Author Archives: Anna Dickman

Interview with Jeffrey Sung, MD

Posted on by

Therapist Eric Stroo interviews Dr. Jeffrey Sung, our consulting psychiatrist, who is an experienced educator in the field of suicidality and suicide prevention.

Jeff, how did you become interested in the phenomenon of suicide as a focus for your professional work?

Sung: In our psychiatry residency training program at the University of Washington, we often worked with people with long histories of suicidality. And as can often happen in these settings, clinicians with the lowest level of training are often paired with the patients with the highest level of severity—people with very desperate and complicated circumstances. Like other psychiatry residents, I had patients who died by suicide. And it had some deep shock associated with it. In the face of it, the response from and work with my colleagues and supervisors was extremely helpful and supportive.
And so I became interested in this question of how we as clinicians understand our responses, knowing that someone might die by suicide or that someone has died by suicide. In particular, I wanted to understand how our responses influence our ability to persist in the clinical work and still find some sense of meaning and purpose.

Afterwards when I started working for UW through a Health Care for the Homeless Network program, I continued to encounter patients with complicated circumstances, often with high levels of suicide risk. And over time, I grew convinced that it’s possible to work with people who are suffering at that level if we are organized and structured with a framework in our minds so that we can sit comfortably and listen to a story with that level of pain.

Interviewer: Given this longstanding interest in suicide care, how have you seen the field evolve over the years?

Sung: Management of suicide risk has the goal of making sure people stay alive and can survive suicidal crises. An important shift in the field has been a move beyond a focus on assessment and immediate management, towards a focus on the treatment of suicide risk. Treatment of risk is working to develop a collaborative relationship so that patients can start to understand what contributes to their having suicidal thoughts and behaviors. Then they can recognize their own suicidality, intervene on their own behalf, and feel more confident in responding to their suicidal thoughts and urges with healthy coping strategies.

Interviewer: In your work as an educator in clinical suicidology, what messages do you believe to be the most important to convey?

Sung: Some of the best research in the field demonstrates the importance of connectedness as an intervention that can prevent suicide. By connectedness, I am talking about conveying general or specific messages of belonging, value, and hope. That might mean remaining quiet and reflective as someone tells the story of how they came to think about or attempt suicide. That’s a way of conveying belonging, value and hope.

Or it might mean simply saying directly, “I’m so glad we’re here. I’m glad we’re talking about this. You’re important to me, and I have hope that things will get better in your life. I want to work with you so that we have time to address the problems and pain in your life.”

Interviewer: You have thought a lot about the role of faith leaders in caregiving for people considering suicide. What do you see in that?

Sung: One entry point is simply that as a faith leader, some of the people you are speaking with might be thinking about suicide or might have attempted suicide. Frame your language and your thinking to be welcoming and open, so that someone in your community would consider confiding in you.  A great way to convey this openness is to have willingness to share your own personal experiences with mental health and mental health care, and those of others who have given permission to have their stories told. Are you seen to be open to talking about mental health conditions, about suffering, about suicidal thoughts and behavior?

As with clinicians, connectedness is critical. For faith leaders, that can mean acknowledging that you don’t necessarily have immediate solutions to someone’s problems.  Facilitating connectedness means that even without solutions, you can still commit to joining a person on their difficult pathway. This is actually a very important and unique role that faith leaders can play—finding connection or communion in suffering, instead of isolation. Finding a way to have meaning and purpose in suffering rather than believing that one’s pain is wasted. Finding a way to have hope versus despair, gratitude versus resentment. Faith leaders have these really amazing skills and a set of traditions to offer. When someone brings a problem that has no solution or no immediate solution, faith leaders can help grapple with suffering and enter into mysteries—to help find a viable pathway.

There is a resource that is supported by the National Action Alliance for Suicide

Prevention: the Faith, Hope, Life campaign for faith leaders. It details different suicide prevention competencies that faith leaders can develop for prevention, intervention, and postvention.

Interviewer: If you could change some aspects of our US culture that exacerbate the rate of suicidal behavior, what comes to mind?

Sung: It’s a great question. So many people in clinical and public health think about it, including the Surgeon General of the United States, Dr. Vivek Murthy. I recommend his recent reports about social media and youth mental health, and about social isolation and loneliness.

These reports bring us back to connection, the importance of relationships with people, family, friends, and the importance of social connection between individuals in

different community settings. It fits together with the role of healthy faith communities as places where people have an organizational level of connection, where a person can form relationships with other people and then develop internal connections and beliefs.

Interviewer: Finally, Jeff, what sustains you personally and professionally, given this challenging choice of focus in your life’s work?

Sung: Clearly, I think that the work is extremely meaningful—confronting these existential questions around finding a reason to go on when one feels that one has lost everything. Important, meaningful questions that need an answer at some point. In my own work, I’ve lost patients to suicide and I’ve had patients make amazing recoveries. And that actually helps me stay in the work, knowing that we need answers not only for patients to get better, but also for the people who survive the suicide of their friends and family members. Answers that can help all of us find community, meaning, purpose, hope, and courage in the face of profound pain and loss.

 

Sources referenced in this article can be found here.

 

The Insurance Dilemma

Posted on by

Ready for an understatement? Accessing mental health services can be really challenging. First, there is overcoming the stigma of needing mental health care. Next comes finding a provider who has an opening in their caseload. After all of that, the individual must contend with the cost of regular and effective care.

The truth is that healthcare can be very expensive, and many people do not begin therapy simply because they are stymied by the prohibitive expense. This has led a large number of people to rely on their health insurance to afford the services they require. However, as the cost of living has increased, evidence suggests that insurance payouts for mental health professionals have not.

This is the quandary at the heart of the Seattle Times article, WA Mental Health Providers Say Insurance Reimbursement Isn’t Enough, written by Michelle Baruchman on December 21, 2023. Baruchman notes that a single therapy session in Seattle averages around $160 out of pocket, which is not a realistic price for many who need routine and consistent meetings. By comparison, an individual carrying a $30 copay could pay for more than a month’s worth of weekly sessions for the same amount of money. However, the issue is that, should a therapist panel with an insurance provider, their rate is set through a contract with that company. Often, these rates are locked and substantially lower than the aforementioned $160, meaning a therapist may forego half their potential earning for a session if the client is to be allowed to access their insurance benefits.

The gap between cost of living and insurance payout has caused many mental health professionals to leave insurance networks, or even to abandon the profession completely. They find that it is not financially feasible to make a living off insurance rates. The number of available providers shrinks, reducing the options for those searching for therapy within their means, particularly for those who are needing specialized services. The result is that mental health care in Seattle, as in other metropolitan cities, is turning into a “luxury service,” restricting large numbers of people from receiving the care they need, oftentimes those who are the most vulnerable or marginalized.

As one of the largest non-profit and insurance-accepting counseling centers in Seattle, Samaritan Center knows the realities of working with insurance–both the frustrations and the benefits. Indeed, health insurance has been an important tool for many seeking therapy at Samaritan. It has often been key in allowing a client to complete services for the full duration of treatment, or for both a parent and a child to find support instead of having to choose one or the other due to financial limitations.

However, health insurance has also shown itself to be a faulty and incomplete tool. Both the client and the therapist experience loss and frustration when therapy is denied or abruptly cut short due to restrictions in insurance benefits or coverage. In moments like these, relationships and empathy seemingly take a back seat to business models and stiff collars.

Considering these failings in the insurance model, we at Samaritan are immensely grateful for those who have come alongside and partnered with our mission. The financial support we receive year after year allows the agency to stay true to its core tenet and open its doors to everyone who may be looking for mental health services. This includes those who are paying out-of-pocket, those who use their insurance, and those who cannot afford either option. We are deeply grateful to those who extend their arms alongside ours to be instruments of love and peace.