In Memory of Jonathan Eggena 1969 - 2024

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A 54 year- old married father of a 16-year old daughter voluntarily checks himself into a psychiatric hospital for having suicidal ideation- with a plan. Yet he is held for only two days; two days later he carries out that plan.

 

How can anyone honestly believe someone can receive two- or even 7 days of “crisis management” services and suddenly no longer be suicidal? What can a psychiatric hospital possibly do in two days that could treat someone suffering from such a serious condition?  

 

With the advent of managed care, and the transition to ‘stabilization’ followed by outpatient care rather than traditional inpatient care, the suicide rate has continuously risen.  In fact, after a long, steady decline in national suicide rates in the 1990s (McKeown et al. 2006), those numbers began steadily ticking up in the late 1990s and have generally risen ever since, with nearly 50,000 people in the U.S. taking their own lives in 2022, up 3% from the previous year.  From 1999 to 2016, suicide rates increased by 30% in 44 of 50 US states and across every age group, though most dramatic increments were observed in men aged 45 to 64 (Stone et al).

 

To point out how closely the increased rate in suicide correlates with the transition to the managed care model of health care in the United States seems too obvious. Since 1994 there has been a more focused turn to the marketplace to provide the impetus for reducing costs. This involved a shift from medical care provided by trained physicians to a system run by business majors and stock holders who continuously decrease the amount of money paid to physicians, while simultaneously decreasing doctors’ decision- making authority. In a marketplace where purchasers of care look for low bidders, it should be remembered that the level and quality of care received is usually commensurate with the level of resources that it is willing to expend. In this case, ‘care’ was clearly not part of the equation

 

Too many have lost their lives as a result. This time it was so personal and so painful that it would be hard to capture here. Just suffice to say that Jon Eggena was at one time my very best friend and the first and closest connection that I ever had in my life.  From the outside he had everything: good looks, a loving wife and daughter, close friends, a beautiful home, incredible athletic ability, a college education, etc. Most of the time he had a successful career, but depressive episodes at times took their toll. He tried alcohol as a way to self-medicate, eventually giving it up 3 years prior to his death in hopes of feeling better. But he didn’t feel better. Only those closest to him knew.

 

Jon was prone to depression as far back as I can remember, but it was in the background. Letters in college hinted of loneliness and a longing for deeper connection despite being in a fraternity and perpetually good looking and popular.  There was always the belief that it would happen and he would find that connection he longed for. But then the head injuries. There were those from football in high school of course, but then an even more significant head injury in his early 20s. It is only relatively recently that we are learning about the long term, detrimental effects of head injuries on mental health.

 

People with a traumatic brain injury (concussion) are nearly eight times more likely to have depression than people without one. They’re also less likely to receive any kind of treatment for depression. And then there is the fact that traditional depression treatments — medication and psychotherapy — have been found to not work as well in those with head injuries.

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I am so sorry Jon. My love for you is beyond words. There will never be another you. I will cherish your memory when things were simple and beautiful as long as I am on this earth. I will also love Melissa and Olivia as if they were my own.

 

 We need to do better- both as a society- and as individuals.  Let’s take time to love more and to share more and to notice more. And let’s continue the fight to put the “care” back into health care.