Express Your Support for Bridge Suicide Prevention Barriers

Dear friends -

Many of you may know that one of the most effective ways to prevent suicide is to restrict the access to means. Recently Dr. John Carsley, medical health officer for the city of Vancouver, wrote a letter to the mayor and council in support of the installation of suicide prevention barriers on Vancouver bridges.

In his letter, Dr. Carsley states that between 2000 and 20012, 122 people died by jumping from bridges in the Vancouver area. Others who did not die suffered grievous injury. He cites evidence that suicide barriers have been proven to be effective in preventing these deaths, and that there is no displacement to other means or locations. He cites the societal cost of a single suicide as being estimated between $800,000 and $1,000,000.

In light of this information, the case for investing in suicide prevention barriers seems clear. If you live in the Vancouver area, please consider contacting the mayor and councillors to express your support of this decision. You can reach the mayor and council by email at mayorandcouncil@vancouver.ca and the city manager, Penny Ballem, at penny.ballem@vancouver.ca

Below is the email of support I sent. You're welcome to plagiarize!

Dear Mayor Robertson and Councillors,

As both an executive board member of the Crisis Intervention and Suicide Prevention Centre of B.C. and someone who has been bereaved by suicide, I am writing you to express my strong support of Dr. Carsley's  recommendations on the installation of suicide prevention barriers.

A number of studies have indicated that when lethal means are made less available or less deadly, suicide rates by that method decline, and frequently suicide rates overall decline. In fact, some of the most dramatic reductions in suicide rates have been due to means restriction. Dr. Carsley provides excellent data on the effectiveness of bridge barriers in this regard.

Dr. Carsley provides a quantified estimate of the societal cost of a suicide death. As someone who has been bereaved by suicide I can testify to how devastating a loss that can be, especially when there is evidence that the loved one's death was preventable, as many suicide deaths are. In light of both the financial and emotional toll such deaths take, the return on investment of installing bridge barriers seems clear.

I hope to see a favourable decision by council on this matter in the near future.

If you're not in the Vancouver area, you could contact your own city council to express support for a similar measure in your municipality.

Right by You

Dear friends -

It's been a busy fall and I'm finally getting to a place where I'm ready to take the time to write to you again. In the next few weeks I would like to tell you about the Canadian Association for Suicide Prevention conference last October, about Andrew's and my experience hosting a Survivors of Suicide event on November 23, the networking connections we've made, and about the work our Washington friends at Forefront are doing.

In the moment, though, I want to forward you an appeal for action by Partners for Mental Health, a new organization that is taking a very active role in advocating for much-needed strides forward in mental health care and suicide prevention. Please see their president Jeff Moat's email below.

Lynn


From: Partners for Mental Health
Date: December 10, 2013 11:05:54 AM PST
Subject: Your action is needed now

Right By You - Partners for Mental Health

Dear Lynn,

We’ve come to a crucial point in our Right By You campaign in support of greater funding for youth mental health and suicide prevention.

Action is needed now. Every day, we lose 2 young Canadians to suicide. Almost 90% of people who die by suicide have a mental illness, yet the majority of children and youth – 3 out of 4 – who have a mental health problem or illness won’t get the treatment they need. And the average wait time before children with diagnosed mental health issues receive treatment is 12 months. This is unacceptable, and we need to work together to fix this.

In order to drive real change, we must show the government that this is an issue that matters to all Canadians. Local politicians need to hear directly from the people they represent – people like you.

It’s time to raise our voices with government. And we’ve got the tools and resources to easily help you get started.

First, sign the Right By You petition to show your support.

Then, contact your local politician using our toolkit to further amplify your voice and put pressure on our elected officials to act.

Specifically, we are calling on:

Federal government – to create a $100 million national suicide prevention fund.

Provincial and territorial governments – to provide access to mental health services, treatment and support to all children and youth when they need it, no matter their ability to pay.

These changes can happen but we need your help today.


Thank you,
Jeff Moat
President, Partners for Mental Health

Take Action to Save Someone's Life

Dear friends,

The September 2, 2013 issue of US Weekly, prominently displayed at grocery magazine stands, features a front-page story on the suicide death of Gia Allemand. You may be aware that sensationalized stories of celebrity suicide deaths are frequently followed by a spike in suicide deaths by the same method. The "Bachelor Suicide" story, which describes the cause of death and normalizes suicide as a response to difficult life events, is a classic example of this type of story.

Please join me in taking action to defend people at risk of suicide from this type of destructive media coverage. I have written letters to grocery story managers asking them to remove copies of this magazine from their shelves, and to US Weekly to ask them to revise their editorial practices. Copies of these letters are included below. You are welcome to use these or variants of them to help lobby for these changes.

Please, if at all possible, do not buy this magazine and ask others not to buy it. I would hate for US Weekly to experience a spike in sales as a consequence of publishing this story, and for them to financially benefit from media coverage that could cause a spate of tragedies. You can skim the story on page 46 to confirm the violations in ethical journalistic practice.

Removing this magazine from grocery store shelving and lobbying magazines and newspapers to change their editorial practices can save people's lives. Thank you from the bottom of my heart for your support in this.

Lynn

http://gifttocliff.blogspot.ca/

http://gifttocliff.tumblr.com/

Letter to Grocery Store Manager

Re: US WeeklyIssue 968, "Bachelor Suicide"

Dear Store Manager;

I am writing to ask you to immediately remove copies of US Weekly Issue 968 featuring the cover story of Gia Allemand's suicide death from your magazine stands.

You may be aware that sensationalized stories of celebrity suicide deaths are frequently followed by a spike in suicide deaths by the same method. The "Bachelor Suicide" story, which describes the cause of death and normalizes suicide as a response to difficult life events, is a classic example of the type of story that results in these deaths.

You, like many others, may be under the mistaken understanding that someone who dies by suicide has made a choice, or that if someone really wants to kill him or herself there is very little that can be done to prevent this. If this were true, we would expect that changes in journalistic practice or restrictions to the means used to cause death would have little effect on the overall number of suicide deaths. Someone who really wants to die would go to whatever lengths were necessary to gain access to lethal means or substances.

The truth is, though, that fewer than 10% of the people who survive a suicide attempt will eventually die by suicide. Over 90% will not. Research also shows that when access to common methods of suicide is restricted, the overall number of suicide deaths declines significantly and often dramatically and remains lower over decades.

For example, when the gas used in U.K. homes was changed from coal gas to less toxic natural gas in the 1960s, suicide deaths suddenly and rapidly declined by 30-40%, and have remained lower through over 40 years. After the Israeli Armed Forces changed protocols to prevent reserve soldiers from taking firearms home on the weekends, suicide deaths dropped by 40%. And after the Sri Lankan government banned a set of highly toxic pesticides commonly used in self-poisonings, suicide deaths overall dropped by 50% and have remained lower over a decade later.

If we can, therefore, increase the likelihood of someone surviving a suicide attempt or provide treatments and interventions to prevent those attempts, we are not just prolonging the inevitable -- we are saving lives.

"My brain is trying to kill me," one woman wrote in her journal a few months before her death. In the crisis of suicidal despair, that brain will use whatever information and means are readily available to try to inflict death. Stories of celebrity suicide deaths that describe the means of death and normalize suicide as a response to difficult life events, such as the one US Weekly has published about Gia Allemand, inadvertantly provide support for the suicidal urges against which someone at risk is desperately battling. These stories are typically followed by a spike in suicide deaths by the same means.

The following changes to a story such as the one published by US Weekly could save lives:

Not reporting the means of death.
Emphasizing the likelihood that the victim was suffering from depression or some other life-threatening mood disorder, mental illness or injury, elevating their suicide risk, and that these conditions are treatable.
Providing crisis line contact information for readers who may be at risk.
Providing information or links to resources on signs of depression and suicide risk.

The vast majority of people at risk of suicide experience the equivalent of a mental health heart attack, a temporary crisis of despair during which they are at high risk of acting impulsively to cause their own death. People at risk of suicide battle desperately against these urges, fighting against their own brains to try to preserve their own lives. These people deserve whatever support we can provide them.

In the interest of preventing suicide deaths among your customers and their children, please remove this magazine from your shelves. Please let your magazine distributor know what you have done and why. Please help prevent future tragedies.

Sincerely yours,

Letter to US Weekly Editor

Letters to US Weekly1290 Avenue of the Americas
New York, New York
United States of America
10104-0298

Re: "Bachelor Suicide", Issue 968

Dear Editor;

I was appalled to read Eric Andersson's story on Gia Allemand's suicide. You and your colleagues may be aware that stories of celebrity suicide deaths are frequently followed by a spike in suicide deaths by the same method.

You, like many others, may be under the mistaken understanding that someone who dies by suicide has made a choice, or that if someone really wants to kill him or herself there is very little that can be done to prevent this. If this were true, we would expect that changes in journalistic practice or restrictions to the means used to cause death would have little effect on the overall number of suicide deaths. Someone who really wants to die would go to whatever lengths were necessary to gain access to lethal means or substances.

The truth is, though, that fewer than 10% of the people who survive a suicide attempt will eventually die by suicide. Over 90% will not. Research also shows that when access to common methods of suicide is restricted, the overall number of suicide deaths declines significantly and often dramatically and remains lower over decades.

For example, when the gas used in U.K. homes was changed from coal gas to less toxic natural gas in the 1960s, suicide deaths suddenly and rapidly declined by 30-40%, and have remained lower through over 40 years. After the Israeli Armed Forces changed protocols to prevent reserve soldiers from taking firearms home on the weekends, suicide deaths dropped by 40%. And after the Sri Lankan government banned a set of highly toxic pesticides commonly used in self-poisonings, suicide deaths overall dropped by 50% and have remained lower over a decade later.

If we can, therefore, increase the likelihood of someone surviving a suicide attempt or provide treatments and interventions to prevent those attempts, we are not just prolonging the inevitable -- we are saving lives.

"My brain is trying to kill me," one woman wrote in her journal a few months before her death. In the crisis of suicidal despair, that brain will use whatever information and means are readily available to try to inflict death. Stories of celebrity suicide deaths that describe the means of death and normalize suicide as a response to difficult life events, such as the one you published about Gia Allemand, inadvertantly provide support for the suicidal urges against which someone at risk is desperately battling. These stories are typically followed by a spike in suicide deaths by the same means.

The following changes to a story such as the one written by Andersson could save lives:

Do not report the means of death.
Emphasize the likelihood that the victim was suffering from depression or some other life-threatening mood disorder, mental illness or injury, elevating their suicide risk, and that these conditions are treatable.
Provide crisis line contact information for readers who may be at risk.
Provide information or links to resources on signs of depression and suicide risk.

The vast majority of people at risk of suicide experience the equivalent of a mental health heart attack, a temporary crisis of despair during which they are at high risk of acting impulsively to cause their own death. People at risk of suicide battle desperately against these urges, fighting against their own brains to try to preserve their own lives. These people deserve whatever support we can provide them.

Because of the importance of this issue, several U.S. suicide prevention agencies have collaborated to publish guidelines for reporting on suicide: http://reportingonsuicide.org/Recommendations2012.pdf In the interest of preventing suicide deaths among your readers, I encourage you to incorporate these into your editorial practices.

Sincerely yours,

International Connections

Dear friends -

As mentioned in a previous update, early in June Ileah and I attended World Congress on Suicide 2013 in Montreal. It was a very rich international research conference, with researchers, academics, and government representatives from the United Kingdom, the United States, Australia, New Zealand, and Canada -- the vast majority of them leaders in this field, some with decades of experience to share.

I felt very privileged and sometimes overwhelmed to be attending seminars on topics ranging from micro-RNA variations and stem cell research to debates on  national strategies and debates on fifth edition Diagnostic and Statistical Manual (DSM V) classifications. Here is a synopsis of the overall meaning I was able to make from that immersion: an overview of some of what has been found to be effective and ineffective in reducing suicide deaths.

I developed this as a presentation and have delivered it a couple times now. If you find the speaking notes leave you with questions or are unclear, please let me know and I'll be happy to clarify.

Invitation: FOREFRONT Launches September 10 in Seattle

September 10 is World Suicide Prevention Day. This year that date also marks the launch of FOREFRONT, a University of Washington initiative to advance innovative approaches to suicide prevention through policy change, professional training, school-based interventions, media outreach and research. It is one arm of the work being done by my dear friend Jennifer Stuber, who has also been a driving force behind recent legislative changes in that state.

I'll be in Seattle to attend FOREFRONT's launch, and warmly welcome you to join me. I promise that it will be a moving and inspiring occasion. Please see the invitation for logistics and links to more information. I would be delighted to have you with us.

Correcting Misconceptions about Suicide

Dear friends -

Last weekend I learned that a colleague had died by suicide the Friday before. I only knew him through conversations with others, had never met the man, but the news of his death has been very painful. A lawyer in his mid-50s, someone who had been successful in his career and risen through management levels, he had been struggling with anxiety and depressions for at least a year before he died. In contrast to Cliff, the organization he worked in is very aware of mental health concerns and suicide risk. He received the best support the people working in the organization knew how to provide.

I wrote the following in the wake of his death, an attempt to help others cope and a reflection of how my understanding of suicide has changed over the past 18 months.

Suicide Misconceptions

1. Suicide is a choice.
   Suicide is no more a choice than dying of cancer or cardiovascular disease is a choice. Someone who dies by suicide has been suffering from a severe, life-threatening disorder, and has not been able to receive the treatment or resources needed to survive.
    
2. The person wanted to die.
   It is the illness or disorder that puts someone in so much pain or distorts his thinking so that death seems to be the only option. Once people recover from a suicidal crisis, the vast majority are grateful and relieved to be alive, even if they survived a suicide attempt. This feeling may not come until the disease or disorder has been resolved, but when that happens it does come.
    
3. A loved one or colleague found the body. Why would the person who died do that to them?
   In trying to make sense of what's happened, we may wonder whether the person who died was trying to get revenge or express anger towards his loved ones, and particularly towards the person who found the body. While that may in some circumstances be a factor, it is more likely that the person who died was driven to act quickly, and wanted somewhere readily accessible where they had the resources to kill themselves and would not be interrupted. The suicidal crisis attacking him prevents him from caring about who will find the body, just as it prevents him from valuing his own life.
   
4. Someone who kills him or herself is weak.
   Someone at risk of dying by suicide is under attack by her own thoughts and emotions. Everyday, she is fighting a battle to survive. This takes an enormous amount of strength and courage. If someone dies by cancer, that doesn't negate the strength and courage she or he demonstrated while living with the disease. The same is true for someone who dies by suicide.
    
5. Why didn't he just take anti-depressants or talk to somebody?
   Someone at risk of suicide has usually tried many types of treatment, therapy, and self-help techniques. Unfortunately, some forms of mood and anxiety disorders may only respond to specific medications, or may not respond to medication at all. Many mental health professionals, who we think of as experts in this area, have received little or no training in the treatment of suicidal crises. Someone in a suicidal crisis may question whether he is beyond or unworthy of help. Receiving ineffective treatment can reinforce those beliefs and worsen the crisis.
    
6. Someone who is suicidal is beyond help.
   Effective treatments are available. Dialectical behaviour therapy has been shown in randomized clinical trials to reduce suicidal thoughts and behaviours. Sometimes medication can be very effective in treating or preventing a suicidal crisis. Restricting access to firearms, poisons, medications, and other means of dying has been shown to be very effective in reducing deaths. Even a change in circumstances can relieve the suicidal crisis and enable the person to recover.
   
   People being attacked by a suicidal crisis deserve the best possible treatment and support we can provide for them.
    
7. Someone at risk of suicide should be in the hospital.
   While hospitalization may sometimes be necessary, it has not been demonstrated to be the most effective treatment for a suicidal crisis. In fact, people are at very high risk of dying just after being released from hospital. These transition times must be managed very carefully. Highly effective treatment for a suicidal crisis is available outside of a hospital setting.
    
8. Teenager girls are at the greatest risk of suicide.
   Sensationalized news coverage of young people's deaths can shape our perceptions of suicide. While suicide is the second leading cause of death for teenagers in Canada (motor vehicle accidents is the first), males are at four times greater risk of dying by suicide than females, and men age 50 and over are the people most at risk. Suicide affects people of all ages and genders.
    
9. There's nothing I can do.
   There are many ways to help people at risk of suicide survive and recover.
   
   a) Blame and fight the disease, not the person the disease is attacking.
   
   b) Encourage the person to keep trying treatments until she  finds something effective.
   
   c) Take any suicidal crisis seriously. Help the person at risk find the treatment and support he needs to stay alive.
   
   d) Remind the person at risk that you care about her and that you want her to be alive. In randomized clinical trials, non-demanding demonstrations of care by others have been shown to reduce deaths.
   
   e) If you are the person closest to the person at risk of suicide, don't assume medical and mental health professionals have expertise in treating suicidal crises, or will provide you with the information you need to be an effective support. Ask questions; advocate for the person at risk; don't be afraid to get involved.
   
   f) Take a suicide first aid course like ASIST or safeTALK.
   
   g) Take care of your own mental and physical health. If you're not healthy, your capacity to support others will be diminished.

Saving Lives

Dear friends -

I had the privilege of being in Montreal with Cliff's daughter Ileah June 10-13 for a world congress on suicide research. For three and a half days, researchers, academics, medical professionals, and government representatives presented their work -- everything from micro-RNA studies to national suicide prevention strategies.

Some of the information I've learned:

• In Canada, a person is three times more likely to take their own life than to be killed by someone else. (The ratio in the U.S. is 2:1.)
• Although men and women engage in similar amounts of suicidal behaviour, men are at four times greater risk of dying by suicide.
• Of everyone who attempts suicide, older men are those most likely to die.
• Despite all the statistics and assessment tools, we are very weak at being able to predict who is most at risk of dying by suicide.
• Suicide is preventable: The physiological and psychosocial factors that put people at risk of dying can be changed.
• Effective treatments are available that reduce psychological suffering, increase capacity for problem solving, and prevent deaths.

The conference was an enormous learning experience and an excellent opportunity to meet others with deep interests in this tragic topic. It was sometimes inspiring, sometimes emotionally taxing.

In the midst of seminars on statistics, cutting-edge research, and evidence-based practices, Government of Canada representatives made an emotional presentation on a Manitoba First Nations youth program they're funding, without providing any evidence the program has reduced deaths by suicide or even improved participants' mental health.

On the other end of the spectrum, Dr. Matt Miller from the Harvard Centre for Injury Prevention showed that restricting means can reduce suicide deaths dramatically. For example:

Suicide rates in Great Britain dropped sharply after residential gas service was changed from coal gas to natural gas. Rates dipped again much more recently when the number of paracetamol pills in each package was reduced to a sub-lethal dose.

Having a gun in the house increases the risk of dying by suicide for all members of the household. Storing guns unloaded and locked separately from the ammunition reduces that risk, but not as much as for a household with no guns.

After the import and sale of World Health Organization class 1 toxicity pesticides were restricted in Sri Lanka, suicide rates declined by 50%. Thousands of people's lives have been saved every year. These same pesticides are still responsible for about 1/3 of suicide deaths world wide each year -- deaths that could be prevented if other developing countries had the same bans and restrictions as North America and Europe.

Why is means restriction so effective? Because a suicidal crisis -- the time period in which a person is most at risk of attempting suicide -- is usually short-lived, and the person at risk is usually acting on impulse. The method chosen is therefore usually one that is readily available. If that method is highly lethal, there is less chance of intervention or survival. Of those who do survive a suicide attempt, fewer than 10% eventually die by suicide -- over 90% do not.

After the conference, Ileah and I spent the weekend in Toronto visiting Cliff's family there as well as a childhood friend. Friday, June 21 marked 18 months since his death. The pain I feel on these anniversaries and the pain I see in Cliff's children, family and friends strengthens my resolve to change this for others.

Sitting with Suffering

Dear friends -

I have been thinking often this past week about Rehtaeh Parsons and Audrie Pott, how to respond to those devastating tragedies.

Rehtaeh and Audrie's rapes and deaths pull the curtain to show the sexual exploitation, public shaming, and social ostracization Amanda Todd experienced was by no means an isolated incident. If these three girls have died, there are many other young women and men who have experienced the same horrendous treatment and who are courageously struggling to survive -- people who deserve to be acclaimed for their strength and bravery, but are terrified to tell their stories.

How do we support these anonymous Heroines and Heroes? How do we make it safe for them to speak up? How do we protect others from exploitation, violence, abuse and hatred? How do we respond to the young men and women who have perpetrated those crimes, and prevent others from doing the same?

The day I learned about Rehtaeh and Audrie's deaths was the day of the Boston Marathon bombings, the horror of so many people maimed and dead, and knowing that, too, is not an isolated incident; that similar and worse bombings happen in other countries -- the nightmare of dismemberment, grief, and trauma the Boston Marathon survivors now share.

And finally the news last night of a five-year old being raped in India. I broke down sobbing on my kitchen table. How could someone speak that news without crying? I remembered working in a group home in my early twenties, one of the teenagers confiding in me she had been at an older relative's house party and walked in on a child being raped. What should she do, she asked?

In the past, I have not done well at being with my own or other people's suffering. "Human beings cannot bear much reality," T. S. Elliot said. When our capacity for being with our own discomfort and pain is low, when we have little empathy for ourselves, have been trained to "keep calm and carry on", find a quick fix, or distract ourselves with work or entertainment or addiction (as most of us have been trained in this culture), what do we have to offer others who are in emotional pain? Especially when it's a pain that persists, or that can't be mended?

How do we learn to be with pain and suffering more skillfully so that it neither engulfs us in fear and depression nor cauterizes our hearts and makes us cruel? So that we can better recognize and respond to the suffering of others? How do we help our children do the same?

This morning, I received this quote from Claude AnShin Thomas in my email inbox:

We are constantly encouraged to reject what is unpleasant, disappointing or difficult. 'What's all this suffering? Let's be happy! Have fun!' But our suffering is not our enemy. It is only through a relationship with my pain, my sadness, that I can truly know and touch the opposite -- my pleasure, my joy, and my happiness.

Collaboration with Andrew

Dear friends -

At the end of November as I was contacting different agencies to learn about their services, one of my contacts introduced me to Andrew Curran. Andrew's wife, Jane Storey, died by suicide January 25, 2012 at the age of 33. Since Janey's death, Andrew underwent a formal complaint process through Vancouver General Hospital and has done an impressive amount of research.

Janey's situation was disturbingly similar to Cliff's. She grappled with anxiety and depression for months. Unlike Cliff, she expressed concerns about the suicidal thoughts she was having, which finally led to her admission to Vancouver General Hospital.

The psychiatrist assigned to treat Janey was not a personable man. Their relationship was uncomfortable at best. Because no office was available, sessions with her doctor were conducted at one end of a hall in the ward. There was no privacy from the other patients. Although Andrew and Janey were married, the professionals treating her gave Andrew no more opportunity to be involved in Janey's care than there had been for me to be involved in Cliff's.

At the end of her hospital stay, Janey's discharge was handled very casually. The suicidal ideation was assessed as being "resolved". Consequently, unlike Cliff, she was never connected with community outreach services despite Andrew's daily phone calls. Far from being resolved, the suicidal impulses Janey was experiencing had, in fact, heightened. She died under very similar circumstances as Cliff only two weeks after her discharge.

Even before Andrew and I met in person or shared our stories, I had the sense we knew each other. We talked for two and a half hours when we first had tea. At our second meeting in early January, we were ready to dive into collaborating. Here's the action plan we crafted.

Strategy #1: Family Involvement in Patient Care

• Meet February 22 with the manager of Vancouver Community Mental Health Services to learn about their Family Advisory Group
• Access opportunities to tell medical professionals about our experiences via the Patient Voices Network
• Identify potential sponsors in health care administration

Strategy #2: Suicide Assessment and Intervention Training for Mental Health Professionals

• Organize a research project to assess the current state of training requirements in British Columbia
• Consult with Jennifer Stuber, instrumental in getting suicide assessment and intervention training requirements legislated for mental health professionals and other front-line care providers in Washington state.
• Identify potential sponsors and allies in professional associations, public policy, and government

Strategy #3: Psychological Workplace Safety

• Continue to learn about and share work being done in this area
• Promote psychological safety principles, and mental health and suicide intervention training within my own workplace as appropriate

Strategy #4: Support for Companions

• Connect with organizations that run support groups for family and friends of people with mood and anxiety disorders (e.g. Mood Disorders Association, AnxietyBC, SAFER)
• Assess resources currently available to companions and opportunities to augment these

If you have connections, suggestions, or an interest in participating in any of the above, please let me know.

I've learned a great deal from Andrew already, both from the research he's done and from his calm and principled approach. Working together, we've been able to develop a clearer sense of direction and bolster more energy than either of us had been able to maintain on our own.

Cliff and Jane were both remarkable, loving, kind, creative people. Part of their legacy will be positive, enduring, systemic changes that improve survival rates and quality of life for others like them.  Meeting Andrew has renewed my optimism that those changes are possible.

Suicide intervention skills training

Dear friends -

I have been shocked to learn that mental health professionals, primary care doctors, and even psychiatric nurses are required to take little or no suicide awareness, assessment and intervention training, and that there is no requirement for them to sustain any particular level of training in this area over the course of their careers. This means that someone at risk of suicide or someone dealing with a person at risk of suicide could be seeking support from a professional who does not have the knowledge or skills to provide it.

That was the situation for me when I sought counseling after Cliff was admitted to hospital in early December because he had tried to kill himself. None of the three counselors from whom I sought help had any training in suicide assessment and intervention, and so none were able to help me address the situation in which Cliff and I were in. They were very skilled and supportive in other aspects -- but the risk of Cliff dying was the elephant in the room that never was addressed.

Tragically, the psychiatrist treating Matt Adler, a lawyer in Washington with a wife and two young children, likewise did not have the knowledge and skills to intervene effectively when suicide became a serious risk. Matt died by suicide on February 8, 2010.

Matt's widow, Jennifer Stuber, was instrumental in getting Washington state legislation passed in June 2012 requiring mental health professionals to take 6 hours of suicide assessment and intervention training every six years. Washington is the only state to require this. There are no similar requirements for mental health professionals or primary care doctors in B.C. -- the latter of whom may be the only people from whom a suicidal person seeks help.

Can you imagine doctors, nurses, and paramedics being unable to perform CPR? That is the state of our mental health system. One of my objectives is to lobby the government and professional organizations so that is changed.

Strategy #2: Mental health first aid / Suicide intervention skills training for mental health professionals and lay people

LivingWorks in Calgary has developed programs in suicide awareness and intervention that are now used by the University of British Columbia, the U.S. Military, and other organizations in Canada, the U.S., Australia, Norway, and other countries. I took ASIST (Applied Suicide Intervention Skills Training) through the Crisis Centre of B.C. in October, and highly recommend it. This type of training should be the minimum standard for anyone working in mental health or primary care.

Opportunities for Action

Bruce Lee said, "We don't rise to the level of our expectations. We fall to the level of our training."

1. Training like ASIST saves lives. It might have saved Cliff's life. You don't know ahead of time when you might need this, and by the time you do know, you may not have the opportunity. Don't place yourself in that position. You don't have to be a medical professional to make a difference.

• Find an ASIST workshop (2 days)
• Find a safeTALK workshop (1/2 day)
• Find a mental health first aid course (2 days)

2. Ask your family physician, counsellor, and friends in the medical or mental health professions how prepared they feel to deal with patients who are suicidal or the people who are supporting them. Do they have consistent processes of assessing clients and patients to determine whether someone might be at risk of suicide? Do they feel confident addressing the situation if they do determine someone is at risk? Are there adequate resources to which to refer clients? Are they aware of the training that's available? Just having the conversation raises awareness and helps us move in the right direction.

Good News

On the positive side, I received an email this week from Cliff's psychiatrist letting me know that he and his colleagues at Vancouver General Hospital are preparing a brochure for visitors taking patients in the psychiatric units out on a pass so that they will be better prepared to respond if they have concerns; and another brochure for any family members and friends who may have accompanied someone to hospital as the result of a suicide attempt. I was heartened to know that these steps towards involvement and education of family and friends are being initiated.

Thank you for taking the time to read these updates, provide feedback and questions, and for your words of support. It means a great deal to me that there are people out there to whom this matters.

Pieces

Dear friends -

It's been eleven months since Cliff died, and an enormous hole was torn out of the lives of his son, daughter, me, and many others who loved him. Since then, I have been on a quest to learn what could have made a big enough difference that Cliff's death might have been prevented, so that this information can be used to make that difference for others.

I'm going to write an update each week for the next four weeks. After that, I plan to write one every two months. Please please feel welcome to refer others who might be interested to this blog or ask them to send me a request to be added to the email distribution list.

Strategies

The areas I've been exploring fall into four categories:

• Changes at the hospital: Admission and discharge procedures, involvement of family and friends
• Support, education, and training for people living with someone with a mood disorder
• Mental health first aid and suicide intervention skills training for both mental health professionals and lay people
• Psychologically safe workplaces

In the next four weeks, I'll give updates on each of these strategies.

Strategy #1: Changes at the hospital: Admission and discharge procedures, involvement of family and friends

Ileah, Christopher and I have met twice with Cliff's doctor from Vancouver General Hospital and others who were involved in his care. As you can imagine, discussing Cliff's situation with them has been highly emotional. 

The benefit of these discussions is that the topic of patient suicide while in hospital or shortly after discharge is being explored more deeply. The psychiatric team has done a review of research in this area and of strategies other hospitals have taken to reduce this risk. It is now a standing topic at their team meetings, and the medical director for the unit has done a session on the subject for doctors in other areas of the hospital.

The doctors have also welcomed hearing our experiences and perspectives on what could have made a difference for us so that we might have been able to better support Cliff. These have included:

• Referrals for someone who has accompanied a person to hospital because of a suicide attempt
• Assessing opportunities for family involvement in patient care
• Provision of basic information to visitors taking a patient out on a pass (e.g. emergency phone numbers)
• Family involvement in discharge and transition

As the research and conversations continue, I hope to see changes in procedures that will strengthen support for people at risk.


Cliff's death left me feeling helpless and confused. As I begin writing these updates, I realize how much I have managed to learn and do this past year (too much to put in one email, I've discovered) and feel heartened by that.

Whether or not you are able to support any of these initiatives or even to read these, I appreciate your care and interest. We each have our own work to do, and varying capacities for anything more.


Lynn