tell your doctor if you feel sad or have other symptoms of depression. Many times, people are embarrassed by these feelings and say nothing. Depression can be treated, and the sooner you get treatment, the better your chance for a quick and full recovery. Untreated depression can get worse, cause other health problems, and may last for years or even a lifetime. It can have a serious impact on both you and the people you care about.

Adults

To find out if you are depressed, your doctor may do a physical exam and ask you questions about your health and your feelings. Some questions may not seem related to your mood. But your honest answers can help give the doctor clues about how depression may be affecting you. Your doctor may ask you about feelings of sadness, changes in hunger or weight, energy level, concentration, guilt, thoughts of death and suicide, sleep, general interest in everyday activities, and more.

Some diseases can cause symptoms that look like depression. So your doctor may do blood tests to help rule out physical problems, such as a low thyroid level or anemia.

Children and teens

Symptoms of depression in children and teens can be different from adult symptoms.

To find out if your child is depressed, the doctor may do a physical exam and ask your child about his or her health and about how he or she thinks, acts, and feels. The doctor may ask your child about grouchiness, temper tantrums, headaches, stomachaches, social withdrawal, and more. It is common for children with depression to have other problems, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. The doctor may ask questions about these problems too.

The doctor may also ask you or a teacher to fill out a form about your child’s symptoms.

Some diseases can cause symptoms that look like depression. So the doctor may do blood tests to help rule out physical problems, such as a low thyroid level or anemia.

For information about Magellan events during National Depression and Mental Health Awareness and Screening Month, downloadable materials and more free resources, visit our website here.

Adapted with permission from copyrighted materials here from Healthwise, Incorporated.  Healthwise, Incorporated disclaims any warranty and all liability for your use of this information.

This month we are sharing an earlier Thought Leaders interview with Patricia Smith about compassion fatigue, given the significant impact COVID-19 continues to have on caregivers across the spectrum, from hospital staff to family caregivers. We are reminded of Patricia’s interview and wanted to share it at a time when it could be so helpful to so many.

Patricia graciously agreed to us re-running her 2017 feature article, and was kind enough to write a new introduction. Many thanks to Patricia for her continued contributions to the field and in caregiver communities! Now, let’s hear from Patricia about compassion fatigue in today’s caregiver climate.

As I write this addition to the 2017 interview on compassion fatigue and caregivers, our world is in the grips of COVID-19. This pandemic has created worldwide confusion, anger, pain and suffering. My work over the past 20 years has been focused on caregivers in all of the helping professions, and family caregivers, as well. Now, with the trauma created by the virus, I consider all of us caregivers. Who hasn’t run errands for their elderly parents? Who hasn’t shopped and delivered the groceries to their elderly, ill or disabled neighbors? Who hasn’t sewn masks to be given out to their community members? Who hasn’t worked diligently in lockdown to prepare nutritious meals for themselves and their family members? Who hasn’t advocated what’s right and life-affirming on Facebook, Twitter and other social media? These, and many more actions and behaviors, define care-giving. It is more important than ever that each one of us begin our healing process. As difficult as that is in the eye of the hurricane, it is imperative if we hope to return to a healthy level of wellness, happiness and good health. Find time in each day for authentic self-care. Take a walk in nature, paint a picture, meditate, practice yoga, listen to music that stirs your soul, bake a cake and give half to someone who is weathering the storm alone, plant a vegetable garden, or sit in silence and be thankful for the good that remains in your life. All of these strategies define and promote healing.

Stay safe. Patricia

2017 Thought Leaders Interview with Patricia Smith on Compassion Fatigue

Magellan: Thank you for taking the time to participate in our virtual interview. Can you share with our readers some background regarding your interest and leadership in the area of compassion fatigue and burnout in the mental health and wellness field?

Patricia Smith: I first learned about compassion fatigue as the training and development manager at Humane Society Silicon Valley. After many years as a journalist, I decided I wanted to work with animals. Within the first two weeks in my new job, the executive director asked me to create a shelter-wide compassion fatigue training. I had never heard the term, and the only information I could find was the academic work of Dr. Charles Figley, who was then the director of the Traumatology Institute at Florida State University. I contacted Dr. Figley and he brought me through the process of understanding exactly what compassion fatigue is and how to address the symptoms. At that same time, I took the Professional Quality of Life Self-Test (https://www.proqol.org/ProQol_Test.html) created by Dr. Beth Hudnall Stamm, who also became a mentor. The test revealed that I suffered from very high levels of compassion fatigue. This started me on a journey that has lasted the past 20 years. After several years on my own personal healing journey, I created the Compassion Fatigue Awareness Project in hopes of helping others in the helping professions to understand compassion fatigue and how high levels can devastate a caregiver’s life. The scope of my work has grown beyond anything I could have imagined.

Magellan: You have done a great deal of work looking at aspects of compassion fatigue and burnout. What have you learned over the course of this work, and what recommendations would you make to peers to support their own wellness and to avoid compassion fatigue?

Patricia Smith: My own work has dovetailed with the amazing work being accomplished by professionals such as psychiatrists and psychologists in the field of traumatology and neuroscience. Powerful new information has come about from studies of the effect of trauma on our Wounded Warriors. Post-traumatic stress disorder is now a common phrase and the understanding of trauma on the human body, mind and spirit is widespread. These studies have branched out to include brain studies and how traumatic events impact our brains – and, more important, what we can do about it.

If, indeed, a caregiver suffers a high level of compassion fatigue, which is a secondary traumatic stress syndrome, the best path to take for healing is authentic, sustainable self care. The practices that promote wellness encompass the Standards of Self-Care: nutritious food, exercise, restful sleep, highly functional relationships and replacing toxic habits (smoking, alcohol, drugs, overeating, pornography, etc.) with healthy, life-affirming habits.

Magellan: Your studies/work around compassion fatigue and personal wellness are of particular interest to our readers, given their work in peer support. How can we influence modifiable lifestyle behaviors to improve individual well-being and battle compassion fatigue?

Patricia Smith: Re-wiring our brains to successfully improve the quality of our own lives takes work – lots of work. Healing is an inside job. We must go back in time to heal the wounds we have endured throughout our lives; one of the main causes of compassion fatigue is holding unresolved pain and suffering within. This takes a toll emotionally, but is well-worth the journey. The work involved in healing our wounds is nothing compared to the time, energy and emotional pain it takes to hold them at bay. Everything that has ever happened to us lives within. Pushing down the memories or ignoring them constantly elevates levels of compassion fatigue. Every time we experience additional trauma in our lives, which today is perpetrated everywhere – Facebook, TV news, newspapers— the new trauma hooks into the trauma that already exists. This pattern continues day after day in the helping professions and, eventually, a caregiver will become paralyzed with compassion fatigue. Businesses and organizations can do their part in helping caregivers to modify their lifestyles by educating their employees about compassion fatigue and putting healthy alternatives into place. This could include an edict wherein no business (emails, texts, phone calls) is conducted on weekends or evenings, encouraging mandatory vacations, providing healthy food alternatives in the cafeteria or vending machines, creating walking or biking groups, and other positive encouragement to promote wellness.

Patricia Smith is a certified compassion fatigue specialist with 20 years of training experience. As founder of the Compassion Fatigue Awareness Project©, she writes, speaks and facilitates trainings nationwide in service of those who care for others. She has presented to caregivers in numerous helping professions including social work, health care, law enforcement, chaplain services, suicide prevention and education, among many others. She has authored several books and training materials for caregivers, including the award-winning To Weep for a Stranger: Compassion Fatigue in Caregiving. She served as the caregiving expert for Spry magazine for several years. In September 2016, she presented a TEDx talk on the subject. Additionally, she was the 2012 and 2013 recipient of a writing fellowship at the Helen R. Whiteley Center, in Friday Harbor, Washington, a scholarly research center sponsored by the University of Washington in Seattle.

This is an excerpt from the Magellan Healthcare eMpowered for Wellness September newsletter. To read the full article, go here.

As if 2020 wasn’t already difficult enough with the stressors caused by the COVID-19 pandemic and protests over social justice issues, the upcoming election adds another level of anxiety for many people. A study published by the American Psychological Association in 2019 found that 56% of Americans, regardless of party affiliation, felt stressed about the upcoming presidential election.[1]  If you are feeling overwhelmed by the current political climate, you are not alone.

These feelings can have a negative impact on your emotional and physical health. Symptoms such as low energy, insomnia, loss of appetite, mood swings and tension are signs that you should not ignore. It is important to recognize what you can and cannot control as the election approaches.

You cannot control other people’s opinions, beliefs, reactions or how they express themselves. Nor can you control others’ votes. There are, however, many things you can control during and after the election:

• The amount of time you spend on election news and discussions. While the 24-hour political news cycle on television, radio and the internet is almost impossible to escape, you can limit the amount of time you spend on media each day.
• The coverage, feeds and groups you follow. When you are watching or reading election coverage, avoid negative-leaning discussions, especially if you feel constantly frustrated or upset by them.
• How you interact on social media. Avoid giving angry or emotional responses to posts that do not align with your views. You are unlikely to change other people’s opinions; you are more likely to get unwanted and hostile feedback.
• The time you spend with people. Prioritize your relationships with positive family and friends. Strong social connections can reduce stress and help you feel happier and more energetic. If you and a friend or family member have differing political views, try not to discuss them.
• How much you talk about politics at work. A February 2020 Gartner survey found that 78 percent of employees talk about politics at work; a third of those employees find the conversations stressful or frustrating.[2] Limit or avoid political discussions at work. When you do engage, treat colleagues with kindness and respect, and be aware that political discussions can hamper teamwork and productivity.
• How you deal with stress. Whether it’s meditation, going out in nature, reading a book or working on a hobby, take time every day to do something that makes you feel good. Make sure you get enough sleep and exercise, eat a healthy diet, and avoid using alcohol or drugs to cope.
• How you use your time and talents. Give your time and skills to a cause you believe in. If you have a strong interest in a political cause or candidate, offer to help with a campaign or other event.

Remember that professional help is available through your EAP if stress and anxiety about the election start negatively impacting your quality of life.

[1] https://www.apa.org/news/press/releases/2019/11/americans-significant-stress

[2] https://www.cnbc.com/2020/02/18/47percent-of-workers-say-the-2020-election-has-impacted-their-work.html

It’s hard to comprehend how much the world has changed since the beginning of the COVID-19 pandemic. It has turned our lives upside down in many ways, from school and business closures to quarantines and social isolation. With no clear end in sight, it is not surprising that many people are having difficulty getting used to the “new normal” that is far from what normal life once was.

Families face the challenges of online and home schooling, and the coming school year brings more uncertainty.  In addition, many people are experiencing financial strain from reduced working hours or job losses. Workers may have to work from home and adapt to an entirely new way of working, with little social interaction.  For some workers, juggling parental and domestic duties with the demands of work has been very stressful. Over time, chronic stress can lead to burnout.

Symptoms of burnout include feeling physically depleted, emotionally exhausted and negative about work.[1]

The signs of burnout are similar to those of depression. If left untreated, burnout can lead to physical illness and mental health problems, such as depression and anxiety. Here are some practical tips to manage burnout:

• Set boundaries between work and private life. If you work from home, set clearly defined working hours and a specific work area.
• Take breaks during the day and build transitions in your life between the start of work and the end of the working day. For example, making a transition to work can be as easy as getting a cup of coffee each day and logging into your computer at the same time. To end the day, practice a daily routine such as checking your emails, reviewing priority tasks for the next day and logging off your computer.
• Take your well-earned time off. Even if the pandemic kept you from going somewhere for vacation, a planned “staycation” will allow you to enjoy the well-deserved rest and relaxation. It is important to recharge; you will feel refreshed when you return to work.
• Don’t forget to socialize. When your colleagues start working from home, you may miss the casual social interactions had throughout the day. Like any skill, use it or lose it. Socialization in a time of pandemic takes effort to maintain.
• Make self-care a part of your daily routine. A healthy diet, getting enough sleep and maintaining an exercise schedule can help you cope with and reduce stress.
• Maintain consistent family routines. A regular routine can help all family members feel more focused and productive. If your child is at home learning online either full or part-time or you’re home-schooling, set consistent times for meals, schoolwork, other activities and bedtime.

Help is available. Your program is completely confidential and here to help you and your household members 24/7/365. No situation is too big or too small. Give us a call or visit your program website to get started.

[1] https://www.who.int/mental_health/evidence/burn-out/en/

Technological and scientific advancements have dramatically altered the treatment landscape in several disease states. These include orphan diseases and conditions that previously had no disease-modifying treatment options. These innovative therapies have also come with unprecedented costs, with some agents introduced at a price exceeding one million dollars for a single patient. Value-based purchasing arrangements (VBPs) have attempted to manage the initial cost of these agents. In a VBP, which is sometimes referred to as an outcome-based arrangement, the ultimate price that is paid for the drug is dependent on the clinical outcome. In addition to a plan’s traditional utilization management initiatives to maintain sustainability, this strategy aims to hold pharmaceutical manufacturers responsible for the result of their product. This is similar to other healthcare environments, such as when readmissions impact hospital reimbursement. Under VBPs, a pharmaceutical manufacturer would issue a reimbursement if their product failed to produce the desired clinical outcome. In addition, this strategy incentivizes the development of unique therapies that are more likely to have a clinically significant impact. Novel medications that improve outcomes would provide a greater healthcare value and could be priced higher in the market. Currently, volume is a large driver of cost, with discounts from pharmaceutical manufacturers often tied to the number of units dispensed. This is less helpful for niche-area pharmaceuticals and genuinely innovative treatments used for uncommon conditions.

Practical considerations of VBPs, such as a higher administrative burden (e.g., paperwork, electronic database access, automated retrieval of data), limit their application to all products. Since it can be expensive to measure outcomes in order to assess the worth of a product to an individual patient or plan, VBP concepts are most commonly applied only to the costliest medications. For instance, VBPs can have a significant impact on the pricing of agents like gene therapy or select oncology agents. Some of these agents can have a large clinical impact on disease progression, survival, or quality of life, but a drug may not have the same results in all patients. However, value-based or outcome-based pricing may provide an increased incentive to payers by decreasing their initial risk and providing more sustainable treatment coverage.

While there has been an increase in the use of VBPs by states, manufacturers, and other payers in order to control drug spending and tie patient outcomes to cost, uncertainty remains in developing novel VBPs. The Medicaid Drug Rebate Program (MDRP) created by Congress under the Omnibus Budget Reconciliation Act of 1990 ensures that Medicaid receives the lowest net price for a single source drug or innovator multiple source drug during the rebate period charged to any payer. Simply put, pricing net of all discounts, must be reported to Medicaid, and the best price would have to be offered to Medicaid as well. It is critical that Medicaid programs continue to receive the lowest price available for a single source drug or innovator multiple source drug.

On June 19, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that is aimed at promoting VBP flexibility for a variety of payers, including Medicaid, with a goal of maintaining a best price for Medicaid. CMS notes that best price creates challenges related to the availability of VBP arrangements. For example, under existing best price rules, if an individual fails to achieve the specified clinical outcome under the VBP arrangement, the drug manufacturer may be required to provide a discount or otherwise may not be entitled to payment for that patient. Thus, the best price of that drug for purposes of the MDRP could become zero. This possibility has stunted the development and proliferation of VBPs. This new proposal from CMS, which includes other regulatory revisions as well (e.g., minimum standards for Drug Utilization Review [DUR] programs), could ultimately lower healthcare costs and potentially limit spending on treatments with limited value over time.

The ultimate goal of a VBP is for all parties to have a vested interest in the outcomes of drug therapy and to share the risk related to healthcare costs. Specifically, it calls on manufacturers to have more “skin in the game.” Moreover, the change to the Medicaid market could have potential savings applicable to a variety of market segments, impacting all Americans. Regardless of the final outcome or any changes made to the current draft prior to its possible rollout, the proposal demonstrates readiness from CMS to pivot prior strategies to mitigate rising drug prices.

As our country continues to navigate the coronavirus pandemic and social distancing, a new concern has emerged – avoiding and delaying medical help when necessary, also known as medical distancing. Maintaining physical and mental health during the current pandemic is essential. If you are feeling ill, need a routine medical check-up, or have severe feelings of anxiety or depression, please seek medical attention.

Stop Medical Distancing 

It’s important that you feel safe and get the care that you need, when you need it. Here are some helpful tips to safely receive medical attention while social distancing:

1.  Mask Up– The Centers for Disease Control and Prevention have asked all Americans to wear a cloth face covering to help prevent the spread of the coronavirus. Medical facilities require patients, staff, and providers to wear a mask to protect you and your community. Take part in the fight against the coronavirus by complying and wearing a mask, too.

2.  Distance Yourself– When you are waiting to be seen by your physician, ask if you can wait outside or in your car. If you have to stay inside, do your best to distance yourself from other patients, visitors, and staff. When returning home, avoid being in the presence of those most vulnerable to coronavirus.

3.  Sanitize– Medical facilities are regularly cleaning waiting areas and exam rooms between each patient. Hand washing and sanitizing your hands before and after your visit is a must to protect yourself and your family from getting sick. Keep hand sanitizer in easy-to-reach places so you don’t forget, such as your bag, purse, pocket, or in your car.

4.  Limit Visitors– To create a safe environment, many medical facilities have implemented restrictions and limitations on visitors. This helps protect you and other patients who are vulnerable to the coronavirus. Going to the doctor alone can be scary and intimidating – but it’s essential to limit friends of family members from going with you when it can be avoided.

5.  Go Digital– If you’re still not comfortable with face-to-face visits or don’t need to be physically seen by a doctor, you should optimize telemedicine or telehealth services. These are appropriate and efficient means of connecting with your provider in the comfort of your own home.

6.   Trust– Finally, trust your doctor and know that your safety is their number one priority. As the pandemic continues, medical facilities are adjusting the way they deliver health and enhancing their procedures and protocols.

Protecting yourself from the coronavirus does not need to get in the way of your overall health and well being. #Stopmedicaldistancing

Written by Thomas Lane, NCPS, CRPS

Every 40 seconds someone dies by suicide somewhere in the world.[1] The human tragedy of death by suicide is getting worse, with global suicide rates increasing 60% in the past 45 years.[1] Most people reading this article will know someone who has been impacted by suicide. One group of folks especially at risk for a suicide attempt are those who have tried to complete suicide previously. Data suggests that 20% of attempt survivors will make another attempt.[2]

I am one with personal experience. I am part of that 20%. As a double attempt survivor, I have haunting memories of those periods in my life when I was more fearful of living than I was afraid of dying. For me, those were the darkest, loneliest, and longest days of my life. After my second attempt in the winter of 1998, I wound up on a ventilator. I was in a coma for 12 days and when I woke up, I felt like someone was choking me. And I was angry. At the time, when I was literally regaining consciousness and coming back to the land of the living, my mom was downstairs with hospital administrators signing an agreement to discontinue life support for me.

As the saying goes, timing is everything.

After a lengthy and very shaky period, I began to get better. I was receiving good mental healthcare, redefining my circles of support, and I had a purpose. I came to believe I still had work to do. Now. On this planet. I had twice crossed the line of deciding I could not be here. Despite my best efforts, I was still here, facing my life. I decided I would seek meaning from as many of my experiences as I could. For the past 20-plus years, I have worked to build and advance peer support, particularly within the context of publicly funded healthcare systems, but also at the grassroots level and through public/private partnerships. I am more convinced than ever of the value, importance and unique perspectives folks with lived experience bring to the table, specifically those who choose to pursue careers as peer specialists. It has been and continues to be a transformative movement, even more so when we understand that many folks who make a choice to work in the peer support field, in the same delivery systems that may not have served them well, do so out of a passion for the work and to give back, to pay it forward.

I share this very personal experience as context for my next point.

In a 2016 survey of Magellan members receiving peer support services, 98% reported their certified peer specialist helps them to, both, improve their quality of life, and feel hopeful about their recovery.[3] Knowing what we do now about the effectiveness of peer support, and understanding the value of lived experience, I believe we can agree about the importance of connecting attempt survivors with peer supporters who have had similar experiences. For most, if not all, attempt survivors, there is a crucial time period after an attempt; I needed intensive support in the days following my second attempt. Sadly, intensive support is not always available, let alone offered by a peer who is also an attempt survivor. I can’t help but wonder, what would universal referral to, or at least an orientation about, peer support opportunities by and for attempt survivors, look like? Considering the COVID-19 pandemic, we have seen a rapid, albeit sometimes rocky, migration to technology-enabled service delivery. Interestingly, peer support has been “technology-enabled” for years in the form of peer-operated warmlines. If you’re not familiar with warmlines, check out the National Empowerment Center at https://power2u.org/peer-run-warmlines-resources/ for great information.

When we consider suicide, we know it is all about prevention, that is, preventing people from attempting to take their own lives. I don’t believe there is a higher calling. Many of my peers with the shared experience of being an attempt survivor have expressed to me this is the most important work they do. We see the positive impact of attempt survivors speaking out about their experiences. We see the importance of eliminating shame associated with the topic of suicide. We know suicide is preventable. We understand that prevention requires dialogue, and dialogue isn’t always comfortable. Nonetheless, the topic of suicide must be brought out of the shadows and recognized as the public health crisis it is, one that we can do something about through evidence-based prevention and education practices. We know it does not increase a person’s likelihood of attempting suicide to talk with them about what they’re feeling. Fortunately, there are many, many organizations pledged to this work. From grassroots organizations founded by survivors of suicide loss to nationally recognized organizations, the conversation is changing. We must continue to be intentional in our approach.

National Suicide Prevention Awareness Month helps shine a light on this often misunderstood and taboo topic. Let’s keep the conversation going for the other eleven months of the year. As peers, let’s renew our commitment to offering support, speaking out and holding the hope for someone until they are able to hold it for themselves. As fellow human beings, let’s take inspiration from Emily Dickinson, and tap the eternal hope perched in all of us.

“Hope is the thing with feathers, that perches in the soul

And sings the tune without the words

And never stops…at all.”

For information about Magellan events during Suicide Prevention Awareness Month, suicide prevention downloadable materials and more free resources, visit our suicide prevention website.

[1] https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

[2] https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1317-z

[3] Magellan Peer Support Services Outcomes in Pennsylvania, 2016