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Patients who need a little extra support while getting mental health treatment at SSM Health DePaul Hospital — St. Louis are getting a buddy to help.

The buddies, who are hospital employees, match with long-term patients in the behavioral health unit who have little to no outside support or don't get visits from friends and family. The pairs make a standing weekly appointment of at least 30 minutes to read together, play a game, color, make a craft, and otherwise forge a supportive relationship.

The Buddy Program started earlier this year, but care providers already see results, including a decrease in negative behaviors among the patients. "Overall, some of them seem happier, and it gives them something to talk about," said Stacie Estes, a nurse who manages the program. "When I come in, I'm always hearing stories about what they've done with their buddy."

Need for stability
The idea for The Buddy Program came in December, when Estes, nurse Caitlyn Obrock, and the nurse manager in charge of the obstetrics department were talking about babies who needed extra attention in the neonatal unit while waiting for placement in the foster care system.

Estes mentioned that the situation of some patients in the behavioral health unit is similar. Some patients come in and out of the unit their whole lives, and sometimes they're part of the foster care system. The unit is for acute crisis stabilization. While most patients stay three to five days, some stays are much longer. The longest so far has been more than 500 days. Stays lengthened during the pandemic because of a shortage of foster families and residential providers available for patients ready for discharge.

"Several patients have been here for what feels like forever," said Estes. "They don't have visitors. Their guardians are state appointed. I'm watching these patients on the unit, who have lacked personal relations with people that are in a positive manner, who need some stability, someone to look forward to."

The discussion about the similarities between the neonatal babies and some of the patients in the behavioral health care unit prompted Obrock to confide that she'd love to take time to play a game or read a book with a long-term behavioral health patient. She asked colleagues if they would like to do the same thing as a buddy, and they said yes. That led to the launch of the program.

Creative solution
The behavioral health unit admits patients from ages 3 to 59. Any patient can get a buddy if they've been in the unit for more than 10 days, and if they don't know where they will go once discharged. The pairs started meeting in January.

At any one time, the unit has about 15 buddy pairs. Some staffers have more than one buddy patient, and some staffers are waiting to be matched. Estes manages the program, keeping a running list of staffers and patients and working to match personalities. She gets assistance from her sister, SSM DePaul nurse manager Hilary Estes.

"We did this not thinking it would become anything huge," Stacie Estes said. "This is a simple need that these patients had. So, we did it. You find ways to be creative and do things. And it is an easy thing to do that has such a huge impact."

To keep the program in compliance with federal privacy regulations, Obrock and Estes ask for permission from the guardians of patients before pairing anyone with a buddy.

They only accept employees within the campus as buddies. That makes it easier to maintain patient privacy. For the same reason, they pointed out, it would be difficult to bring in an outside volunteer group to be buddies to patients.

'A basic need'
In May, the U.S. Surgeon General released an advisory calling attention to the public health crisis of loneliness, isolation, and lack of connection in the United States.

"Given the profound consequences of loneliness and isolation, we have an opportunity, and an obligation, to make the same investments in addressing social connection that we have made in addressing tobacco use, obesity, and the addiction crisis," Dr. Vivek Murthy wrote in his report.

Research shows that loneliness can lead to various physical and mental issues. Loneliness and social isolation were associated with a 29% increased risk of heart disease and a 32% increased risk of stroke in many adults aged 50 and over, as well as with higher rates of depression, anxiety, and suicide, according to the Centers for Disease Control and Prevention. Loneliness can lead to issues like depression, alcohol abuse, child abuse, sleep problems, personality disorders and Alzheimer's disease, according to a study published in the Journal of Clinical & Diagnostic Research.

For those already being treated for mental health issues, Obrock said loneliness can exacerbate their illness. "Human connection is a basic need," she said. "And I think day to day we can get lost in that because we take it for granted."

Estes said she had one patient come to her office every day for a week, repeatedly asking if her buddy was coming.

Finally, one day Estes asked the patient, "Has she ever not showed up?" When the young woman replied no, Estes told her: "Well, I need you to learn to trust that she's going to be here. And if she doesn't, I think she will call or email or let me know in some way."

The encounter has stayed with Estes because that young woman "didn't trust that anyone was ever going to show up because she's probably been let down many times throughout her life."

Highlight of the week
Obrock said that employees love the program just as the patients do. "I would argue they were more impacted than we would have anticipated," she said. "It's been kind of a highlight of a lot of the staff's week."

The buddies do whatever activity strikes them. They color, they paint rocks together, they paint their nails — one patient even proudly got her hair cut like her buddy. Once they get to know one another, they have genuine conversations, Estes said.

Obrock played a kids' version of the card game We're Not Really Strangers with her buddy, a young woman. Players get to know each other by asking various questions. At the end of the game one day, she told Obrock, "This is helping me talk to people."

One buddy pair enjoyed playing chess together. When the patient was discharged, his buddy gifted him a chess set.

One day, Estes noticed two patients who have the same employee buddy sitting together. One patient was reading to the other. "That warmed my heart, because I think it's building further relationships," she said. "These guys are here for so long, and they're making healthy relationships, too."

Obrock said the impact of having a buddy can be especially profound for young patients. "If you sit down and look at the trajectory of a child's life, you just don't know what one person showing up for six months for 30 minutes can do," she said. "It can do a lot."