Change Can Be a Beautiful Thing

If you have been following this blog you know that I’ve been trying to make the moral, scientific, and humanitarian case that providers of healthcare services ought to be better trained in suicide prevention. From primary care providers, resistance to mandated training has been stiff. Change, it seems, is only desirable if your diapers are dirty.

 

Well, good news!  Change happens.

 

The Washington state House of Representatives just passed House Bill 2315 by a vote of 94-3!

 

HB 2315 would oblige primary care providers (PCPs) to complete the same kind of training now required of mental health professionals in my state (HB 2366 passed into law in 2011 and training is underway).

 

Briefly, PCPs would have to learn something about suicide risk assessment, treatment, and management to keep their licenses, and the mental health problems that motivate suicidal behaviors.  The mandate would impact chiropractors, naturopaths, all nurses, osteopathic physicians and surgeons, physical therapists, physicians assistants and physicians.

 

The bill now goes to the Senate and you can read it at: http://www.leg.wa.gov/pub/billinfo/2013-14/Htm/Bills/House%20Bills/2315.htm. The bill does a couple of other good things, but the training mandate is key to real change.

 

For a rock solid rationale on why the bill is needed, I invite you to read the bullet points in the opening of the bill following “The legislature finds that…”  My House testimony on this bill is posted in an earlier blog (Oh Doctor, Where Art Thou?).

 

Remember, this bill does not require additional continuing education training hours, or additional costs, but rather a retargeting of existing required CE hours with an aim to mitigate a major public health problem.  To any who have lost a loved one to suicide, and given the scope of impact a death by suicide has on every aspect of our society, this requirement hardly seems an imposition. 

 

When a cause of death is at once knowable and avoidable through education and training, only four questions need answers.  And to each of these, we can now say yes. Is the training:

·       Affordable?

·       Available?

·       Accessible?

·       Adequate?

 

Richly-funded modern medicine leaps forward on every path to extend life but one: preventing death by suicide.  Learning how to interact and talk with suicidal patients is not neurosurgery or spinal manipulation, and it only costs only a few dollars to learn how.  Yes, the interviews will slow the processing of X many patients per hour, but the payment mechanisms and integration of behavioral care into primary care under the Affordable Care Act are going to make these conversations much more possible for everyone, patient and provider alike.  It is very difficult to have a deep, existential conversation about life and death in 9 minutes, which is what we have been asking PCPs to do and, to boot, not get paid for.    

 

HB 2315 passing the house is real change, and this is good.  Many in the public sector wonder why it hasn’t happened before.  Just off the phone with a reporter, I explained to him the scope of the problem and the recommended fix (six hours of training every few years), to which he said, “That seems like a pretty low bar.”  I did not disagree, but I will take a low bar to a no bar every time.

 

It sometimes helps me to think like the tax payer I am. For example, unless I am much mistaken, my tax dollars helped support the medical educations of the folks targeted in HB 2315. Having helped fund their training, do I have any right to ask that – since their medical schools overlooked the topic – they now spend a few hours fixing this gap in their education?  I think not.

 

Being suicidal is not like having high blood pressure or trying your first cigarette. That first cigarette can lead to life-long addiction, perhaps emphysema, and even cancer, but a first suicide attempt can lead to death, and too often does.  In the case of helping people lose weight or stop smoking you have time; in the case of dissuading an acutely suicidal patient from attempting suicide, you don’t.  

 

Many of us here in the real Washington will be contacting Sen. Randi Becker, chair of the Senate Health Care committee to request that she schedule the HB 2315 for a public hearing.  In case you live in Washington, or know someone who does, take minute to act.

 

Change only happens when people act – not talk, think, consider, or pee down both legs while contemplating what might happen if, some day, soon perhaps, I stopped tossing around ideas about what I might do and, just, you know, do it! 

 

Nike made a fortune and changed the athletic activity of an entire nation with the slogan “Just do it!”

 

My work here is done.

 

Sen. Becker can be reached at randi.becker@leg.wa.gov or 360-786-7602.

 

Quote for the day: Preventing suicide may be easier than overcoming our fear to try.

Dr. Paul

3 thoughts on “Change Can Be a Beautiful Thing”

  1. Hello Fredric,
    Thanks for your comment. The current Matt Adler bill covers only mental health professionals and you are correct about the six hours, verses more or fewer. House Bill 2315 will cover primary care providers and, in the case of physicians, the time period during which the training must be completed could be almost 8 years, depending on when the bill passes, when the physician was licensed, and how their rules committee implements the bill – if it passes. Each professional licensing board has some room to adjust the length of training under their rule development and scope of practice decisions. For example, the occupational therapists and chemical dependency professionals impacted by the law elected to require only 3 hours of training. Basically, their role will be limited to screening and referral, and not assessment, treatment, and management. For physicians, research-focused doctors working in genetics labs who never see patients might be excused entirely… Best, Paul

  2. Strong work, Paul. Now to get the other States on line. Shouldn’t this training be a Federal mandate along with “Brandon’s Law” passed in MN the day my son died to compell phone companies and police depts to cooperate with families to locate people at risk based on last known cell phone location?

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