Wednesday, May 20, 2015

Doing Something vs Doing Something Effective About Suicide

We all want to know that what we do is effective, right?
What can we effectively do about suicide? 
We can vote for politicians to “do the right thing” which normally means that THEY vote to spend more of OUR money … in the War on Poverty, or the War on Drugs, or government education … or suicide… 
We can learn the skills to intervene when someone we encounter seems to be at risk for hurting themselves or taking their own life. 
We can give to a charity that “does something” about humanitarian issues like suicide in hopes that we’ve picked the best organization that will make the biggest difference with our money… 
We can re-learn the interpersonal skills that give us authentic human connections with our family and friends and co-workers – connections that can intervene when the stresses of daily life grip us. 
We can assume that “something is being done” by behavioral health care professionals and try to ignore the fact that more people are taking their own lives today than ever before…
We can take a realistic, reasoned and educated look at our own communities and the organizations in them to learn which initiatives REALLY reduce suicide and why, then begin to replicate those efforts.
It is no longer enough to assume that “something is being done” about suicide when so much effort and money has already been spent without results. It’s no longer enough to assume that our favorite humanitarian organizations are able to get out in front of suicide. And it’s certainly high time we understood that government is NOT about doing what it right because government, while it is good at making and enforcing laws, has a decades-long expensive track record of failure at effectively getting out in front on humanitarian issues.
If you have a friend or family member who’s depressed, stressed and anxious, what are you doing to intervene? Is it working? If not, there are resources available to you – such as The QPR Institute and Mental Health First Aid – that will help you be more effective. If so, teach your family and friends how to do what you do.
That would be doing something effective…for a change.

Thursday, May 7, 2015

Is Technology Undermining “Veterans First?”

We all know that patience with the VA wore thin long ago. One of the many remarkable results of that impatience is that Vietnam Veterans of San Diego created what is now known as Veterans Village of San Diego rather than wait for the VA to get its own act together and truly serve homeless drug-addicted combat Veterans. Fortunately, Veterans Village of San Diego has shown by example what can be done when Veterans truly come first.

Doubtless there are many remarkable individuals serving the VA, but it’s a shame that the VA’s own computer systems limit the effectiveness of the individuals working there. Part of my life was spent as an IT systems analyst, and I would like to offer insight and suggestions from my own experience of the Veterans Administration San Diego Healthcare System (VASDHS) over the last few months, seen from the point of view of a friend who is a disabled Veteran.

One example:

How is it that medical procedures at VASDHS can be cancelled last minute without notification to transportation services? My friend was told he had lost transportation privileges because a van came to pick him up for a procedure that had been cancelled. The cancellation computer failed to advise the transportation computer, which made more work the human beings serving the Veteran as well as the Veteran himself. That’s not putting Veterans first.

Another example:

Why is it that my Veteran friend can be called to an urgent appointment with less than 24 hours’ notice, requiring him to arrange his own transportation, only to wait hours for that care to be given after arriving on time as demanded? That doesn’t seem to be putting Veterans first.

Yet another:

How can the VA computer system cancel all transportation contracts for disabled Veterans without first checking to see if those Veterans have appointments on the books? This happened today at the VASDHS, and it put a number of excellent VA staffers into damage control mode. How can that be putting Veterans first?


A Veteran trying to respond to chain yanking in any of these examples is told to call the “Primary Care Call Center.” The capable caring call center crew has only one way to put Veterans first: send an email message to the proper Primary Care provider. In this open-ended system, there is no guarantee that the Veteran will get a response, and the system is useless in some cases since the only response window offered by the call center is “two to three working days.” A disabled Veteran without transportation who must be at appointments with less than 24 hours to respond doesn’t have two to three working days. In this case, the only thing that is being put first is an open-ended broken system with no accountability programmed into it.

Some suggestions, free for the taking:

A)   Most industry-standard call center software has escalation capabilities that facilitate human intervention when necessary. It’s not hard to implement such features, nor is it hard to find capable managers and team members to use them effectively. Even the most backward third-world call centers can do this; let’s make it a part of putting Veterans first here in San Diego, and soon. An in-place escalation process would have smoothed out the response to today’s transportation cancellation issues.

B)   Require human review of computer-determined actions with a potential negative impact on ten or more Veterans. A human being could easily apply the brakes before such automatic actions become a train wreck. This could have prevented today’s transportation snafu, and would also help keep transportation from being wasted on cancelled appointments. Ultimately, the underlying deficiency in the computer systems must be corrected; until they are, let’s put Veterans – not computer systems – first.
C)   Require human review of all computer-initiated appointment notifications where a Veteran is given less than 24 hours to arrive for care to make sure that the communication to the Veteran is clear and that any questions the Veteran has can be answered during the notification process. This may mean that the automated notification system won’t work in some cases; until that’s done, let’s put Veterans first.
It seems obvious that the human capital needed to implement these suggestions is available; I witnessed it today doing damage control and it seems obvious that excellent staff would be much happier re-deployed out in front of a problem rather than reacting to the fallout from one. It also seems obvious that if a third-party civilian like myself – and I’m not a rocket scientist – can notice such things, they must already be painfully obvious to many others.

How about it, VASDHS? Doable?