Blue envelopes and suicide prevention

In this episode of the MGMA Insights podcast, we spoke with this year’s winner of the MGMA Harwick Innovation Award, director of operations for psychiatry and behavioral medicine at Corewell Health, Natalia Szczygiel, MHSA, CMPE, OMC.

The MGMA Harwick Innovation Award recognizes one individual each year who has developed an innovative solution to positively affect their community. Szczygiel’s efforts to spearhead a suicide prevention program at Corewell Health have equipped providers with the tools to catch suicidality in everyday patient encounters. Her work has reverberated through the community of West Michigan from the Corewell Health hospital system to nearby school districts.

Editor’s note: The following Q&A has been edited for length and clarity.

Q: I’ve read a lot of research studies about Americans, behavioral health and how there have been spikes in crises during pandemic time. What’s it been like at Corewell Health? How have you had to handle that?

A: “Prior to the pandemic, in one of our outpatient practices, for example, we would have a crisis situation maybe once or twice a month. Today, unfortunately, that happens daily. So we are seeing that the acuity and the needs of our communities are increasing. We really have to think creatively and innovatively, because we also know that nationally, there's a scarcity in behavioral health providers. And so how do we continue to develop programs and increase those services for a community that really needs them? When resources are not as plentiful?”

Q: As director of operations, what's your primary role?

A: “I'm responsible for the strategic planning, the business operations and financial management functions for psychiatry, behavioral medicine. I really feel like today, I am a collaborator and a program developer. … Prior to COVID, my role wasn't as focused on partnering with external organizations as it is today, but we've realized that behavioral health is such an epidemic in our country that it really takes a village to problem solve and identify the appropriate interventions. So that is what I focus my time on.”

Q: The reason you won this award is because of something you helped spearhead and develop at Corewell Health - a suicide prevention program. Tell us about the program, and what some of the steps and processes are in getting it up and running.

A: “Corewell Health developed an algorithm, and we've coined the term ‘blue envelope.’ The way it started is that it was a physical blue envelope that contained all of the resources a staff person, a provider would ever need whenever they were confronted with a patient that was exhibiting signs of suicidality. So even in a specialty that doesn't encounter this every single day, like orthopedics, a staff person could pull out that blue envelope and know what to do in the moment.

And so later over the years, we've developed that blue envelope. It's still coined the blue envelope, but it's now electronic - it's embedded within our electronic medical record system. Everyone across our organization has been trained on this blue envelope protocol, which essentially keeps the patient safe, whenever there is suicidality involved. We are now looking at this program and seeing, ‘How can we use this and help others use it in our communities?’ So we've launched a school blue envelope version, which trains faculty and staff on the very same algorithm, how to keep students safe so that we don't escalate crises, and we really equip students and patients early on with an intervention so that they can stabilize much faster.”

Q: At MGMA, one of our major mission statements is to transform healthcare. That's where we're dedicating our education and research this year, and so I just want to know how you see this program helping to transform healthcare.

A: “We know that mental health has tremendous impacts to overall health outcomes. So by developing this as a prevention program, hopefully I am making an imprint on impacting overall health outcomes. Right now we're looking at the sharing the best practices that we've learned through the implementation of this program and providing that to our local communities, our state and also nationally, via various forums, because we want other folks doing this work. Like I said, it takes a village, it takes a whole country, it will take the world for us to really make a significant improvement in mental health.”

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The MGMA Insights podcasts are produced by Daniel Williams, Rob Ketcham and Decklan McGee.