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Pierre man seeks help for mental illness, finds hope

November 4, 2017

It wasn’t something that happened overnight.

In fact, Sylvester Birchem said, he’s suffered from depression and anxiety for most of his life. But when he lost his job at Highland Cafe last year and started looking for work again, he started to isolate himself. During the first few months of 2017, Birchem said, he started to lose interest in his hobbies.

Riding his motorcycle and going down to the shooting range just didn’t have the same appeal. As a devout Mormon, Birchem continued to go to church. There he would smile and tell his fellow congregants that he was doing just fine and that his job search was progressing.

That wasn’t exactly true, though. Birchem was suffering quietly and was good at hiding his pain.

“I went to church and put on a fake smile,” he said. “I didn’t let anyone catch on that I was struggling.”

It wasn’t exactly hard to hide how much he was hurting. There were no outward symptoms. He wasn’t losing his hair, he didn’t have stitches. Birchem wasn’t being attacked by some bacteria or virus; his disease was more subtle. He was suffering from a mental illness. And he couldn’t see a way forward.

“You just go into a deep, thick fog and there’s no hope,” Birchem said.

For months, he kept it to himself. Then, one day, he found the muzzle of his pistol pressed against his head and his hand was holding the gun. Birchem said when he realized what he was thinking about doing, he got scared.

Scared enough that he went to see his doctor, a family-practice physician at the Sanford Clinic in Pierre. Birchem asked for help. And he got it.

“I just told him what was happening,” Birchem said.

He was prescribed medication to treat his depression and was scheduled to meet with a counselor and Capital Area Counseling Service. Birchem has been getting better ever since.

Birchem’s story isn’t uncommon. In fact, studies have shown that about half of the people who attempt suicide have visited a doctor in the 30 days prior to their attempt. Most don’t come out and ask for help but they do look for it.

It’s that piece of information which informs the Zero Suicide Initiative, a national effort among hospitals to prevent suicide among people who are receiving care from the medical community. Zero Suicide is a big piece of the 2012 National Strategy for Suicide Prevention and is a priority for the National Action Alliance for Suicide Prevention.

The idea is to close gaps in a given healthcare system that allow patients who are struggling with mental illness to slip past their regular doctors without getting the help they need. Locally, Avera Health, which operates Avera St. Mary’s in Pierre, began adopting Zero Suicide programs in 2016.

Basically, said Steve Lindquist, assistant vice president for Avera McKennan Hospital in Sioux Falls, Avera began asking it’s primary-care physicians to begin asking more and more detailed questions about their patient’s mental health. Doctors now use a standard form with 9 questions that, Lindquist said, have been shown to help identify people who are struggling with mental illness.

“We wanted to see if we could do better,” Lindquist said.

So far the results are promising, Lindquist said. System-wide, there has been higher than 90 percent decreases in the number of suicide attempts in patients who have received inpatient behavioral health care, emergency room visits for people who have received inpatient care at behavioral health centers in Sioux Falls, Aberdeen and Marshall, Minn., and in repeat behavioral health assessments for people who have been treated at inpatient behavioral health centers.

Avera also has improved its process for working with patients’ families to help limit a patient’s access to things that could be used to attempt suicide. In Sioux Falls, Lindquist said, Avera clinics now also have access to on-call therapists who can help right away if a physician thinks their patient needs help immediately.

“It’s made us more aware of the process people go through to get help,” Lindquist said of Avera’s efforts.

In more rural areas such as Pierre, Avera is working to expand it’s telemedicine programs to include psychiatry, as well as training the system’s primary-care doctors to help identify patients who are suffering from a mental illness. Avera also has been working with Capital Area Counseling service, Lindquist said.

“We want to try to address access,” he said.

Birchem, for his part, is feeling better. He’s rediscovered his hobbies and still is looking for work.

“I just want to let people know that there is hope and not to give up,” Birchem said. “There’s no shame in getting help.”