By Varun Choudhary and Greg Dicharry

The impacts of suicide on population subsets

Suicide is a leading cause of death in the US.[1] It has become the hidden epidemic in our society that is spreading with the COVID-19 pandemic. Statistics show certain populations are more vulnerable than others. While a recent study shows that 11% of adults seriously contemplated suicide in June 2020, the same was disproportionately reported by young people aged 18 to 24 (26%), Hispanic people (19%), Black people (15%), unpaid caregivers for adults (31%) and essential workers (22%).[2]

Medical professionals have historically been at higher risk for suicide than those in most other professions.[3] Over 400 physicians a year commit suicide, yet the cause for such tragedy is not addressed.[4] A recent example was the suicide of Dr. Lorna Breen, the 49-year-old medical director of an emergency department in New York, who felt like she was drowning amid trying to save lives during the COVID pandemic. She had no history of mental illness and was considered an exemplary physician before succumbing to trauma of witnessing so much death.

Suicide has also been a silent killer within our military for several years, as troops dealing with trauma are unable to get the care they need. This was the case with the recent suicide of 34-year-old Master Sergeant Andrew Christian Marckesano, who had served six full tours in Afghanistan and was nicknamed the real “Captain America.” We must take a proactive approach to suicide prevention so we can help these heroes before they become tragic statistics.

Magellan’s approach to suicide prevention

Magellan is a national leader in suicide prevention and is addressing this health crisis that is devastating so many individuals, families and communities. We believe the first and foremost action that must be taken is to destigmatize the need to ask for help. There is still an ingrained culture in medicine and the military, as examples, that it is a weakness to address mental health needs. We need to build a culture of acceptance and promote the concept that reaching out is a strength, not a weakness. Changing this paradigm will take the effort of many mental health agencies and organizations.

Magellan is here to lead the initiative and use our expertise to bring awareness and training through a preventive model that pushes a zero-suicide approach. We were very successful in launching this campaign in Maricopa County, Arizona, and received international recognition for its effectiveness in reducing suicide. We are working with other organizations to promote this approach, so communities are aware of the signs and warnings of potential suicide, know how to engage suicidal individuals and are able to address the acute mental health needs of these individuals before they escalate.

In recent years, we have had the privilege of hosting a series of suicide prevention summits in Pennsylvania, Florida and Idaho. These events have brought together over 1,000 local and national leaders to exchange ideas, share successes and discuss solutions around the challenges we face together in addressing this crisis in our communities. In addition to this work, Magellan regularly supports local suicide prevention efforts in communities we serve, including sponsoring and participating in annual American Foundation for Suicide Prevention (AFSP) Out of the Darkness Walks around the country.

The Hope Rising for Suicide Prevention virtual summit, September 26, 2020

Most recently, we have established an internal suicide prevention innovations team to develop and implement a plan to enhance our suicide prevention efforts to create more awareness, training opportunities and support for our employees, members, providers, customers and the communities we serve.

Magellan is officially launching the initiative this month for National Suicide Prevention Awareness Month with the Hope Rising for Suicide Prevention virtual summit. This event is being planned and hosted in partnership with the nation’s leading suicide prevention organizations, including the National Suicide Prevention Lifeline, LivingWorks, American Association of Suicidology, Zero Suicide Institute, and numerous other national and international suicide prevention and mental wellness experts, lived experience advocates and people new to suicide prevention to share inspiration, information, wellness techniques and best practices.

This uplifting virtual event will empower attendees with the motivation, skills and resources needed to positively impact suicide prevention efforts in their communities.

Hope Rising for Suicide Prevention is just the beginning, as Magellan continues to create and support impactful suicide prevention initiatives that will help people find the hope and help they need to stay alive and thrive.

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

[1] https://www.cdc.gov/vitalsigns/suicide/

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

[3] https://www.healthline.com/health/mental-health/healthcare-workers-suicide-covid-19#3

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526882/

People from all walks of life drink to cope with stress from work. While the rate of alcohol abuse varies by industry and occupation, no workplace is immune. In the short term, drinking can result in feelings of relaxation, but ongoing reliance on alcohol to manage stress often leads to physical and psychological problems.

Prevalence of Binge Drinking

According to the 2017 National Survey on Drug Use and Health (NSDUH), 26.4 percent of people ages 18 and older reported that they engaged in binge drinking in the past month, and 6.7 percent reported heavy alcohol use in the past month. Binge drinking is defined as having 5 or more drinks within 2 hours for men, and 4 or more drinks within 2 hours for women. Heavy alcohol use is defined as binge drinking on 5 or more days in the past month, or 60 days a year.

Binge drinking has been on the rise over the past twelve years, particularly in women ages 30 to 44. While most excessive drinkers don’t meet the clinical criteria for alcohol dependence, binge or heavy drinking can still take a toll on workplace productivity, health, and relationships.

A Paradoxical Effect

Using alcohol to relieve stress and anxiety can have a paradoxical effect. Drinking may provide temporary feelings of relaxation, but habitual use alters the balance of chemicals in the brain that regulate mood. Alcohol can contribute to and worsen symptoms of depression, anxiety and other mental health disorders, and it can interfere with sleep. It becomes a vicious cycle: the person drinks in response to stress, feels worse later on, and turns to alcohol again to avoid dealing with painful feelings instead of learning healthy coping skills.

Drinking to self-medicate can also have serious health consequences. Heavy drinking is linked to higher risk of developing an alcohol use disorder or alcohol addiction, characterized by tolerance, withdrawal symptoms, strong cravings and an inability to cut down on drinking. Other medical conditions associated with excessive drinking include heart and liver disease, stroke, high blood pressure and cancer. Long-term alcohol use can also cause neurological problems such as cognitive deficits and dementia.

Impact on Employers

Most people who drink excessively or have an alcohol use disorder are employed, and many try to hide the problem. Nevertheless, U.S. companies lose billions of dollars a year due to lost productivity, workplace accidents and injuries, absenteeism, and illness related to employees’ alcohol and drug use.¹

An Employee Assistance Program is a valuable resource for employers. EAPs are designed to address work-related stress, substance use, mental health issues and other problems that negatively impact employees’ well-being and job performance. Besides offering confidential counseling and referral services for employees, EAPs can provide a range of health promotion activities and help for supervisors dealing with troubled employees.

¹”National Drug-Free Workplace Alliance.” National Drug-Free Workplace Alliance, https://www.ndwa.org/drug-free-workplace/industry-statistics/.

The following is an excerpt from the 2018 Magellan Community Impact Report.

Standing tall is a tall order. How do  you know what the right thing is? Answers aren’t often cut and dried. Instead, we know by having lived through similar, difficult experiences ourselves and standing beside those we support—standing together as peers on the path to recovery.

Living through the same kinds  of challenges

Magellan’s recovery support navigators represent our best practice approach to tapping the power and potential of peer support. Peer support is an evidence-based practice, and numerous studies continue to validate the effectiveness of these supports. Recovery support navigators are professionals who have lived experiences with some of the same challenges our members face. They have experienced substance use disorders or psychiatric disabilities and may have personally been homeless, had their utilities turned off or experienced food insecurity. They can relate to the members they support, empathize, and then draw on real-world solutions to help them.

Sharing our stories

Every day recovery support navigators show up and not only listen to and support our members, but also share pieces of their own stories to inspire hope and change. Dana Foglesong, director of recovery and resiliency services for Magellan Complete Care of Florida, knows first-hand the transformative power a peer specialist can have. She knows not just because she has been certified as a peer recovery specialist since 2010, but because Dana had the support of a peer support specialist herself.

Dana describes her journey: “In my late teens and early twenties, I bounced from state hospitals to crisis stabilization units. I was desperate to end my life. I had no hope that my former goals could ever be realized. When I started working with a peer specialist, I began to view myself and my future more positively. My peer specialist expected me to recover and connected me to the resources that empowered my recovery process.”

Dana not only recovered—she has thrived! She recently completed a master’s degree in social work and leads Magellan’s diverse team of recovery support navigators. She has been awarded for her commitment to providing help and hope to others, including for her work founding the Peer Support Coalition in Florida, which expands leadership, advocacy and employment opportunities for people, like her, with lived experience. Dana describes her life now, saying: “At Magellan, I have the opportunity to do such meaningful, passion-filled work. It keeps me inspired and grateful to be a part of helping our members lead healthy, vibrant lives.”

Leading the way

Magellan was the first managed care company in the United States to recognize and incorporate peer support services into the continuum of care. Since 1999, we have been a leader in increasing access to peer support through partnerships with the recovery community and providers. We have assisted state customers in developing robust certified peer specialist capabilities, driven in large part by our depth and breadth of experience. Magellan continues to create shared learning opportunities for the peer workforce and others to improve and enhance the knowledge, skills, and competencies of the peer workforce.

The following is an excerpt from the 2018 Magellan Community Impact Report.

It is estimated that 130 Americans die every day from an opioid overdose. The opioid epidemic has become a national crisis and is continuing to grow rapidly, affecting families in every city across our nation.

No one is exempt from experiencing the effects of the opioid crisis. Magellan’s own Janet Edwards, RN, senior clinical director of Magellan’s Chronic Pain Management program, describes how close to home the opioid epidemic hit her:
It is estimated that 130 Americans die every day from an opioid overdose. The opioid epidemic has become a national crisis and is continuing to grow rapidly, affecting families in every city across our nation.

“My daughter, Nikki, was 26 when she  died of a Fentanyl overdose. As the mother of a six-year-old and a critical care nurse working in a respected healthcare organization, Nikki was the picture of success. But to handle the pressures of nursing school, a full-time job, and life as a single mother, Nikki sought prescriptions for Adderall and Xanax from multiple physicians. Over time, her addiction to these substances gave way to a new addiction: Fentanyl, which she began to confiscate from the critical care unit where she worked.
Like many others, Nikki didn’t show any signs of addiction. But five years after her son was born, Nikki sat at my kitchen table and admitted that she was addicted to heroin. She was afraid to get help, because she did not want to lose her job or the respect of her peers. She insisted she could recover on her own. Even though I, as a nurse, knew the odds were not good that Nikki could manage her recovery alone, I respected my daughter’s wishes. It’s a decision I will forever regret. Eleven months later, Nikki died of an accidental overdose in front of her son and a friend.”

Following the loss of her daughter, Janet has openly shared Nikki’s story, becoming an advocate for helping prevent opioid addiction. Further, Janet has taken on clinical leadership of Magellan’s Chronic Pain program, which offers alternatives to opioid use.

Meeting opioid users where they are

No matter where or how someone encounters opioids or where they may be in the cycle of use, dependence or addiction, Magellan offers many other ways to address the opioid problem. Our behavioral health products forged from decades of serving the public, our specialty healthcare solutions supported by clinical excellence, and our customized pharmacy programs are ready to answer the call as organizations and individuals look for answers.
Hosting a forum for sharing successes  and discussing solutions

In September 2018, Magellan brought together  national and local leaders in Pennsylvania to  exchange ideas, share successes and  discuss solutions to the opioid  epidemic in our communities.  The free, second-annual  conference featured  keynote addresses and  workshops and highlighted  the proactive efforts of local  organizations. Participants included  national and state officials, county human  services and drug and alcohol leaders, legislative  staff, providers and community stakeholders.

Not staying silent on the silent epidemic

Magellan is actively helping individuals and families on their path to recovery. Further, to educate the public, doctors and other healthcare providers, we offer resources on our Magellan Health OPIOID INSIGHTS microsite. The site includes links to blog posts, videos, resources and published articles.

Hosting a forum for sharing successes and discussing solutions

InSeptember2018, Magellan brought together national and local leaders in Pennsylvania to exchange ideas, share successes and discuss solutions around the challenge we face together in addressing the opioid epidemic in our communities. The second-annual conference featured keynote addresses and workshops and highlighted the proactive efforts of local organizations. Participants at the free one-and-a-half-day conference included national and state officials, county human services and drug and alcohol leaders, legislative staff, providers and community stakeholders.

While there have been significant drug shortages in the past as a result of unforeseen circumstances, such as Hurricane Maria’s effect on Puerto Rico’s drug manufacturing facilities in 2017, drug shortages often crop up and continue despite no obvious reason. The ongoing shortage of vincristine, an older, traditional chemotherapy agent used for several cancers, has compelled tough decisions by providers and families. In some cases, there are few other treatment options for patients or the treatment regimen is incomplete without vincristine. Other shortages, including those for heparin, critical antimicrobials, and immunoglobulin, have also made national news. The United States (US) Food and Drug Administration (FDA) monitors and reports drug shortages and has historically worked with manufacturers and public health partners to mitigate the impact of shortages. For instance, during Hurricane Maria, the FDA allowed temporary importation of certain products from select manufacturers and worked to expedite reviews of drug applications that could alleviate shortages of affected medications. According to the FDA, the biggest causes for drug shortages are quality or manufacturing issues (37%), lack of raw materials (27%), and manufacturing delays and capacity concerns (27%).

Due to the ongoing issues associated with drug shortages and prompting from a bipartisan Congressional group in June 2018, the FDA developed an interagency Drug Shortages Task Force. This group was tasked with studying shortages, determining their root causes, and developing strategies to limit the occurrence and widespread effect of drug shortages. The Task Force evaluated products that were affected by a shortage between 2013 and 2017 and solicited public and key stakeholder feedback. In late October 2019, the FDA issued a press release announcing the publication of a report from the Task Force entitled, “Drug Shortages: Root Causes and Potential Solutions.” Notably, the Task Force confirmed that drug shortages not only persist but also have continued to rise again recently since falling from their peak in 2011. As an example of their impact, the group highlighted select medications whose shortages have had a significant clinical impact (e.g., pediatric oncology medications, medications for septic shock). Of the 163 drugs in shortage they analyzed, 63% were sterile injectables and 67% were products available as a generic. The median time since first approval was nearly 35 years and most were considered relatively “cheap,” as they were several years off-patent (median price of $2.27/unit for oral drugs and $11.05 for injectables).

The Task Force identified 3 root causes associated with drug shortages: (1) lack of incentives for manufacturing less profitable drugs; (2) lack of recognition and incentives for mature quality and production management, as well as production contingency plans; and (3) logistical and regulatory hurdles that limit production responsiveness. Moreover, the Task Force proposed solutions to alleviate the impact of drug shortages. The first recommendation is to create a shared understanding of the impact of drug shortages, including quantifying costs, frequency, persistence, and intensity, as well as improving transparency of contracted price and stipulations. The group also recommends the development of a rating system to incentivize a manufacturer’s investment in maturing quality management, beyond the minimum threshold of Current Good Manufacturing Practices (CGMPs), to improve voluntary transparency. Finally, the group recommends the promotion of sustainable private sector contracts. This recommendation would involve providing incentives for manufacturers that would mitigate the financial risk of introducing or keeping products on the market, in addition to quality-based manufacturing financial incentives. The Task Force further identified legislative proposals that could limit product availability interruptions (including improved data sharing), risk assessment to identify vulnerabilities, and additional expiration date/shelf-life data. Likewise, the Task Force also stated that the FDA plans to publish guidance for the industry. These would be regarding FDA notification of permanent or temporary manufacturing of a product and risk management plans to prevent and limit shortages.

In addition, other legislation has been proposed, such as the Mitigating Emergency Drug Shortages (MEDS) Act, introduced to legislation by Senator Susan Collins (R-ME) and Senator Tina Smith (D-MN). According to Collin’s office, shortages can add approximately $230 million in drug costs and $216 million in labor costs annually in the US. Key priorities of the Act include strengthening transparency to disclose causes, expected impact, and estimated durations of shortages; extending reporting requirements to include active ingredients (not only the finished product); requiring contingency and redundancy plans for critical medications; and incentivizing manufacturing of products in shortage. Furthermore, the proposed legislation would require the Department of Health and Human Services (DHHS) and Department of Homeland Security (DHS) to conduct a risk assessment associated with shortages of critical drugs that could affect national security. So far, the MEDS Act has support from several healthcare organizations, including the American Pharmacist’s Association (APhA), American Society of Health-System Pharmacists (ASHP), American Society of Clinical Oncology (ASCO), and the American Hospital Association (AHA).

In the meantime, drug shortages continue to creep into national news. While a lack of drug accessibility is often linked to cost, drug shortages are a reminder that cost is not the only roadblock to treatment. Despite the innovation of the US healthcare system, and the novel drug and biologic discoveries that have dramatically altered care, some Americans, because of a variety of factors and causes, still find themselves scrambling to obtain routine or essential medications.

The Drug Shortages Task Force’s report may be found here: https://www.fda.gov/media/131130/download.

As an Adolescent Support and Counseling (ASACS) Counselor, it has always been a passion of mine to provide counseling and prevention serves to teens and their families. I’ve been very fortunate to fulfill that calling and having a platform to make an impact at Daegu Middle High School in Daegu, South Korea.

In supporting and working with the Daegu students, I developed a year-round leadership club called the Role Model Club. The goal of this club is to develop middle and high school students so they serve as peer leaders for younger students in elementary school.

All Role Model Club candidates are selected by their teachers and are interviewed for entry into the Club.  Once selected, students participate in several field trips, planned by ASACS, to the elementary school and school-age services for Red Ribbon Week (an awareness week that raises awareness on the importance of a drug-free, healthy youth) and Military Children’s Month. The club members also assist fifth graders as they being their transition into sixth grade.

Role Model Club members also participate in the planning and facilitating of various campaigns and serve as a positive advocate for youth in the community. Role models learn to act as ambassadors through positively influencing their peers and learn important skills to engage and connect with peers that are graduating to the next grade level. 

Through weekly meetings, students create educational skits to promote healthy decision-making skills. We focus on a variety of topics such as: drug refusal, fire and bullying prevention, developing interpersonal skills, technology management, positive body image and many others.

Throughout the school year, I actively engage with parents of Role Model Club students, making sure they are informed of activities, fieldtrips, contests, and various campaigns that students plan and implement throughout the school year and summer months.

The positive feedback that this program has received from both students and their parents truly reaffirms my belief that the Role Model Club is a unique and enriching experience for teens to learn leadership skills that will last a lifetime.

About Jasmin Coty

Ms. Jasmin Coty has been an ASACS Counselor since December 1989 helping military and civilian families throughout Germany for over 20 years and in the last five years assisting teen and their families at Daegu MHS in Daegu, South Korea.

We live in a fast paced, on-demand world, one in which information is available to patients through multiple channels on any medical topic. So, how do you help your patients navigate all the information and working with them, determine what is right for them and their loved ones? How do you help patients understand a diagnosis or a medical condition that needs to be effectively managed?

Care management is a solution that is intended to improve patient care and reduce the need for medical services by helping patients effectively navigate their own health condition. These programs have become a vital tool for organizations in order to meet the needs of their patients while also effectively improving quality and reducing the cost of care. Care Management can be provided by various types of clinical professionals, such as nurses, social workers, and pharmacists.

A successful care management program should include an integrated suite of services such as:

1. Care Coordination: Coordinating with the patient’s physician on assessments, care planning, and interventions.
2. Patient Engagement: Identifying opportunities for patients and developing a care plan that is supported through educational tools and resources to help them achieve their healthcare goals.
3. Health and Wellness: Helping patients make positive and lasting changes to their health through establishing healthy habits and setting achievable goals.
4. Advanced Digital Tools: Providing patients with the convenience and ease of managing their health through digital applications.
5. Data Analytics: Identifying members at risk for non-adherence or in need of care management through data-led and evidence-based algorithms.

A care management solution should be a comprehensive system that offers a suite of products to help patients navigate their health journey. Our MRx Navigate program is one such program that offers a medical management solution for customers and patients. MRx Navigate integrates data-driven, population health, and personalized intervention that leads patients to healthy, more vibrant lives. To learn more about MRx Navigate, click here.

The following is an excerpt from the 2018 Magellan Community Impact Report.

Learning and evolving aren’t just how we approach doing business. Magellan is committed to helping people reach their fullest human potential. But reaching your fullest potential could get derailed at any minute by a disaster.

Serving state employees during their toughest moments

The Camp Fire, which began November 8, 2018, was the deadliest and most destructive wildfire in California history to date. It destroyed much of the town of Paradise, took 85 lives, and destroyed 13,972 homes, 528 businesses and 4,293 other buildings. The fire was followed by severe flooding. As the Employee Assistance Program (EAP) provider to the State of California, Magellan was immediately there to help. Through centralized specialty critical incident stress debriefings (CISDs), Magellan provides structured on-site support to employees who have been impacted by a traumatic event.

Delivering an employee wellness strategy best practice

CISDs give employees access to immediate, expert and compassionate support to help them understand and process their feelings about the traumatic event. Magellan can also recommend additional resources available through EAP, such as legal and financial assistance, and provide referrals to community resources. And, where appropriate, we provide one-on-one follow-up support. Magellan’s dedicated call center is available 24/7 and is staffed with trained clinical professionals to take calls and work with employers to develop appropriate support.

Providing support in critically stressful times

Magellan provided more than 40 CISDs for over 300 California state agency employees in response to 2018 wildfire and flooding natural disasters. Magellan CISD provider Shammy Pius, MFT, describes her experience leading debriefings for the Camp Fire event:

“I conducted numerous sessions with state agency employees, many of whom had to cope with their own personal losses while serving and supporting others. The support Magellan gave state employees was beneficial to them but also had a positive ripple effect in their communities. The group sessions helped employees feel like they weren’t alone. The feelings they were experiencing were normalized when they heard that their colleagues were also experiencing anger, sadness and stress. Importantly, it was essential that each employee not minimize their own experience.    Everyone felt disruption to some degree. Educating them about resiliency and coping techniques during the event and soon after encouraged employees to accept the support that was offered to them. We help set the expectation that recovery will take a while, but there is hope and things do get better over time. It’s incredible how people come together in times of adversity – it’s truly heartwarming. I’m essentially a stranger going into these workplaces, and I get to be a part of people’s journeys during some of their most difficult times. It’s an honor to me to do this work  for Magellan.”

Evolving through our experiences

Magellan’s team responds to more than  5,000 critical incidents annually. Our CISD program offers access to a network of 8,100+ masters-level clinicians with crisis intervention training. We intervene carefully and thoughtfully, listen, reassure and teach resiliency. We wish these services were never needed, but since they unfortunately are, we embrace them as times to learn, evolve and help others live healthy vibrant lives.

Satisfied customers

•   99% of clients said the CISD plan was easy  to arrange and done in a timely manner
•   98% of clients said the EAP counselor was professional, courteous and understood their needs In response to tragedies and detrimental weather events, Magellan sets up a 24-hour toll-free hotline for individuals to access, regardless of whether or not they are Magellan members.

The 24-hour crisis lines are staffed by behavioral health professionals who provide free, confidential consultation services and other resources, such as referrals to local non-profit organizations, shelters and additional community based support.