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Talking & Training: Suicide Prevention Q&A

Published in Behavioral Health Services, Mental Health, For the Health of It, Suicide Prevention Author: Ryan Engdahl, PhD, LP, Behavioral Health Operations and Collaborative Care Director; and Lisa Bershok, CentraCare Suicide Prevention Program Manager

Bob Hughes: What is CentraCare doing to respond to suicide in our communities?

Ryan Engdahl: Every health system in the country is aware that suicide rates are on the rise and there’s encouragement for addressing this head on and directly in ways that maybe we haven’t before.

Bob Hughes: The CentraCare Foundation Community Year-End Campaign is focusing on suicide prevention and education. What do we need to know about helping people prevent suicide?

Lisa Bershok: I think one of the most important things that we need to discuss in our community is suicide prevention. Being able to feel comfortable having conversations with our family members, our friends and our coworkers when we see warning signs of suicide.

Bob Hughes: A common response to someone who committed suicide might be: Why didn’t they say something? Why didn’t they talk to me? That was my friend. I would’ve loved to have helped them. Is there an answer as to why people who are or who do take their own lives, why they just don’t reach out to get that help?

Lisa Bershok: Sometimes it’s related to stigma. Individuals might be having these thoughts of suicide or might be experiencing either mental health symptoms or a number of life stressors and they feel isolated from family and friends and coworkers. How do they talk about this? The stigma that even they might themselves have, that self-stigma that if I talk to somebody about this, they might think that I’m crazy.

We know that asking will not put that idea in someone’s head. What happens is when you can ask directly is that you become a safe person for that person to talk to and it allows them to have an ability to open up, to know that you’re safe and they can express things to you that they may be feeling or thinking. And in turn if you know how to connect them to help and resources in the community.
We, as a community, as individuals and family systems, we’ve taken steps then toward helping that person because we know that mental health symptoms, we know that suicidal thoughts are treatable and if that person is able to get connected with the right help, they can go on to live full and engaging lives.

Bob Hughes: How bad has been the increase in suicide rates and how did we get there?

Ryan Engdahl: Suicide is the 10th leading cause of death in the country and it’s the eighth leading cause of death in Minnesota. We have a tremendous opportunity to provide education so that we can intervene earlier. The sooner we can get connected with folks, the sooner we can become involved and the more aware people are of the resources they can get access to, the more people we're able to connect with and help.

As you mentioned earlier, it’s hard to talk about. And so our goal is to help people find the ways to ask the people who they care about, if they can support them. We’re trying to provide avenues for people who are struggling to reach out to the right resources and also provide a resource for those people who are concerned about somebody around them. We talk about crisis response and crisis resources in our community as being available for people who are struggling themselves but also for their caregivers and for people who are concerned about their friends or family.

I think the goal is that we make it comfortable to talk about, we make it something that families can talk about at the dinner table because if we don’t, we will continue to have sort of the same problem. We have to essentially give people the tools to make this something that is very simple to discuss.

Bob Hughes: What is another medical condition that has broken down that uncomfortability factor and now we talk about things like this all the time?

Lisa Bershok: I think suicide prevention has started to work from a public health model — similar to the work that’s been done with drugs and alcohol..

For example, decades ago parents didn’t probably talk to their kids about the dangers of drugs and alcohol, but now we say talk early, talk often. It’s the same for suicide prevention.

Ryan Engdahl: Getting the information in front of the right people is what our goal is and our hope with this program is that we become that resource for our community. That people can call us and say, “I would like get some information for my workplace or for my group or for my church or for this event we’re having.” And we can be there to show up and provide a consistent, appropriate and accurate information and training.

Bob Hughes: What do you know about events that led up to someone actually going through and committing suicide?

Lisa Bershok: That’s kind of a myth, that there is one event that leads to this. Oftentimes it’s a combination of life stressors, mental health symptoms, family histories and personal histories. So what looks to us as family members or community members is one triggering event is actually kind of a long process of individuals struggling to cope. We also know in terms of suicide prevention, talking about it, doing the anti-stigma work so we feel more comfortable about this as a community is helpful. But we also need to get in front of the crisis. We need to start doing early intervention. When we see that somebody is struggling with mental health symptoms, we have the ability to say it is OK to get support and help. It is OK to go to therapy to deal, to learn how to cope with something that you’ve never experienced before.

Mental wellness exists on a spectrum, so we talk about these things existing in different places. There’s mental illness and mental health and suicide is part of all of these things. And our goal is to help support people to recognize that this is part of your whole health — your mental health — your mental wellbeing is part of who you are as a person.

You know, being a well person is so much more than just not being 30 pounds overweight. Absolutely. Our focus again is mental wellbeing as whole person and instead of separating your brain and your body.

Bob Hughes: What do we do? What, what are the tools that are available out there for us to start talking about suicide? And who should we be talking to? Younger kids should, you know, is there an appropriate age to discuss mental health?

Lisa Bershok: Well, I think the conversations around mental wellness, brain health, so to speak, those are things that we can infuse into our children’s lives from an early age. Talking about how important it is to be able to express your feelings and have a safe avenue to do that. And I think, as parents, to be able to acknowledge that if our child is struggling to cope with some things that are more difficult for them, that it’s OK to talk to your pediatrician about whether or not mental health support is helpful. What we know is that for most individuals that half of all mental health symptoms will present by the age of 14 and three quarters by the age of 24. We also know from the time somebody has symptoms of mental health related diagnoses to the time they get connected with care is eight to 10 years, eight to 10 years of somebody dealing with those symptoms. Within that, you can get to a point where you could feel hopeless — that it’s too difficult to deal with.

Some will say “The older generations are not as invested in this conversation.” That’s not the case either. When we start giving people permission to talk about this, everyone has a story. They have their personal story; they have the story of somebody who they love and care about and that’s why it’s so important to bring this out into the community.

Bob Hughes: What is changing when it comes to attitudes on how to discuss suicide?

Lisa Bershok: I think as we have more voices of what we call “lived experience,” people who survived suicide attempts. When we have suicide loss survivors coming and sharing their voices and their experiences. The term committed suicide. We’re changing that language. Language has an impact on our culture and how we think about topics. When we talk about suicide, we talk about people who have lost their lives to suicide, people who have died by suicide, mostly because once upon a time in this country, it actually was illegal to attempt suicide. You could be arrested if you survived. What we want to do is talk more about how early connection to treatment can give people hope and options for how to survive a suicidal crisis. We also want to focus more on the fact that there is hope as a community, even when deaths by suicide occur.

Bob Hughes: How about warning signs? What do we know what to look for when it comes to warning signs? And then what do we do?

Lisa Bershok: Attend a suicide prevention training in your area. CentraCare will be, through our suicide prevention program, offering trainings for free to your community groups, schools, faith leaders and other workplaces in the community. But things that people can look for are warning signs of suicide might be somebody feeling hopeless, feeling trapped, like there’s no way out of their situation. You might see some pretty dramatic mood changes that are not normal for that person — maybe rage or uncontrolled anger. Increased drug or alcohol use can be a sign. And especially withdrawing from family, friends and the workplace.

Those are what we call indirect warning signs. That person might be at increased risk of suicide but may not be suicidal, but this is still something you should pick up on and start the conversation with your loved one.

Bob Hughes: What about a direct warning sign?

Lisa Bershok: Those are what we call emergency warning signs. If you see these with friends or family, you need to connect them with help right away, which could be connecting on a health and welfare check with your local police department. It could be connecting them with behavioral health assessment immediately. Oftentimes it may be through an emergency room. The direct warning signs are somebody actually threatening to hurt or kill themselves or talking about wanting to die. It could be looking for ways to kill themselves such as searches on the internet or trying to get access to a weapon. Again, things that are outside of the norm for the person who you know, and either that, or somebody talking or writing about death, dying or suicide. And those you need to immediately connect somebody with mental health support and assessment.