Photo by Mike Erskine | Unsplash

In support of Well Being Trust’s (WBT) goal to save 100,000 lives from “deaths of despair” (i.e., deaths due to drugs, alcohol, and suicide), IHI partnered with WBT to create A Guide for Health Systems to Save Lives from “Deaths of Despair” and Improve Community Well-Being. The following excerpt from the guide presents a hypothetical example of how a health care organization can work with others to create a community-wide, coordinated ecosystem to support optimal mental health.

A local health care organization (HCO), part of a larger national health system, serves a population that crosses both an urban and a rural area near Portland, Oregon. Within their region and reflected in their community health needs assessment, they have seen an increase in both suicides and drug overdoses in teens and pre-teens. Though kids of all races are affected, the rate appears to be increasing most dramatically in teens of color. Recently there was a highly publicized suicide of a nonbinary teen.

Each loss of life represents an extreme trauma for the local community. This has sparked an increased will for action across many sectors and organizations in the community as well as departments in the HCO. Key leaders from the HCO community benefit department, the young adults psychiatric unit, population health division, and diversity and inclusion council come together to discuss if there is action they can take to improve outcomes for this population.

The leader of the community benefit department reaches out to a local funder who has supported initiatives to address teen health. Together, they choose to invest initial funding to convene key stakeholders for a community-based Equity Action Lab to scope the problem, set an aim, create a shared initial theory of change, and propose solutions to test and advance. A group of local students, a trusted local LGBTQ+ community-based service organization, some teachers and administrators from a local high school, a couple of parents, and some health care providers and leaders coalesce to share their recommendations from the two-day Action Lab experience.

In service of reducing teen deaths from suicide and substance use and improving well-being, they see opportunities in their community to build on existing assets to strengthen activities related to their theory (or driver diagram). They form working groups or improvement teams to pursue four initial tests of change, as described below.

• Train health care providers and educators in trauma-informed approaches. There is general recognition that many teens in the community have experienced trauma whether based on historical oppression (e.g., race, gender identity, sexual orientation), interpersonal or family trauma, and/or current events. Often, interaction with community institutions (e.g., schools, health care organizations) can result in re-traumatizing youth and aggravating rather than relieving distress. Next step: The improvement team will seek to learn from local and/or national or global experts as they plan to explore, test, and advance trauma-informed approaches in both school and clinical sites.
• Expand peer-to-peer support for teens struggling with issues of coping. In this community, there is already a small but strong peer support group based in the LGBTQ+ community-based organization. The partners choose to invest in and expand these services in partnership with the community-based organization and local students. The expanded services include helping identify students in need and linking them to other available services.
• Strengthen linkages between schools and health care. The local school and HCO agree to strengthen their relationship to support improved screening, early identification, access, treatment, and support for all students in need.
• Ensure availability of telehealth services for all in need. All stakeholders recognize that the use of telehealth services has increased more than 1,000- fold during the COVID-19 pandemic. Early interviews with local teens indicate that many prefer this format due to multiple privacy, anonymity, and convenience issues. The HCO commits to continuing to offer telephone and other virtual visits as key access points (and simultaneously commits to advocating for appropriate insurance coverage). The school will investigate creating a private consultation room for remote mental health visits during the school day after classes resume on campus.

Overall, the local health care organization both commits to advancing specific actions within its organization to drive improvement (e.g., training emergency room, primary care, and mental health service providers on trauma-informed approaches; making all aware of peer support services available in the community; linking with school-based services; continuing access to telehealth services) and supporting collaborative community-based action. As the working groups pursue these improvements, they may choose to learn, adapt, or adopt from interventions that have been implemented elsewhere.

For more detailed guidance — including “start here” suggestions for making incremental improvements — please download A Guide for Health Systems to Save Lives from “Deaths of Despair” and Improve Community Well-Being.

You may also be interested in:

IHI white paper — Improving Behavioral Health Care in the Emergency Department and Upstream

Equity Action Lab Implementation Guide

Why Is “Psychological PPE” Important for the Health Care Workforce?

A Population-Based Approach to Saving Lives from Deaths Due to Drugs, Alcohol, and Suicide