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

We are excited to re-introduce our Thought Leaders series with Dr. Karen L. Fortuna, one of the world’s leading researchers and activists focused on digital peer support and the role of technology in recovery. As a result of COVID-19, technology-enabled peer support has become the norm and vitally necessary to ensure continuity of care. We hope you enjoy our exclusive, virtual e-interview with Dr. Fortuna as she shares her unique insights about the transformation of peer support.

Dr. Fortuna holds a doctorate in social welfare and a master’s degree in social work. She is an Assistant Professor of Psychiatry in the Geisel School of Medicine at Dartmouth College. Her primary research interest is service delivery strategies for older adults with serious mental illnesses and chronic health conditions. Dr. Fortuna is using community-engaged research methods to develop and implement peer-supported mobile health (mHealth) intervention. Dr. Fortuna was awarded a NIMH K01 award (K01MH117496), a NARSAD Young Investigator Grant from the Brain and Behavior Foundation, the Alvin R. Tarlov & John E. Ware Jr. Award in Patient Reported Outcomes, and the Gerontological Society of America’s AGESW Faculty Achievement Award. Dr. Fortuna served on the International Standards Advisory Committee to develop the first-ever international accreditation standards for behavioral healthcare for older adults. Dr. Fortuna also serves on the American Psychiatric Association expert advisory panel on smartphone apps.

Dr. Fortuna led the development of the first digital peer support curriculum to equip older adult peer supporters with the skills and knowledge to offer digital peer support. The Digital Peer Support Certification was co-produced with Dartmouth scientists and peer support specialists and has been found to be an effective knowledge translation training that has shown to increase peer support specialists’ capacity to use digital peer support in practice (http://digitalpeersupport.org/).

And now, let’s hear from Dr. Fortuna!

Magellan: Dr. Fortuna, thank you so much for your time. Can you share what brought you to this field?

Dr. Fortuna: Thank you! My background is in social work. I went into this field because my dad had multiple sclerosis and he was very sick as I was growing up. People treated him like he was different just because he was in a wheelchair. I would say he was marginalized—but, to me, he was always just my dad—not different—not helpless—one of the most amazing and capable people I have ever known in my life. So here I am. Working with peer support specialists that may have at one point in their life been viewed as “different” or “helpless” and I work with peer support specialists to accomplish things they maybe never thought possible.

Magellan: You are recognized as one of the world’s leading researchers into the area of digitally delivered peer support. What drove your interest in pursuing this topic?

Dr. Fortuna: My initial exposure to mental health services began in the first year of a Masters in Social Work internship at the University of Pennsylvania. During this internship, I provided group-based self-management training to adults with a lived experience of a mental health condition and chronic health conditions. During this experience, I was impressed by the severity of disabilities that continued to be present for adults with a lived experience of a mental health condition despite participation in evidence-based programs. I subsequently pursued a volunteer opportunity with Dr. Mark Salzer to learn about efforts to improve the effectiveness of interventions for people with a lived experience of a mental health condition; in addition to being introduced to community-based research and peer support specialists.

As a result, I have developed an understanding of the history of the peer recovery movement, peer perspectives and theories of service delivery—and I saw recovery for the first time. I was sold! Recovery is real! This experience laid the foundation for my research career focused on digital peer support as an innovative service delivery strategy. Digital peer support is defined as live or automated peer support services delivered through technology mediums.

Magellan: One of the hallmarks of your work has been using a co-design approach, working collaboratively with persons with lived experience to inform your projects. Would you share with our readers what co-design is and why you choose this approach?

Dr. Fortuna: Co-design is a partnership in research that promotes shared decision making in all aspects of the research process. Our model, the Peer and Academic Partnership, supports collaboration, engagement, shared decision-making, principles of reciprocal relationships, co-learning, partnership, trust, transparency and honesty. We use this co-design approach because peer support specialists bring new insights and energy to our research that our team believes will lead to the next discovery in the social sciences. Plus, it’s fun! I have an amazing group across the globe that I work with!

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

As the COVID-19 pandemic continues, and social distancing becomes the new normal, we have seen rapid expansion of digitally delivered peer and family support. In this post, we explore emerging issues and considerations for using technology to reach others.

The use of technology to offer peer support is a practice that has been around for quite a while. Think about telephonic peer support via peer-operated warmlines. A from December 4, 2019 said this about warmlines:

“Unlike a hotline for those in immediate crisis, warmlines provide early intervention with emotional support that can prevent a crisis.”

Magellan has long been a supporter of peer-operated warmlines and has helped launch warmlines in multiple states.

You can find more information about warmline availability by state at www.warmline.org or by visiting the National Empowerment Center’s directory of peer-run warmlines.

As opportunities for in-person, face-to-face support have decreased, many peer-run organizations, along with traditional mental health providers, have shifted delivery of services to telehealth platforms. Yet, during this unprecedented COVID-19 public health crisis, we see increased demand for support from folks living with anxiety and depression. As more families are impacted by the pandemic, access to peer support is more critical than ever.

Peers have been quick to step up with a national grassroots-driven expansion of support via video conferencing platforms like Zoom. With this rapid expansion, however, we see wide variability in practices. Skills learned by providing in-person peer support do not necessarily translate onto a digital delivery platform. Individuals who are used to seeing a peer supporter in person may have a different experience when it’s offered through technology. In some cases, apps that purport to offer peer support are actually “peer-bots,” with real-time interactions being driven by algorithms and predictive analytics.

Fortunately, solutions to address the nuances of digital peer support have been developed. One of the most beneficial is training in digital peer support. Magellan partnered with Dr. Karen Fortuna to provide specialized training to our team members who provide peer and family support. Many other organizations and agencies have completed this training as well. It’s an important and necessary step to take as we navigate this new normal.

If you want to learn more about the state of practice relevant to digitally delivered peer support, check out this article from the April 2020 Journal of Medical Internet Research by Dr. Fortuna, Digital Peer Support Mental Health Interventions for People With a Lived Experience of a Serious Mental Illness: Systematic Review.

As we learn more about what works and what could be improved with peer support services via telehealth, we are paving new ground. What we do over the coming weeks and months will set the trajectory for digitally delivered peer support.  Let’s make sure we get to where we want to go safely, respectfully and responsibly.

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