Support and Education for Companions

Dear friends -

This update is a long one. When I began writing, it was short, impersonal, and off topic. Finally, I realized I was avoiding writing about what happened for Cliff and I. That was difficult to write and has also ended up being long.

With that caveat...

In the last update, I wrote about the role Cliff's workplace played in his anxiety, depression, and death. Many of you wrote to me to say you appreciated knowing more about what had been going on for him. Some of you who were colleagues could identify with some of what Cliff was going through.

Witnessing the anxiety, depression, and suicidal urges that overtook Cliff was nightmarish, even though it was mild compared to what Cliff was experiencing. When he first learned the contract at work would be ending, I was happy and relieved. I did not have a high opinion of his employer, having worked for them myself for almost seven years. The former colleagues I knew who had left the organization were much happier in their new roles. Cliff was an intelligent, creative, gregarious man with a skill set that was in high demand and a solid resume. I had no doubt he could find better employment.

The anxiety he began experiencing at the end of September surprised me. It began mildly. By Thanksgiving it was strong enough that going to friends' for a big social evening -- something that he normally would have loved -- was a challenge. He was having difficulty sleeping, and started having digestive problems. His doctor diagnosed irritable bowel syndrome, gave him a sleep aid, and also prescribed medication to help manage the anxiety.

From the beginning, Cliff tried numerous strategies to get the anxiety under control and manage the situation. He quit drinking, because he found it made the anxiety worse. He was exercising, meditating, taking vitamins, walking, being more frugal, applying for other jobs, going to yoga class. He downloaded personal growth audio files, listened to relaxation sound tracks, and read books he'd found inspirational in the past. We began doing daily check-ins during which we would each take turns just talking about what we were experiencing that day while the other person listened.

In many ways, even this experience brought us closer together. Any good front that we were still trying to maintain for each other was blown away. We opened our hearts to each other in our daily check-ins. I did my best to support him in doing whatever he needed to do to try to bring the anxiety under control. Although he was obviously suffering, Cliff continued to demonstrate his love for me, do kind things, and offer his help in my own endeavours.

Despite everything Cliff was trying, the anxiety continued to worsen. Whenever he had a better day, we both continued to be hopeful that this was the turning point, that the worst was over, but that never proved to be the case. Eventually the anxiety became so bad that without medication he felt like his skin was burning and would repeatedly jump up and pace the floor, talking over and over about the worries that had engulfed him.

Cliff tried getting professional help, but this proved challenging. Services through his Employee Assistance program were free, but of low quality. Paying for a coach or counsellor was expensive, and much of his anxiety was focused on finances. His doctor referred him to a Mood Disorder Clinic, but the groups there met during the weekday, and the last thing Cliff was going to do at that point was miss work. He became terrified that at any sign of weakness, he would be fired.

As the situation progressed, I became more and more confused and concerned by Cliff's reactions, and felt more and more helpless and uncertain about what to do. He was certain that the world was heading towards an economic collapse; that his financial situation was dire (from my perspective, it was definitely not); that no one would hire him; and that he was now incapable of continuing to do IT work (although he was continuing to do high level work capably even while he was obviously not well).

His suicide attempt at the beginning of December caught me completely off guard. The topic of suicide had arisen twice earlier. The first time was when he shared the results of a counseling assessment with me in which he'd been asked to rate how often he thought of suicide. I was concerned when I saw there was a "1" beside it, but he told me this was a very low rating, that it wasn't an issue. The antidepressant medication he was later prescribed had "suicidal thoughts and feelings" as a side effect, so we talked about how to handle that, agreeing that he would just have to tell me and his doctor if that started happening. I didn't know what else we would do.

The first weekend in December, I went to Seattle to visit friends and attend a workshop. I had repeatedly asked Cliff to come with me, but he was  committed to working that weekend. When I arrived home Sunday night, I found him passed out on the bed. I managed to wake him, but he was obviously heavily medicated. Unable to convince him to go with me to the hospital, I called 911. Then I found the suicide note and the packages of pills he'd taken.

We spent three days in emergency and the Acute Medical Unit at Vancouver General. After they stabilized his physical condition, they moved him to the Brief Intervention Unit of the psychiatric ward where he stayed for another 13 days. During this time, I consulted three counselors as I looked for someone to work with, and talked with three psychiatrists within the hospital. None of them talked to me about what signs had shown that Cliff was at risk of suicide; what to watch for in case he became suicidal again; or what to do if that happened. Although I spent hours at the hospital with him every day, none of the professionals there involved me in their meetings with him.

I myself was a weak advocate, not knowing what role to play. The psychiatrists advised me to let Cliff retain as much control over everything as he was able. He didn't want to tell his children or his friends why he had been admitted. I didn't want to violate his trust in me. We weren't married, and I'd only been living with him for nine months. I was unsure to what extent I could or should question what was happening or ask to be more involved. I was also relieved that he was finally getting dedicated professional help, and hopeful that this would finally be the turning point; that they would be able to do what Cliff and I had been unable to do on our own: straighten everything out and help him get well again.

Tragically, as you know, this was not the case. I think his psychiatrist was in almost as much denial that suicide could be a possibility for Cliff as I was. The Tuesday morning that Cliff was discharged, I skipped work at the encouragement of my director and arrived at the hospital while Cliff was in a session with his psychiatrist. When they came out, surprised to see me, the doctor told me he was discharging Cliff. He handed Cliff a set of prescriptions, gave us his blessing to go to Mexico the following Saturday, and reminded Cliff to connect with the outpatient mental health team before we left. The doctor seemed cheerful and optimistic. Cliff seemed as agitated and fixated on financial worries as ever.

At a couple points that afternoon, Cliff's behaviour concerned me enough that I sat him down and asked what was going on, what was he thinking? He reassured me both times, coming up with plausible explanations -- plausible, at least, within the context of what we'd been through in the past few months. I had no instructions on what to do if I was concerned, didn't know what support was available other than to phone 911 if he was at imminent risk. He didn't seem to be in crisis, so I didn't think of phoning the crisis line. By now, unusual behaviour had become the norm.

That evening we went to an early Christmas dinner with friends, and he seemed happier than I'd seen him in a very long time. "Finally," I thought, "the medication must be working."

In retrospect, it's easy to see the signs that Cliff was being driven toward suicide: The swings between cautious optimism and deep despair; saying he wasn't going to finish the dental work he'd started; telling me he didn't want to be burden on me; giving things away; his last happy evening with friends thinking that his suffering would soon be over. With more support and education, I might have seen those signs and been able to intervene. I was probably in a better position to do that than anyone else. I know there are many other suicide survivors who have been left with that grief, too.

Strategy #4: Support, education, and training for people living with someone with a mood disorder

Living with someone who is experiencing a mood disorder such as anxiety, depression, or bipolar disorder can be a confusing, painful, and challenging experience. If the situation persists for an extended time, spouses and close friends may be at risk of burnout.  In some circumstances, sadly, the stress of the situation and lack of understanding can result in conflicts or breakdowns in relationship. All of this reduces support and heightens risk for the person who is ill.

Those living with a person experiencing a mood disorder may not be aware that suicide is a risk, may be in denial about its possibility, and very likely do not have the knowledge and skills needed to intervene even if they are concerned. The person themselves is not in a mental state to care for themselves and may be at varying risk of self-harm. Under these circumstances, it is vital that that those closest to them, whether a spouse, friend, adult son or daughter, or other relative, receive support, information, and opportunities for training so they can be compassionate companions, and be more capable of intervening effectively if the risk of suicide does present itself.

Some support is available. The Mood Disorder Association of B.C. runs support groups for family members in Vancouver, North Vancouver, Delta, and Langley. FORCE Society for Kids' Mental Health has a  peer support network for parents. These organizations and AnxietyBC all offer information and resources online. I could not easily find information about suicide or links to suicide prevention resources on any of their websites, which makes me think this is a topic even mental health advocates find difficult to address [but please see my comments below for more information].

It is 13 months ago today that Cliff died. If we want to save lives, we have to educate ourselves and each other about suicide. We have to listen to each others' experiences, as painful as they may be. We can't rely only on professionals to assess and intervene. We can't depend on someone who is suicidal to save their own lives.

Psychological Safety in the Workplace

Dear friends -

After Cliff died, I was furious at the leaders and managers at his workplace for the role I perceive them to have played in his death. Because I had worked for the same organization and with many of the same people, I had my own experience and perspective of what he was dealing with.

Cliff's experience

The extreme anxiety and major depression that took Cliff's life were precipitated and aggravated by events in his workplace. The anxiety began after he learned that his employer's contract for IT services would not be renewed by BC Hydro, which put his job in jeopardy. Other aspects of the situation added to the stress and pressure:

• Management of Cliff's team had changed frequently, especially in the past two years. The current manager seemed inexperienced, awkward, and unaware of his impact on the team. He was focused on pleasing his superiors rather than taking care of his employees. Some of the decisions he made and the way those were implemented caused Cliff to feel ostracized, scrutinized, or embarrassed, and Cliff did not trust him.
  
• Contract workers from India, paid at a much lower rate, had been brought to B.C. to do work closely related to that of Cliff's team. The employer made no attempt to educate the Canadian team members about working cross-culturally, and there were many communication challenges. The use of contract workers was perceived by Cliff and some of his colleagues as a threat to their employment.
• Some team members were already leaving to work for other employers, meaning the team was losing knowledge, skill, resources, and established relationships. This increased pressure on the remaining team members.
• Cliff's team was responsible for maintaining the integrity of an enterprise IT system, SAP, through which all of BC Hydro's customer, human resources, and financial information is managed. Despite the team being under-resourced and dealing with news about the impending end of the contract, they were still required to take on a project to integrate customer payments into SAP -- further increasing the profile and risk of the system, and the pressure on the team. The suicide attempt that led to Cliff's hospitalization in December occurred immediately after he finished work on this project.

Strategy #3: Psychological safety in the workplace

There were other factors that made Cliff vulnerable to these events -- just as there are factors that heighten people's risk of cancer, broken bones, and other illnesses and injuries. That doesn't negate the effect that workplaces have on people's lives, or the responsibility that we each have as employers, managers, and workers to take reasonable steps to promote the physical and psychological safety of our employees, our colleagues, and ourselves.

Risk stimulates us, challenges us, makes life more interesting. Workplace safety isn't about eliminating risk or not engaging in risky activities; it's about recognizing risk and taking appropriate precautions so that at the end of the day workers return home with their health and safety uncompromised. In North America, we've been protecting worker's physical safety for years. Only now are we recognizing we also need to attend to workers' psychological safety.

Initial steps towards regulating psychological safety

Last June, British Columbia passed Bill 14, legislation that expands eligibility for compensable psychological workplace injuries. (Because mental stress and injury due to management behaviours and decisions are explicitly excluded from coverage, someone in Cliff's position would still not be eligible for compensation.) This legislation paves the way for Workers' Compensation Boards and other provincial health and safety regulators to begin playing a role in developing and enforcing psychological safety regulations.

An important factor in that will be defining the standards which employers are required to meet. This month, the Canadian Standards Association is certifying a new voluntary standard for psychological health and safety in the workplace.

Neither Bill 14 nor the voluntary standard for psychological health and safety are yet enough to prevent deaths like Cliff's, but they are significant changes in how we hold ourselves responsible for workplace mental health. Mental illness and injury are not just individual weaknesses or problems, they are societal, cultural, and economic issues that affect more of us than we may believe; that really do debilitate people and threaten their lives; and that are often caused, triggered, or worsened by outside events.

Where I'm at with this

While I still believe Cliff's workplace conditions played a pivotal role in his death, I haven't found a way to influence significant change in this area. I tried to meet and talk with managers and leaders in Cliffs organization soon after his death, and met with resistance, fearfulness, and stonewalling. The most positive thing I was able to achieve was a brief email exchange with his immediate manager, who refused to meet in person. With the end of the contract with BC Hydro, that area of the organization is folding up shop. Many of the things Cliff was afraid would happen in that process have happened.

On a much more positive side, people like Martin Shain, founder of Neighbour at Work; Great West Life, commissioners of Guarding Minds at Work; and Bill Wilkerson, co-founder and CEO of the Global Business and Economic Roundtable on Addiction and Mental Health have already been doing impressive work in this area for many years, work that is paying off in new standards and changes in legislation.

Psychological workplace safety remains a concern for me. For now I am putting my efforts into other areas where change seems possible and much needed.