James Donaldson on Mental Health – To Prevent Suicide, Often You Have to Ask

James Donaldson notes:

Welcome to the “next chapter” of my life… being a voice and an advocate for mental health awareness and suicide prevention, especially pertaining to our younger generation of students and student-athletes.

Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.

Having gone through a recent bout of depression and suicidal thoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  http://bit.ly/JamesMentalHealthArticle

The difference between a person surviving suicidal thoughts and giving in to them can sometimes be just 15 minutes, said Michael Hartman, behavioral health director at Lamoille County Mental Health.

His organization is working to eliminate suicide in Lamoille County as part of a nationwide initiative called Zero Suicide.

The initiative, which began in 2012, includes new ways to treat depression and focuses especially on removing the stigma from discussing suicide. Hartman says that, once people open up about their suicidal thoughts, they’re less likely to go through with any plans they’ve made.

Suicide prevention should be considered a core responsibility of health care, the organization says, with comprehensive screenings to identify patients who have had suicidal thoughts and treating them with compassion.

Often, suicidal people slip through the cracks of the health care system because they don’t know how to bring up how they’re feeling, Hartman said.

Asking people directly whether they are suicidal can bring to light what they’re facing.

“There’s such a stigma around the word that, for many people, uttering those words is very difficult. The chances of them bringing it up independently — i.e., there’s nobody asking them, there’s nobody hinting at it, no indication that anybody’s giving them that it’s safe to talk about suicide here” — are very slim, he said.

“If it is brought up and questions are asked, very often, people will talk about it. It’s not like they won’t talk about it; it’s more like you have to ask. One of the things (Zero Suicide) is designed at is, how do you make your system capable of making sure that people ask, and that they know what to do if they get a positive response?”

Suicide in Lamoille County

A Zero Suicide fact sheet says 83 percent of people who die by suicide saw a doctor within a year before their deaths, and didn’t bring their mental states to their doctors’ attention.

In the last 17 years, death by suicide increased about 50 percent in Vermont, according to the Centers for Disease Control and Prevention.

Lamoille County has the third-highest suicide rate in the state.

That’s not counting attempted suicides; several a month can be found within the logs of local police departments, since officers are often on the front lines, accompanying emergency response personnel, when a person tries to take his or her life.

For every person who dies by suicide, 25 people try, experts say.

“The growth of suicide in Vermont has been pretty tremendous,” Hartman said.

In 2007, he said, 12.5 people per 100,000 died by suicide every year; now, 12 years later, that number is 18.9 people per 100,000.

“We certainly know that the kind of challenges that have gone on in many people’s lives for 10 or 15 years have been pretty strong,” Hartman said, including economic shock still rippling through Vermont after 2008’s recession, and depression in veterans who served in conflicts in Iraq or Afghanistan.

“We have a changing social structure of people who at one time, you had a job, you were all set, you had health insurance, holidays, things working out OK, and moving to an economy where everybody’s sort of doing gigs, where there’s very little stability,” Hartman said.

He also noted an increase in diagnosis of anxiety disorders in people ages 15 through 25.

“Those things all seem to be factors. … The challenge is, can we change how people look at this?”

A health care issue

Hartman said people who work in health care, emergency response, public safety and the school system need to look at suicide as an ingrained public health problem, not something to be ashamed of.

To do that, people need to get comfortable asking the tough questions.

Hartman says there are two ways to ask — the “hard ask,” and the “soft ask.”

“‘Sometimes, you must hear things that are pretty sad or depressing. Have you ever had a day when maybe a lot of that happened, and you go to bed and you think, it’d be fine with me if I didn’t wake up tomorrow morning?’ That’s an example of a soft ask,” Hartman said.

A hard ask?

“Have you had times where you wished you were dead?”

If the person says yes, Hartman says whoever posed the question should call Lamoille County Mental Health with the person and make sure they know they aren’t alone, and there’s help.

Often, the window in which someone thinks about suicide and then acts on that idea is between 15 minutes and three hours, Hartman said. If the person gets through that period, the likelihood of suicide drops.

People who commit suicide don’t want to die, Hartman said; instead, they feel trapped, and don’t see a way out of what they’re feeling.

“The challenge is, can we do enough things to prevent that moment from happening?”

Hartman praised an effort by the Vermont Agency of Transportation in Quechee to install fencing on the sides of the Quechee Gorge Bridge to make it harder for people with suicidal intentions to go through with their plans.

“It’s sometimes that simple of a delay, that you slow the process down, that people make a different decision. It really does take a community-wide application of this,” Hartman said.

Lamoille County Mental Health has trained most of its core staff, and works with community partners such as the Lamoille County Sheriff’s Department and Lamoille South Supervisory Union to help people recognize the signs of a person who’s struggling.

“We try to establish some kind of line of communication with people, just to see if they’re off, if they’re depressed, if they seem to care about themselves, care about what’s going on. Quite a lot of it is communication, and just to see where people are at,” Lamoille County Sheriff Roger Marcoux said.

A warning sign for his department is when family members or friends request wellness checks for a specific person.

“I think that it’s just important for law enforcement to do their best to recognize the signs and connect the people that are in crisis with Lamoille County Mental Health. Sometimes, it’s worse than that. Sometimes, we’re at the point where we have enough for an emergency evaluation, and we can take them into custody,” Marcoux said.

That happens once or twice a year.

Tracy Wrend, superintendent of the Lamoille South Supervisory Union, says her schools work with Lamoille County Mental Health to provide counseling and education about mental health for students, and professional development for faculty and staff.

“We collaborate … to support students and families in need, such as for emergency assessments, case management support, and coordinated services plans, all of which help to ensure children and their families’ needs are addressed across the school, home and community environments,” Wrend said.

People who are suicidal “are basically people who are seeing no end, no way out of a bad situation, and by suddenly being able to talk openly about this, start letting the pressure off. As the pressure goes off, the intensity dissipates,” Hartman said.