An extraordinary moment occurred in a most ordinary place: a store check-out line. A shopper noticed that a cashier seemed upset, then she noticed cut marks on the cashier’s arms. The shopper decided to do the tough thing. She asked – really asked – “Are you OK?”
The cashier responded that she wasn’t, so the two women stepped aside to talk privately. The shopper encouraged the cashier to seek professional help and to hold onto hope.
The two women saw each other again later. The cashier told the shopper that her simple question and their quiet conversation kept her alive. Three words sparked a change that saved a life.
Suicide as a Community Issue
On the average day in the United States, 132 people will die by suicide. In North Carolina alone, a death by suicide will occur every six hours. American suicide rates have risen 16 percent over the past 11 years and have increased 2.6 percent in the past year alone. Recently, these rates have only risen. The reported the number of suicide deaths in 2022 is the highest ever record. Suicide is the 11th leading cause of death in North Carolina and the United States.
Now more than ever, teammates across Atrium Health are working to ensure that conversations like the one in the check-out line occur much more frequently: between people, between friends, between colleagues, and between doctors and patients. Suicide has become a community issue, and the best tools we have to reverse these trends is to make suicide a community conversation. One tool Atrium Health uses is Mental Health First Aid training. This training – a free, eight-hour course that is open to everyone in the community – teaches attendees, in part, how to recognize and respond to signs of suicide and mental illness. The shopper in the check-out line had taken this training, and she credits it for empowering her to help.
Another tool used is QPR (Question. Persuade. Refer.) Just like CPR, QPR is an emergency response, though to someone in a suicidal crisis, that saves lives. Those who are trained in the hour long QPR course learn to recognize the warning signs of a suicide crisis and how to question, persuade, and refer someone to get the help they need.
Any place where people gather and talk – faith groups, to community centers, and even to barber shops – is a place where people should learn how to talk about mental health and suicide.
“There is hope”
After decades of addiction, Calvin Harvel now leads powerful conversations and mental health interventions as a peer support specialist in the psychiatric emergency department at Atrium Health.
His lived experience is now an inspiration to so many, but Harvel remembers a time when he just wanted to die. “Really, I wanted to die temporarily. I just wanted the pain to stop.”
Harvel’s story begins with heartache after losing the love of his life, Renee, back in the 1980s to suicide. “Renee was a bright, beautiful lady. She was a nurse at the time,” Harvel says. “And now she was gone.”
This is when Harvel remembers his own addiction spiraling out of control – and then he lost his father and two brothers to alcoholism in less than five years. “I would try to drink myself to death hoping that I wouldn’t wake up. And that went on for a long, long time as I was depressed as my family was dying.”
Many ask Harvel how he found the hope to carry on and what message he shares with others today. He says he learned how to just live in the moment and take life day by day. “Everything is temporary, but suicide is a permanent solution to a temporary problem,” Harvel says. “And if we can get through that problem by talking, by listening, by hugging, by touching hands, by going for a walk, it will pass.”
While talking about his past brings up old feelings, he’s willing to do it to help someone else and hopefully save another life.
“I don’t regret my past. And I don’t forget it because the minute I start forgetting my past, then I’ll forget about that pain, and I’ll start doing what I did before,” Harvel says. “There is hope no matter what you’ve been through or where you’re going or what you’re going through now.”
Today, he’s full of gratitude for where the pain and grief led him. “I have two beautiful grandkids. They are just such a joy to my life,” Harvel says. “Life is good today.”
Creating Open Conversations with Patients
Seven years ago, Atrium Health began to screen all patients in the emergency department for suicidality, whether or not a behavioral health issue brought them there. Millions of encounters later, Atrium Health earned an award for the innovation of the program and the volume of its screenings.
“We found a lot of people who wouldn’t have told us that they were suicidal. We save lives by asking the questions,” says Kate Penny, program coordinator of Zero Suicide at Atrium Health.
Penny has expanded upon this idea through her work on Atrium Health’s Zero Suicide initiative. Zero Suicide creates a network around each patient, assessing for suicidality at multiple points and with multiple providers throughout the care process, and collecting and sharing data to ensure proper follow-up with patients.
“As clinicians, we ask patients if they’ve traveled out of the U.S. or if they’re allergic to latex,” says Jennifer Ziccardi Colson, RN, vice president and chief nurse executive of the Behavioral Health service line at Atrium Health. “Shouldn’t we ask them if they’re suicidal? This should be a priority and considered our 5th vital sign”
Nearly three years after its start at Atrium Health, Zero Suicide has already become embedded throughout the behavioral healthcare department. More than 1,000 teammates across the continuum of care – doctors, nurses, environmental staff, and more – have completed training. Each person who interacts with patients has learned motivational interviewing techniques that encourage people to open up during conversations, in a style that points them toward a hopeful direction.
“Our vision for Zero Suicide is coming to fruition within behavioral health care, and we hope to eventually spread the program throughout Atrium Health,” Penny says. “It’s a great opportunity to make a huge impact.”
Instilling Confidence to Ask the Hard Questions
Normalizing the conversation around suicide will become an important first step in connecting people in crisis to the help that they need. Whether at work, in a doctor’s office, or even in a check-out line, programs are empowering people to ask important questions and listen to answers compassionately and helpfully.
“Mental health can still be a taboo subject,” says Ziccardi Colson. “We’re working to change that, to make it more normal to ask these questions. These programs really work, and we’re instilling hope back into our patients and their families.”
If you or a loved one is attempting suicide, please call 911. Atrium Health’s Behavioral Health Help Line is available 24/7 for crisis assistance at 704-444-2400 or you can reach the Suicide & Crisis Lifeline by calling or texting 988.
Mental Health First Aid is an evidence-based eight-hour course that teaches attendees how to recognize and respond to signs/symptoms of suicide, mental illness and substance use disorders. Learn more about Atrium Health’s Mental Health First Aid program and register for a class online.
QPR is an hour long course that teaches you to recognize the warning signs of a suicide crisis and how to question, persuade, and refer someone to get the help they need. Learn more or register for the course online.
