HiThere, the ambitious Dutch startup, wants to reinvent insurance. They strongly believe they can improve the quality of life by providing customers a safety net through insurance. This safety net should be affordable and available to everyone all over the world. So that is why they decided to build their own unique platform: HiThere. A fully automated, modular back-office insurance platform that integrates the back-office seamlessly with the front-end, operates securely in the cloud, is accessible for customers, intermediaries and the insurer and is able to deal in a fully automated way with all life insurance products - closed books and open books - in a fast and flexible way. It is possible to provide personalized premium quotes, based on AI and advanced analytics. HiThere started from scratch and did not have to keep existing, outdated systems in the air. By making progress in the six key dimensions discussed in the McKinsey report, the making of a Digital Insurer, they build a brand-new insurer based on the latest insights, new regulatory demands, greater administrative efficiency, growing cost pressure and digital transformation. The total amount invested in the current HiThere application is around € 4 mln. [caption id="attachment_28053" align="alignnone" width="570"] McKinsey (The Making of a Digital Insurer)[/caption] See also: Lemonade: Interview With CEO   Advantages of a fully automated back-office HiThere has full, digitized processes, the latest data analysis technology and is not bound to a physical location. It offers great cost reduction, pricing based on pay per policy, personalized premium quotes and the ability to provide all the required business information real time to all the stakeholders. Handling the whole life insurance back-office chain in a fully automated way. The startup concentrates on designing creative and new ways to involve their customers and thereby radically improve customer experience. This will ensure that it becomes part of a much larger service platform that consists of a community of companies around the customer with all the services that he needs. Digital platform for funeral insurance The HiThere team developed tailor-made software for the funeral and cremation association Bleijerheide (BCB) in Kerkrade. They automated all the processes and created a full digital platform. New members can sign up online and existing members can make changes online at any time and view their information. All automatically and fully automatically processed in the BCB administration. The HiThere team also manages the actuarial consulting, the auditing and asset management. The membership administration, sending invoices and making transactions are now completed a flip of a coin. The contributions are automatically generated via HiThere, which greatly accelerate and simplifies the collection process. Why we selected HiThere for DIA Munich HiThere is reinventing insurance. In the current environment of rapid change, core processing, data analytics and digital engagement hold the potential to optimize the insurance lifecycle. HiThere is built on these pillars whilst putting the customer at the center of the business. With their digital platform for BCB they showcased their abilities. We’re very pleased HiThere wants to showcase their game-changing approach at DIA Munich. See also: Innovation: ‘Where Do We Start?’   Who is HiThere? HiThere is founded in 2016 by Ruud Kleynen, owner of Kleynen Consultants and associate Member Maastricht Centre for Taxation, Maastricht University. The HiThere crew are actuaries and econometricians with a profound background in IT. They call themselves: the Game Changers.

In 1931, Ethel Merman sang a song titled “Life Is Just a Bowl of Cherries.” The phrase “life is a bowl of cherries” carried on – meaning that life is carefree. The life and annuity industry certainly can’t adopt this phrase because generating profit and growth has been significantly challenging since the 2007-2008 financial services crisis. Given that the low interest rate condition the economy currently lingers in isn’t going to dramatically change anytime soon, L&A insurers need to determine how to improve financial outcomes in other ways. According to LIMRA, there is a $16 trillion coverage gap in the U.S. In the language of the song title – that’s a lot of cherries! And an amazing opportunity for L&A insurers who are willing to change the way they approach the market. The recent SMA L&A data and analytics survey  revealed several important insights relative to this significant coverage gap. See also: 10 Trends on Big Data, Advanced Analytics   Financially protecting loved ones in the case of the death of a bread-winner isn’t a brand-new concept. In fact, it’s a fairly fundamental concept going back to original native tribes who had a structure for that. Yet, the identified coverage gap remains today. L&A insurers need to gain insight into those without life insurance coverage. What will trigger buying? What is important about products and services? How do they want to buy? The questions go on. However, only 38% L&A insurers indicate they are advanced users of dashboards and scorecards – which have been around a long time. Without modern dashboard technology that facilitates interaction with data, line of business experts cannot learn about the untapped and sometimes unknown opportunities. Closely aligned to the dashboard gap is the gap around predictive analytics. Only 19% of responders indicate they were advanced users of predictive analytics and models. These are critical areas for L&A insurers to dedicate time, skills, and financial resources to – if they want to convert a portion of the $16 trillion coverage gap. Overall, SMA research reveals that all insurers, both P&C and L&A, continue to invest in things they already do well. Investment in data and analytics for risk-based activities such as reserving, pricing, and product portfolio analysis has been high (between 70% and 76%) and are historically the top areas. Clearly, no one should stop investing in risk analysis as these activities are critical. However, customer-related data and analytics investment is very low. Customer segmentation and single view of the customer only garner 52% investing, and the investment percentages go as low as 29% for lifetime customer value. Even CRM only gets 48% investing. There is a clear imbalance. See also: Why to Refocus on Data and Analytics   While there are many other insights emanating from SMA’s L&A data and analytics research, the story around customer areas and the lack of proportional focus by life insurers is very important. Simply hoping that investments in advertising and websites will result in new customers from that previously uninsured $16 trillion is not a winning strategy. L&A insurers must know what is important to the uninsured population of the U.S. And there won’t be one right answer – there will be multiple right answers. Data and analytics investment for customer insights must increase. While there is a very low probability that a winning insurer in the L&A space is going to be playing Ethel Merman songs in their lobby, it won’t be an awful thing if insurers feel like there is a growing bowl of cherries in their corporate halls.

In the 1980s, when so many tech companies made so many empty promises that the term "vaporware" came into widespread use, cynical IBMers referred to their marketing department as "where the rubber meets the sky." Last week's InsureTech Connect gathering in Las Vegas suggests that, after some fits and starts for the insurtech movement over the past year and a half, we're about to see the rubber meet the road. 2018 should be an eventful year.

Any number of companies made compelling cases about how insurtech is cutting costs and setting companies up for much deeper reductions—so much so that, were I a carrier, I'd be looking over my shoulder. There's an argument to be made that brokers and agents, far from going away, will use technology to increase their access to knowledge and to deepen relationships with clients, then will feed business straight to reinsurers. And plenty of people in Las Vegas were happy to advance that argument. (Rick Huckstep explores the threat to traditional insurers in one of this week's Six Things articles: "Time to Get Personal.")

A senior executive at a big regional brokerage wouldn't go as far as Huckstep but did say the pressure on carriers is growing: "We tell clients that we swap out carriers at least as fast as general managers trade baseball players."

It seemed that everyone in Las Vegas had bought into the idea of innovation and was arranging for proofs of concept (POCs) with a number of startups, which is great—as far as it goes. But there are two issues to watch.

First, to continue the baseball analogy, you can't tell the players without a scorecard. In other words, the cast of characters is now changing rapidly. We tend to focus on the launch of interesting startups and on the rounds of funding they line up, but startups fail, too. We can all celebrate Guidewire's $275 million purchase of 3-year-old Cyence, but, historically, about 90% of startups fail, and there's no reason to think that insurtech will be immune. We track some 2,000 insurtechs on our Innovator's Edge platform (along with 70,000 other companies that are of interest to insurers looking to accelerate their innovation), and I'd bet that, a year from now, we'll still be tracking about 2,000 insurtechs—just not the same ones, in many cases. You have to stay on top of the new ideas and keep initiating POCs.

Second, don't congratulate yourself too much for getting to the POC stage. We've seen this sort of thing happen in other industries: Someone will visit Silicon Valley, then go home, put a ping pong table in the office, start providing free food and declare victory. Surely, the reasoning goes, innovation will now follow. Now, POCs are much better than ping pong tables, but they can still create a false sense of assurance. They only matter if they get beyond any sort of innovation silo, get exposed to the core business and ultimately get pulled into areas where they can produce major gains. Identifying the right POCs to pursue is hard—but it's actually the easiest part of the innovation process. Driving a new technology or idea into the business is far harder. (Contact our Guy Fraker at guy@insurancethoughtleadership.com if you want some help or just want to hear some war stories. Guy has been running or consulting on innovation projects at insurers for decades—starting way back when he had hair.)

We'll certainly do our best to keep you up to date on the latest and best ideas at www.insurancethoughtleadership.com, beginning with the six articles below that are my favorites from the past week. Driving innovation in insurance and risk management is a worthy goal that we can all get behind. Please let me know if we can do anything else to help. 

READ FULL LIST AND COMMENTARY

Many insurance companies are not moving to cloud computing because they believe they can’t recover their sunk costs in IT infrastructure. This is not correct. Insurers can achieve big total cost of ownership (TCO) savings by migrating to the cloud.

Cloud computing offers insurers substantial benefits as they endeavor to adapt to changing market conditions and introduce new digital products and services. Many insurers, as I mentioned in my previous blog post, are not capitalizing on these benefits because of some serious misconceptions about the cloud. One of the most persistent and widespread of these fallacies is the belief that sunk costs are not recoverable. According to our research, 35% of insurers are holding back from embracing the cloud because they believe it offers unfavorable total cost of ownership (TCO). Such views are way off the mark. Take a look at Suncorp. This Australian banking and insurance group reduced its data center space by more than 75%, and also curbed its utility costs, by moving to the cloud. Several mergers and acquisitions had left Suncorp with a highly complex IT environment with considerable redundancy. It was operating more than 2,000 applications across many different technology silos. Furthermore, the company needed to support multiple major business brands. Instead of continuing to maintain and enhance its complicated and expensive IT infrastructure, Suncorp opted to move to the cloud. It first migrated its storage facilities and then transferred its other workloads and applications. The shift to the cloud has been a big success. See also: Lost In The Cloud: Five Strategies For Risk Managers Facing The Challenges Of Cloud Computing   Other insurers should take a fresh look at the substantial benefits that cloud computing offers. We’ve found that 60% of insurance companies replace their legacy infrastructure every three to six years. Most of these insurers, therefore, can optimize and align their IT replacement cycles with a migration to the cloud. This would allow them to avoid unnecessary capital expenditure, minimize write-offs and sunset their depreciation schedules. These benefits add up to considerable cost savings. What’s more, insurers can also capitalize on the data center space they’re no longer using by subletting to an IT services provider or cloud operator. This would generate additional revenue and improve their asset utilization and energy efficiency. In my next blog post, I’ll discuss why the cloud is essential for digital transformation in the insurance industry.  Until then, have a look at this link. I’m sure you’ll find it helpful. Eighty percent reduction in insurance carrier costs? Cloud as rainmaker.

Like a stool that is most stable when it’s on three legs, driving business results from digital customer experience stands on traffic, engagement, and conversion activities. When the three are done in conjunction with one another, you’ll see the strongest results. Traffic-driving activities through organic and paid efforts, and establishing content marketing strategies to ensure engagement take up a lot of investment and resources. The last thing you would want is for visitors to land on or engage in an experience that’s not fully optimized for them. That’s where conversion rate optimization (CRO) comes to the rescue. CRO is a data-driven, results-focused approach to taking the user experience to a higher level to transform more site visitors into paying customers. The insurance industry is perfect for taking advantage of CRO strategies, especially in driving quote submissions. Today, everything starts with a Google search. For shoppers who are in the market for new insurance, the journey usually starts from search with a goal in mind. Let’s say that is finding a new auto insurance. This search for auto insurance will expose available options to the shopper, after which he or she will decide which option looks the most fitting and then visit the insurance company web/mobile site. Once a potential customer lands on that insurance company’s website, it has very limited time to get the person's attention and funnel the person into the quote process. See also: Insurtechs: 10 Super Agents, Power Brokers   For insurance companies, web and mobile sites play an important role in driving quote generation. Optimizing these platforms to drive higher conversions is critical. Here are three ways to best use CRO tactics on insurance sites: 1. Connecting the right user to the right product: There are multiple tests we can conduct to figure out how much information about the site visitor we can capture in advance and make sure that the person sees the most relevant content up-front in a visit. For example, if everything we know about the visitor suggests that he may be interested in homeowners insurance, should you be showing him the other 20 product options? The conversion goal here would be to connect this prospect to a homeowners insurance company as quickly as possible and get him to engage in the quote process as fast as possible. 2. Highlight the main call-to-action (CTA): If the user is faced with multiple engagement points, different product options, or various next step alternatives, the result would be increased confusion, and the user potentially leaving the site. To get the insurance customers to the quote process more effectively you need to offer easy to follow designs, clear messaging, and clear call-to-action for the next step. Use CRO to determine how best to display your main key performance indicators from a visual design and placement standpoint. For example:

• Testing “sense of urgency” on the CTA language: “Get A Quote Today!”
• Testing visual treatments for quote start CTA: Usually darker, bolder colors that contrast well with the rest of the page design and content work the best.
• Testing placement: Place your quote start CTA always in the same section of the site to train users’ expectations. Test placing it as a part of the global navigation or as a part of the hero banner.

3. Optimize the quote process: One of the most important steps in the insurance customers’ journey is the quote submission process. Getting users to fill in the quote process is what seals the deal. You would think that anyone who came that far along would be likely to fill out the form, right? Why else have they been through that much work to get to this page? There is some truth in that but the fact that your site visitors made the journey all the way to the form doesn’t guarantee that they would not leave without completing it. See also: FinTech: Epicenter of Disruption (Part 2)   Luke Wroblewski, a product director at Google, wrote an amazing book titled, “Web Form Design,” which discusses ample approaches to testing forms, design, placement, labeling, orientation, single versus multiple steps, progress bars, etc. Do an analysis and understanding how users are going through your form pages first. From there, start a series of tests and play with various elements that can impact form submissions. Here are a few strong starters to prioritize:

• test number of form fields
• test single versus multiple (2-3) steps
• test CTA button on the form submission

These CRO tactics will help any insurance company get to a better conversion rate on their sites and start seeing immediate results. Happy testing!

Why do we base product KPI on data to begin with?  Product KPI (key performance indicator) is defined so we can measure how well the new feature works or resolve an A/B testing. That’s why it is only natural that when we come to set the KPI for a new product or feature, we start by looking at the data. This methodology fits nicely with the "scientific" and lean approach to product development: We base decisions on data and measurable KPIs rather than "soft," qualitative guess work. See also: 10 Trends on Big Data, Advanced Analytics   The limitations of working only with data But confining ourselves to data has its limitations. For starters, data is not immune to biases. We tend to interpret data to confirm our assumptions. But even if we reduce the bias risks, we can only look at the data we have. So if we already accumulated a lot of data, it still does not include behaviors and use cases that occur beyond our data, in the dark side of the data. Defining product KPI based on existing data is like looking for the solution under spotlight. That’s fine if the solution is there, but what if what we need to improve in our product market fit, or hack in our growth challenge, is hiding in the shadows? The importance of articulating a product strategy  Product life-cycle often starts with use cases. We ask ourselves what do our users do and how can we solve their problems or improve their experiences. That helps us to define the product KPI. But there is another important step in between. That is articulating product strategy. That is to say: given certain use cases, what do we want our product to achieve. Is it simply to help existing users do something faster? Or in a more sharing manner so we can hack viral growth? Or, are we looking for the product to serve a more business oriented goal of up-selling new features? Or, even help attract new types of users? While these questions may not change the basic use cases, nor our deep dive into product flow, these questions could be critical in defining the product KPI and eventually measuring product success and ROI. See also: Big Data? How About Quality Data?   Using product strategy to define product KPI A well-articulated product strategy can influence our prioritization along the product life-cycle and make MVP decisions easier. We still want to test our value and growth assumptions first, but without a well-articulated product strategy we can find ourselves arguing about the definition of value. There are many ways to generate value in a certain use cases. Setting the product KPI based on product strategy means we are prioritizing the value proposition according to our preferred target segment and our business goals. That’s why when we define product KPI it’s not enough to look at data and use cases. We must define product KPI in the context of our overall business strategy and its derivative product strategy.

It’s crunch time for P&C. Investment yields are declining while combined ratios are holding up in the 97% range.  This has P&C insurers wondering: “What can we change in our operations to improve our economics?” Conclusive answers are now coming from the field of cognitive technology, the variety of artificial intelligence that deals with knowledge and textual information. In this post series, I want to share three areas where cognitive is delivering unprecedented productivity gains and insight, and leading to deep changes in how P&C insurers do business. Why cognitive technology is a great match for P&C P&C insurance is particularly people- and paperwork-intensive. Both underwriting and claims management revolve around the production or retrieval of information from documents – a policy or a claim package - that capture the specifics of the insured’s case. These are particularly time-consuming tasks that up to now have entirely fallen into the lap of human operators and typically represent 20% of the combined ratio. What cognitive technology brings to this picture is its ability to read documents much in the same way humans do, in a fraction of the time. It automatically harvests a case’s characteristic pieces of information and reasons on them. This reduces the time operators need to spend on such tasks from hours to seconds. As a result, insurance professionals can focus on the highest-value areas of their jobs, such as decision-making, rather than the more time-consuming, menial tasks. And it takes significantly less time to service a case. See also: P&C Insurers: Come Out of the Dark Ages   As a first example, let’s look at how this plays out in claims. Accelerate Claims

• Automate claim routing
• Summarize key claim characteristics
• Suggest claim valuation
• Focus claim handlers on high value activities

Because claims workflows critically depend on proper information flows, grooming even ancillary information may take up a disproportionate share of claims handlers’ time. Cognitive technology alleviates a large part of this issue. When dealing with automotive claims, for example, it can review claim packages automatically to evaluate their complexity and route them accordingly, recover essential aspects of accident descriptions to support liability determination and suggest an appropriate settlement value based on the facts of the case, such as which injuries were incurred, what medical tests or treatments were applied, what the medical history is and how the prognosis looks. Overall, this accelerates the claims workflow and helps claims handlers focus on the highest value part of their work: decision making. A second area where cognitive plays well is underwriting. Accelerate Underwriting

• Consistently grade risk and flag exposure
• Accelerate quotes
• Optimize risk engineers’ time

An essential part of underwriters’ jobs is to evaluate the risk profile of the customer they will be insuring. In commercial property insurance, for example, this involves analyzing third-party risk reports that describe the facilities to be insured, their particular risk factors (such as building combustibility, presence of flammable materials …) and mitigators (smoke detectors, sprinklers, fire extinguishers, site surveillance …). Cognitive technology quickly and consistently extracts each of these indicators and reports an overall, evidence-based, risk grade to the facilities. This means risk engineers can allocate more of their time to direct verification of the most complex cases, and underwriters can turn around quotes on new policies faster. When applied to the review of existing policies, cognitive can analyze clauses and compare them to reference policies to flag misalignments and excessive exposure. This means underwriters can more easily prioritize which clauses of a policy they may need to renegotiate in the future. See also: P&C Core Systems: Beyond the First Wave   That's it for today, but in part 2 of this series we’ll look at a third area where cognitive can help, as well as some ideas on how you can start building a business case for applying cognitive to your own business. If the suspense is too hard to bear, you can also download the full white paper here. Let's discuss it! My co-author Pamela Negosanti and I are curious for your insights. If you're involved in applying cognitive to insurance, we'd love to know how you see it from your vantage point -- so please share your thoughts below and let's connect.

It’s no secret that telemedicine delivers faster, more accessible and more affordable medical care for patients across the world. However, when integrating a new telehealth program into your business, there are some details that employers should not overlook. Let’s start with state regulations. Because they vary across the country, it's important that employers be aware of the specific compliance regulations issued by their state. If an employer is in compliance with these state regs, the chosen telehealth provider will then help navigate the onboarding process and provide concierge support throughout the duration of the program. Telehealth and Workers' Compensation Another important factor to take into account is workers’ compensation. While telehealth and workers’ compensation have existed for years singularly, thanks to the rapid evolution of technology they have recently come together under the same vertical. To ensure that they’re getting the specific advantages that their business needs, employers should educate themselves on the available options for integrating telehealth into workers' compensation. See also: Consumer-Friendly Healthcare Model   One option for integrating telehealth into workers’ compensation is to make it available to treat acute conditions. It could be particularly useful for employees with minor injuries or those who would rather seek self-care over in-person treatment. Making telehealth available in cases where a clinic might not be immediately available is another option. In these cases, an employee might be at a remote location and may not have prompt access to healthcare. Telemedicine solves this dilemma by bringing the doctor to the patient. And should injured employees require further care, telemedicine providers will refer them to specialists or ancillary services within their network for continuity of care. Telehealth is the ideal platform to deliver healthcare to injured employees if they meet the screening process. While all serious cases, emergency or otherwise, should be addressed in person by a physician or at an emergency room, there are far more minor cases that can be safely treated via telemedicine. The Big Telehealth Picture Many telehealth programs offer several direct benefits to the injured employee and the employer alike, including 24/7/365 availability, increased productivity, reduced absenteeism, greater employee satisfaction and reduced unnecessary visits to urgent care facilities, which incidentally allows for further cost saving. Whichever telehealth program employers choose, it's a good idea for them to make sure they have a strong communications plan to stay educated on benefits, onboarding and more. This often comes in the form of onsite education seminars where employers and employees have direct access to the extended boutique health and wellness services. See also: Case for Reimbursing for Telemedicine   And, of course, as with all healthcare benefits programs, it’s equally important to research the benefits, platform features and plan options available in any potential telemedicine services you subscribe to, as no two telehealth programs are exactly the same.

This year's InsureTech Connect blew me away. More than 100 senior leaders attended our Salesforce Exec Summit and shared their firms' transformation stories. I especially enjoyed hosting a discussion, "A View from the C-Suite," with Paula Downey (CEO, CSAA) and Naveen Agarwal (Chief Customer Officer, Prudential). I got a lens into what makes other leaders tick: their habits, their values and their sources of inspiration in the face of difficult and risky change. For example, one CEO intimated how she keeps herself out of her comfort zone.

"I read everything. Just to get diverse perspectives. I try to read for 2 hours in the morning, and then finish my day with more reading whenever I can."

That really struck me. Every morning, the day-to-day minutiae of email, texts and news sound bites all conspire to rip our attention apart. Yet here's this very busy leader of a $3 billion company who still manages to schedule time for quiet, concentrated, contemplative reading. Every morning. Every night. I have no more excuses. See also: Future of Digital Transformation   And there were more equally moving insights about leading change. I put six of them into this infographic: Why the urgency? Financial services and insurance -- industries that are built not on tangible products, but on customer trust -- are among the industries that are bracing for the most significant change. The shift from product-centricity to customer-centricity is now tablestakes. With a supercomputer in every pocket, and the impending explosion of IoT data, digital upstarts are vying to become the next Amazon Prime of insurance that's personalized, on-demand and mobile-first. How are you driving change? What are your secrets of success? Please share. See also: 4 Rules for Digital Transformation   Thanks so much to everyone who attended the Exec Summit!

The popular image of someone who is in danger of suicide goes like this: A crisis occurs. The person has overwhelming urges to die by suicide. Through the benefit of a call to a crisis hotline, loving remarks by family and friends, good psychotherapy, hospitalization or simply the passage of time, the crisis resolves within days or weeks, if not much sooner. That’s the popular image, and, I'm happy to say, it does happen for many people. But for many other people, there is no crisis that stimulates suicidal thoughts. Or maybe there was a crisis long ago, and it planted a seed that over the years has grown into a towering tree, one not easily felled by crisis intervention, therapy or time. For these people, suicidal thoughts are chronic. The trajectory is similar to that of a person with any other kind of chronic condition: There may be flare-ups where it is far worse than normal, and then the symptoms subside, but only temporarily. And for some people, the symptoms never subside. They live with their symptoms – in this case, suicidal thoughts – every day. Chronic suicidal thoughts are especially common in people with borderline personality disorder, an illness characterized by difficulty regulating emotions, impulsive actions and unstable relationships. The psychiatrist Joel Paris says that, for many people with borderline personality disorder, “suicidality becomes a way of life.” However, chronic suicidal thoughts can occur in concert with other mental illnesses, such as recurrent episodes of depression, or even with no illness at all. See also: Suicide and the Perspective of Truth   Many people who regularly have suicidal thoughts will tell you they do not view the thoughts as a problem. In fact, they might have considered suicide for so long that it feels normal to them. Some have thought of suicide ever since they were young children. And some have made multiple suicide attempts, sometimes so many that they lost track long ago. Often the psychological pain of people with chronic suicidal thoughts is intense, but even seemingly minor challenges can awaken the wish to die. Frank King captures this dynamic well in his TedX talk, A Matter of Laugh or Death. Although King is a comedian, he provides this example in all seriousness: “See, people don’t understand. Let’s say my car breaks down. I have three choices: Get it fixed, get a new one, or I could just kill myself. I know, doesn’t that sound absurd? But that thought actually pops into my head…. It’s always on the menu.” Some people who think of suicide do not want to stop. They say it comforts them to know they can die by suicide if ever the pain of life gets to be too much for them. This dynamic led some experts to refer to “suicide fantasy as life-sustaining recourse.” As the philosopher Friedrich Nietzsche stated, “The thought of suicide is a great consolation: by means of it one gets successfully through many a bad night.” This is not to say that chronic suicidal thoughts are harmless. The more someone thinks of suicide, the more they might get used to the idea, thus dissolving their inhibitions and fears around suicide. And chronic suicidal thoughts typically indicate that an unhealed wound needs the person’s attention, whether that wound arises from past trauma, mental illness, grave loss, or some other cause. Even for people who do not view their recurrent suicidal thoughts as a problem, it certainly is better if they can come up other escape fantasies besides death. Better yet, they can be helped to develop problem-solving abilities, coping skills, hopefulness and reasons for living that will make the option of suicide unnecessary. So, for someone with chronic suicidal thoughts, therapy tends to take longer than it does for someone in an acute crisis. The goals of therapy are not only to keep a person safe but also to help them develop the skills and resources that will weaken suicide’s allure. Often, it is not a realistic goal for a person with longstanding suicidal thoughts to stop. Suicidal thinking has become a habit. And nobody can control what thoughts come to them, only how they respond to the thoughts. One way for someone to respond constructively is to observe their suicidal thoughts with curiosity and detachment. Some of my therapy clients say to themselves something like, “That’s not my real self talking. That’s my depression (or stress, or post-traumatic stress, or some other condition) talking.” Mindfulness can be especially useful here. The psychologist Marsha Linehan, PhD, developed dialectical behavior therapy, a form of cognitive behavior therapy combined with principles from Zen Buddhism. She uses a metaphor of a train passing by: You can sit on a hill and watch the cars of the train pass, or you can jump onto one of them and get carried away by it. So if you know someone with chronic suicidal thoughts, you don’t need to respond as though it is an emergency unless the suicidal thoughts have intensified to such a degree that the person is in danger. If the person is intent on acting on their suicidal thoughts soon, that’s an emergency. See also: Blueprint for Suicide Prevention   If the person is simply having the same thoughts that they have had for many years, then don’t panic. Compassionately listen and empathize with the person. Ask how you can be of help. Talk with the person about resources they can use, like the National Suicide Prevention Lifeline (800-273-8255) or the Crisis Text Line (741-741). Also talk about how they can keep their environment safe, like by removing firearms from the home. Chronic suicidal thoughts are not ideal, but they also are not a crisis in the absence of intent to kill oneself. As odd as it sounds, the option of suicide might be the very thing that helps some people to stay alive.