October 12, 2022
A friend called recently. His daughter suffered from severe depression, and he was looking for a referral for a psychiatrist. Despite ample resources and adequate insurance, my friend couldn’t find a psychiatrist who would accept the young woman as a patient, because she has a history of chronic suicidal thinking, as well as a past suicide attempt. Within an already stigmatized field, a history of suicidal thinking confers yet another level of stigma, which makes their search for care that much harder.
Situations like this are not uncommon and highlight how finding a willing mental health professional is a hurdle for patients with serious mental illnesses and suicidality.
Despite this sobering backdrop, a promising new treatment – bibliotherapy – may offer hope, both in terms of rapid responses and the potential for quick implementation and scalability. Last month, researchers at Harvard published a ground-breaking paper on bibliotherapy, a process in which individuals read brief first-person narratives about coping with suicidal thinking as a way of mitigating these ideations. The preliminary results of the study found a positive correlation between reading these narratives and reduced suicidal thinking.
Being aware of the latest research in our field and approaching every aspect of our business from a scientific perspective is core to what we do at Cerebral. The bench to bedside orientation is key to improving clinical outcomes that put patients first. In addition to first author Dr. Pete Franz, other authors included researchers from Harvard, including Dr. Matthew K. Nock as well as myself.
This study consisted of a double-blind, randomized control study, with one group reading the material and one that did not, underscoring the reliability of the results. The materials patients received were first-person narratives, easily relatable, and told the story of how others have worked through and managed suicidal thoughts and behaviors. Digitally based, the study showed this approach may work because of shared experiences and optimism, which leads to patients feeling less isolated and seeing a path to recovery.
While the findings are preliminary, bibliotherapy represents a breakthrough in addressing a particularly difficult public health challenge.
Given its digital nature, bibliotherapy is highly scalable. Caregivers can rapidly expand the availability of articles, allowing flexibility and scalability. In addition, bibliotherapy is essentially free. This cost-effective approach decreases barriers to access. This could be of particular interest to health insurance companies and employers, for whom traditional outpatient and inpatient care can be costly and therefore less widely available.
Psychiatrists treating patients with life-threatening illness are often not paid for additional hours spent responding to late-night phone calls or handling hospital admission paperwork. Instead, many caregivers selectively prefer to treat the ‘worried well,’ people suffering from mild and moderate illnesses that are less likely to result in hospitalization or self-harm.
As a result, those with more serious illnesses are particularly vulnerable to not receiving care at all. Some patients are waiting weeks or months for desperately-needed treatment due to a shortage of healthcare providers willing to treat them. That delay is especially worrisome when suicidality is a risk. To make matters worse, medications can take six to eight weeks to take effect, and often require multiple trials to determine effectiveness. All of this underscores the need for treatment, especially since suicide is now the second leading cause of death for Americans aged 10 to 14 and 25 to 34.
Cerebral plans to implement principles of bibliotherapy in the coming months, further underscoring the company’s commitment to treating patients with serious mental illnesses, and to our dedication to evidence-based practice.
Above all, we are always seeking new, evidence-based approaches to reduce suffering and improve patients’ lives that typically stay cloistered within the ivory tower. For bibliotherapy, this may just be the beginning. Although more study is needed, there is good reason to believe that the same approach can also be used to ameliorate the symptoms of depression, anxiety disorders, and other mental illnesses.
Too many lives have been lost to suicide. Clinicians, researchers, and policymakers must collectively develop and deploy new approaches that can transform care at scale, and make a real impact for individuals and families who have suffered too long in silence.
Dr. David Mou
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