APhA2019 opens with keynote on pharmacists’ role in suicide prevention—and some big announcements
In helping with those struggling with thoughts of suicide, “pharmacists are first responders,” said 2019 APhA Annual Meeting & Exposition Opening General Session keynote speaker Kevin Briggs, a retired sergeant with the California Highway Patrol. Briggs delivered his remarks to APhA2019 Opening General Session attendees in Seattle on March 23.
Briggs is the founder of Pivotal Points, which is aimed at raising awareness about mental health and reducing associated stigma. The organization also provides education on crisis management and suicide prevention.
In 2017, more than 47,000 people died by suicide—more than from homicides or traffic accidents. Briggs said that, in his 23-year law enforcement career, he has found that the major contributors to suicide are rejection, emotional pain, abuse, mental illness, helplessness and hopelessness, and guilt.
Many people don’t seek help because of shame and stigma. “I battle depression and suffered for many, many years, and this is exactly what I did. I didn’t talk to anyone close about it because of the internal feeling of disgrace.” Denial is another reason people don’t reach out for help. Briggs has experienced this in his own life while serving in the U.S. Army, in corrections, and in the highway patrol. “In these macho jobs where you do not show weakness, you hear, ‘I can go to work and function at 100%.’ But at home, they might sit on the couch for hours at a time. They don’t want to go out. They’re tired.” Avoidance and vulnerability also hold people back from seeking help.
Warning signs include stopping or stockpiling medications, isolation—“I don’t have enough energy to go out”—sleeping too much or abusing substances, and change in appearance—“I don’t even feel like taking a shower.” Someone contemplating suicide might say, “Nothing matters, it’s no use,” “If I weren’t around, no one would miss me,” “If I killed myself, then people will be sorry,” and “Everything’s going to be fine soon, don’t worry about me.”
To intervene, engage in courageous conversations. “How can we have these courageous conversations—probably the most difficult conversation you can have with someone?” Briggs asked. He encouraged pharmacists and pharmacy staff to prepare for such conversations, ensure they take place in an appropriate location that feels safe, use supportive body language, stay in the moment, and establish a connection by eliminating distractions and exercising active listening skills. “Use little encouragers, repeat what they said to you—reflecting, mirroring.”
Validation, normalization, and gratitude are crucial. “Validating someone is a simple act,” Briggs said. “‘Wow, that sounds really tough.’ To normalize, tell them, ‘You’ve been through so much. Anyone’s who’s been through that much might think about suicide.’ For gratitude, say, ‘Thank you for sharing with me. I know that was hard.’”
Follow up. “A simple text—‘Just thinking about you, I’m here for you’” is very meaningful, Briggs said.
Use negotiation techniques when talking to someone contemplating suicide—techniques Briggs often used when approaching people on the Golden Gate Bridge.
A famous photo shows Briggs comforting a man who is perched on a 6-inch pipe along the outside edge of the bridge. A slight move of his foot, and he would have fallen. Briggs listened to the man for 90 minutes. “I spent maybe 5 minutes of that entire conversation talking. He ultimately decided on his own to come back over the rail.” Briggs then displayed a photo from years later of the tuxedo-clad man presenting him with an award honoring his suicide prevention work.
“Ego has no place in negotiations,” he said. Briggs advised avoiding “I” statements. “This is about them.” Use the 80/20 rule—spend at least 80% of the interaction listening. “And silence can be golden.”
Briggs would establish a rapport with a person he feared might be at risk of suicide. “I would ask them, ‘It’s supposed to be a great day tomorrow—what are you doing?’ If they didn’t have an answer to the question, that’s a huge indicator.”
Don’t neglect one’s own needs. “Have compassion for yourself,” Briggs said. That was a challenge for him. “I did not balance my job and my own life. For you pharmacists, you give and give, but you might fail to see what’s really going on within yourselves and what’s going on with your families. Don’t be afraid to seek professional [or personal] assistance.”
Briggs reiterated his belief that pharmacists are first responders. “You have direct contact with people, and you know somewhat what’s going on with them," he said. “Ask that question. Establish that rapport. It takes courage, but you could help someone in their darkest time.”
The Opening General Session began with a color guard from Base Seattle Coast Guard, and USPHS LT William Charles sang the national anthem. Mark Walberg, the host of “Antiques Roadshow,” was back for his 11th appearance as emcee. He called out APhA’s partnership with Mary’s Place, an organization that fights homelessness in Seattle, and introduced the APhA Board of Trustees. The audience then recited the Oath of a Pharmacist.
APhA President Nicki L. Hilliard, PharmD, MHSA, BCNP, FAPhA, presented the 2019 Remington Honor Medal to Lucinda L. Maine, RPh, PhD, FAPhA. The medal is the profession’s highest honor. “This year we can truly call it ‘the Maine event,” she said.
Maine identified stress and anxiety as the biggest challenge facing pharmacists today. “I like to think of the [pilot] Chuck Yeager ‘going through the sound barrier’ analogy,” she said. “Yes, these are turbulent times,” but it’s right before breaking through the sound barrier that the plane shakes the most.
To move the profession forward, “[provider status] at the state and national level is essential, but we also need to make sure that when people come to find our services, they can. That’s what every individual pharmacist can do,” she said. Maine plugged a new campaign called Pharmacists for Healthier Lives, which aims to raise awareness. “Let’s let the public know that pharmacists do a lot more than just simply get the medications into those little bottles.”
She noted that until 1969, pharmacists weren’t even legally authorized to counsel patients, but thanks to years of hard work to raise awareness of what pharmacists can do, that’s changed. “We’ve come a long way—thank God,” Maine said.
Honoring pharmacy’s finest
Maine was not the only honoree at the session. The Daniel B. Smith Practice Excellence Award, administered by the APhA Academy of Pharmacy Practice & Management, went to Betty J. Dong, PharmD, FAPhA, FACCP, FASHP, AAHIVP. Christopher P. Calderon, PhD, received the Ebert Prize, administered by the APhA Academy of Pharmaceutical & Research Science.
The APhA Academy of Student Pharmacists (APhA–ASP) honored the late Tery Baskin, PharmD, FAPhA, with the Linwood F. Tice Friend of APhA–ASP Award. Baskin, a former Treasurer of APhA and revered figure in pharmacy, recently lost his battle with cancer. “Tery would have loved being honored today with the Linwood Tice Award,” said presenter Nimit Jindal, APhA-ASP President. “I feel confident that Tery is with all of us in this room in spirit.”
The Hugo H. Schaefer Award was presented to Kenneth Michael Hale, RPh, PhD. Milap C. Nahata, PharmD, MS, received the Gloria Niemeyer Francke Leadership Mentor Award. The H.A.B. Dunning Award went to Albertsons Companies.
The candidates for APhA President-elect, Daniel Buffington, PharmD, MBA; and Sandra Leal, PharmD, MPH, FAPhA, CDE, came to the stage to answer randomly suggested questions about how they would lead the Association.
APhA CEO Tom Menighan, BSPharm, MBA, ScD, then addressed the session’s attendees. Menighan's mantra, "'We promote consumer access and coverage for pharmacists’ quality patient care services,'" he said, "describes what’s in it for patients rather than what’s in it for us and allows me to succinctly discuss everything we do, in 2 minutes or 2 hours."
Menighan cited the many initiatives APhA has led and supported during his 11-year tenure—among them, expanding community pharmacy residencies, founding the Pharmacy Health Information Technology Collaborative, increasing the number of BPS certifications for those seeking specialties, advancing interprofessional education and partnerships, and developing the Pharmacist Patient Care Process.
Now, he said, APhA will undergo a transformation in structure, systems, member engagement, and pursuit of provider status by a united profession.
“To participate as providers, we need payers to know who they’re paying.” In service of that goal, he announced the launch of Pharmacy Profiles, “a subsidiary of APhA [that] will serve as a trusted and verified repository of the nation’s pharmacist providers,” he said.
The platform, already in use in California and Florida, allows pharmacists to securely manage all their professional information and position themselves for future opportunities by allowing payers and others to find them. It was developed in collaboration with the National Association of Boards of Pharmacy and the Accreditation Council for Pharmacy Education and in coordination with the American Association of Colleges of Pharmacy and the National Alliance of State Pharmacy Associations. Pharmacists can create their profile free of charge.
Menighan made another big announcement. “My flight path as your CEO is on course for a successful landing in 2020,” he told the crowd, his voice tinged with emotion as he shared that he will retire from his position at APhA in 2020. “I love this organization. I’m committed to helping the [APhA Board of Trustees] to find the most excellent and outstanding new leader.” The search for Menighan’s successor will begin in April 2019.
“I live my life with gratitude and in service of this profession. It’s been an honor and privilege to work for you,” Menighan said. His remarks were met with a standing ovation.
In her address, President Hilliard reflected on the APhA2019 theme “Moving Pharmacy Forward.”
She acknowledged the tough challenges pharmacists contend with.
“Last summer, my family traveled out west and were standing on the southern rim of the Grand Canyon, where we heard a woman nearby complain about the sand in her shoes. Here we are before the most majestic views in the country, and she’s focused on a few grains of sand,” Hilliard said.
There’s a pharmacy analogy here, she said. “We have sand in our shoes—admittedly a lot of sand. We’re dealing with DIR fees, inadequate reimbursements, staffing challenges, growing demands from employers and patients, a lack of recognition on health care teams, and tuition debt, just to name a few.”
Hilliard pointed out that it’s important not to let the sand in our shoes keep us from appreciating the positive developments in pharmacy. “My family’s next stop was Antelope Canyon. When the light is just right and you throw sand in the air, you can illuminate a path of light streaming into the canyon. Without the sand, the path is not visible,” she said. “In pharmacy, we’ve got to find a way to use our sand and challenges to see a clear path.”
She announced a new initiative—another piece of the APhA transformation initiative that Menighan described—focused on reducing the burdens on pharmacy staff, with significant resources devoted to well-being, resilience, and work–life balance. In July, APhA will hold a consensus conference with stakeholders to identify contributing factors and provide tools to improve well-being and work environments. The input from stakeholders will guide the direction of the efforts.
APhA will also offer new membership models and member engagement opportunities, along with launching Pharmacy Profiles.
“We can fight change and get rolled over, or we can innovate,” Hilliard said. She encouraged pharmacists to embrace the unknown, relaying a story of her grandfather passing on the opportunity to embark on a new business venture with his weekly tennis partner. Hesitant to take the risk, he instead bought stock in the bank where he worked. “That tennis partner was Sam Walton, the founder of Walmart.”