“Just recognizing that somebody is having a bad day is a suicide prevention technique” explained Judy Davidson, a nurse researcher involved in a three-pronged suicide prevention program at the University of California San Diego (UCSD).
A recent report released in the UK showed that 300 nurses died by suicides during the last seven years. Similar data for the US are not available and researchers concluded that nurse suicide in that country was “shrouded in silence, avoidance, and denial”.
Nurses at high risk of suicide
Nurses work exhausting hours, often short-staffed, at duties that are complex and with an ever-present possibility of errors. There is also the emotional toll of tensions between co-workers, bullying, and violence from patients.
Furthermore, nurses experience emotional stress from deaths and trauma almost on a daily basis. They’re expected to just carry on with their work, without the debriefing offered to those in other occupations such as police and firefighters.
These circumstances put nursing staff at a high-risk burn-out, caregiver fatigue, and depression – all of which could trigger the worst case scenario of suicide.
Let’s take a look at the suicide prevention strategies used at UCSD which consists of three interlinked programs: Code Lavender, a Caregiver Support Team, and the Healer Education Assessment and Referral (HEAR) program.
Code Lavender
Code Lavender kit contents. Image via: researchgate.net
Code Lavender involves simply reaching out to a coworker, acknowledging that one is aware that they’re going through a rough patch – either personally or after a particularly bad workplace experience. Code Lavender doesnt prevent burnout or stress but is rather akin to psychological first aid.
One is often at a loss for words of support when you want to reach out to a stressed-out colleague. Code Lavender consists of a packet with a comforting message, a bar of chocolate, lavender essential oil, and a referral card for employee assistance. There’s also a starfish sticker that the nurse can put on their uniform to show that they’re feeling fragile.
A coworker gives this token a colleague to show that they’ve noticed and care – and to possibly nudge them to seek professional help if they need it. Even this small act of kindness can help to prevent suicide.
After the pilot project with Code Lavender, Davidson and her colleagues found that there was an improvement in self-reports of feeling cared for. All those who had received the Code Lavender intervention reported that they had found it helpful and 84% recommended its wider use.
Caregiver Support Team
The introduction of the Caregiver Support Team initiative was an extension of the Code Lavender project. While team members don’t give professional counseling, it’s described as providing emotional first-aid in the workplace.
A survey was conducted to identify persons whom staff felt they would turn to for emotional support at times of stress. These nominees were invited to become peer supporters. They had eight hours of training by a psychologist, which included how to recognize the signs of burnout, depression, and risks for suicide. They were then encouraged to actively identify and reach out to staff in crisis.
At the end of the pilot project, 40% of the respondents had received intervention by a member of the Caregiver Support Team and all reported that it had been helpful and that they would recommend it to others.
At least one suicide had definitely been prevented after a peer supporter had reached out and was able to set a process in motion which concluded in a professional intervention. Staff had also started to proactively contact peer supporters for emotional debriefings.
HEAR program
The Healer Education Assessment and Referral Program (HEAR) had been running for seven years for medical practitioners at UCSD when a number of nurse suicides prompted its extension to nursing staff in 2016. The aim of this program is to get those who need it into mental health treatment.
The program has two components. Firstly, educational presentations are provided to create greater awareness about depression, burnout, and suicide among healthcare staff, and to emphasize that it’s okay to seek treatment for mental health issues.
The second part is a digital survey tool which is sent at least once a year to all healthcare staff. The questionnaire is used to identify at-risk individuals and to help them connect to mental health services. Respondents can choose to remain anonymous until they themselves choose to connect to the counselor for a referral.
The counselors also arrange appointments to avoid the possibility of delayed treatment or that the person gives up when they can’t get an appointment with a therapist after a number of unsuccessful few phone calls.
A culture of caring and action
According to Davidson, the success of these programs is that they are pro-active. It reaches out to people as opposed to employee assistance programs that wait for staff to contact them.
Who developed a similar peer support program in Missouri, explained that the peer-initiated intervention eventually changed staff attitude towards work stresses. “What we’ve seen now in 10 years,” she said, “Is that we now have this culture of supportive presence for staff.”
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