Mental Health First Aid

 Another training program that I highly recommend is Mental Health First Aid, from the National Council for Mental Wellbeing (formerly the National Council for Behavioral Health). This is a much more in-depth training than the ASK About Suicide training I discussed in my last blog. It’s 8 hours long, but I believe it’s worth every minute you’ll need to invest in it.

This is a very interactive training, not an 8 hour lecture, so don’t worry that you’ll be bored or falling asleep. In fact, I’ve taken this course twice now, and both times I spent the entire night before in an emergency room with a family member in crisis, but I had no trouble staying awake, and I certainly wasn’t bored.

The first section of the course is a general overview of mental health and an explanation of Mental Health First Aid. According to the manual provided with the course, Mental Health First Aid aims to: “preserve life when a person may be a danger to self or others; provide help to prevent the problem from becoming more serious; promote and enhance recovery; and provide comfort and support.” (National Council for Behavioral Health and the Missouri Department of Mental Health, Mental Health First Aid USA: First Edition (Revised), Adult, 12)

Like any first aid, Mental Health First Aid is not meant to replace professional help, but rather to provide help until professional help can be obtained. This first section also shares why this training is needed and outlines the 5-step Action Plan, “ALGEE,” of Mental Health First Aid.

ALGEE stands for:

• Assess for risk of suicide or harm
• Listen nonjudgmentally 
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other support strategies

(Mental Health First Aid, 13)

The second section of the course is an in-depth look at 5 common mental health disorders: depression, anxiety disorders, psychosis, substance use disorders, and eating disorders. Through examples and role-playing, attendees are trained to apply the “ALGEE” action plan to developing mental health disorders. The instructor may not cover each of these disorders in the training, but the book that accompanies the course provides very detailed information about each of the disorders, including symptoms, statistics, and resources.

The final section of the course covers first aid for certain mental health crises (8 in all). Again, the instructor probably will not cover each of these crises in depth, but there is plenty of information about each crisis in the course book.

Mental Health First Aid may not be for everyone. I know it’s a big investment of time. However, if you have a loved one with mental health struggles or you work with vulnerable individuals, I urge you to seriously consider getting trained. Vulnerable individuals are those who have a higher risk of being in crisis, including: children, teens, and young adults; the homeless; women in crisis pregnancies; military members and veterans; and many more.

Follow the link below to find out more about the training and to find a trainer in your area:

https://www.mentalhealthfirstaid.org/

ASK about Suicide

 When you suspect that someone may be contemplating suicide, the most important thing you can do is ASK. Many people believe that asking someone about suicide will put the idea into his head, but most studies show that this isn’t true. If you do ask and the answer is yes, you must be prepared to act immediately.

There are many resources that teach you how and when to ask this important question and what to do if the answer is yes. I’ll be outlining several of them in my next few blogs.

Today I’d like to talk about a video series called “Ask about Suicide (ASK),” which you can access here:

https://texassuicideprevention.org/training/video-training-lessons-guides/ask-about-suicide-ask/ 

This is a series of short videos from the Texas Suicide Prevention Collaborative. There are five videos in all, but if you don’t have time to watch them all, I urge you to at least watch episodes 2, 3, and 4. It only takes about an hour to watch all 5 videos, and the individual videos are pretty short.

The first video is an introduction to the series. It also explains what the acronym “ASK” stands for: Ask about suicide; Seek more information and keep safe; and Know where and how to refer.

This video gives a lot of statistics, many of which are out of date or specific to Texas, but there are a few key points that don’t change much over time:

• More females attempt suicide, but more males die by suicide, probably because men tend to use more lethal means than women.
• African American females have a lower rate of suicide, most likely because they tend to have a strong support system.
• Latino youth tend to have a high rate of suicide attempts, possibly because of isolation and a feeling of not fitting in at home or at school.

The second video is “Risk Factors and Protective Factors.” It discusses risk factors in 3 categories: biological/psychological; social/cultural; and environmental. It then goes on to list some protective factors (things that help to reduce the effects of risk factors, such as a strong support system). Finally, the video emphasizes the importance of decreasing risk factors and increasing protective factors to reduce the likelihood of suicide.

Video #3 is “Warning signs.” It discusses warning signs, direct and indirect, verbal and nonverbal. It also addresses the “suicidal zone,” a period of time when risk factors are high and protective factors are low, when the person is at extremely high risk of a suicide attempt.

This suicidal period usually only lasts a few hours or even minutes, but it’s a time when quick action is crucial. Asking someone if he is thinking about suicide, and taking action if he is, can interrupt the suicidality long enough for the crisis to be averted.

The fourth video, “ASK: The 3 Step Process to Save a Life,” is probably the most important of the 5 videos, so if you can only watch 1 video, this would be the one to watch. It outlines and explains each of the 3 critical steps in the ASK process.

The first step is to ask about suicide. The video teaches you how to ask and, just as importantly, how not to ask. For instance, you shouldn’t say, “You’re not thinking about suicide, are you?” It’s also important to be aware of your nonverbal cues when asking this question.

The second step is to seek more information and keep safe. This should be done in a private place.

 If someone has told you they are thinking about suicide, you should ask them if they have a plan and if they have access to lethal means. If the answer to either of these questions is yes, the person is likely at an immediate high risk of suicide, and you need to take immediate action.

The video goes into great detail about some of the things you can do. One of the most important things to remember about this step is to never leave the person alone, unless your own safety is at risk. As I said in my last blog, don’t just give the person a number to call and then leave, expecting the person to follow through.

The final step is to know where and how to refer. This step needs to be taken before the crisis occurs. That means researching sources of help in your area ahead of time.

The final video is only about 5 minutes long. It contains the testimony of a young man who used this ASK training to save a life.

The National Suicide Prevention Lifeline

 As soon as possible, I urge you to add the following number to your phone contacts, so you can access it quickly in an emergency: 800-273-TALK (8255).

This is the number for the National Suicide Prevention Lifeline. It is manned 24 hours a day, 365 days a year, by people trained in crisis intervention.

It’s important to put this number in your phone now, before a crisis occurs, because in the midst of a crisis it’s often hard to think clearly. That’s not the time to be searching around, trying to find the number.

I also recommend that you visit the Suicide Prevention Lifeline website, where you will find a lot of information about helping someone in a suicidal crisis. This page is particularly helpful:

https://suicidepreventionlifeline.org/help-someone-else/ 

The time to educate yourself is now, before a crisis occurs. This "help someone else" page teaches you how to recognize a crisis, and gives tips on what to say and do (and not say and do) when someone is in a crisis.

The lifeline can help when:

• You are having thoughts of suicide yourself. They will listen to you, offer emotional support, assess your risk, and connect you with resources in your area.
• You are concerned about a friend or family member that you think may be contemplating suicide. The counselors can answer your questions and advise you about how to help your loved one.
• You are with someone who is thinking about suicide. Don't just give the person the number and leave. Stay with him or her and call the lifeline together. Help the person follow through with the counselor's advice. Do not leave the person alone until the crisis passes, unless your own safety is at risk.
• You need someone to talk to about your struggles, even if you're not thinking about suicide.

This page on the Lifeline website talks about who can benefit from the lifeline and what happens when you call:

https://suicidepreventionlifeline.org/talk-to-someone-now/

If you prefer to text or chat online with someone, there are also options for that. If you go to the Lifeline website (listed on the image below), you can chat confidentially with a counselor.

To text with a counselor, text HOME to 741741. You can also chat with a counselor from the crisis text line at https://www.crisistextline.org/

If you or the person you’re calling for is a veteran, call 1-800-273-8255 and press 1 to be connected to a counselor who is trained to understand the special needs of veterans. You can also text to 838255. To chat confidentially online, go to VeteransCrisisLine.net 

Finally, I recommend that you download the Suicide Prevention Lifeline wallet card to your phone. It is a PDF document, which lists the suicide warning signs, and can be found here:

https://store.samhsa.gov/product/National-Suicide-Prevention-Lifeline-Wallet-Card-Suicide-Prevention-Learn-the-Warning-Signs/SVP13-0126

Suicide Warning Signs

 There are many warning signs which may signal that someone is thinking about suicide. I will mention a few of them here, and I will post links to websites that list other warning signs.

I encourage you to commit these warning signs to memory. Print out the list and post it on your refrigerator, or put something in your phone that you can access in an emergency.

If someone starts talking about feeling hopeless or trapped, of being a burden to others or having no reason to live, they may be thinking about suicide. This may come up in a conversation, or you may encounter this kind of talk in a text message or a post on social media.

If someone starts talking about wanting to kill himself, you must take it seriously. Some people mistakenly believe that people who talk about killing themselves are just trying to get attention, but in many cases this kind of talk is a cry for help which should never be ignored.

There are also some behavioral signs to watch for: withdrawing from normal activities or from family and friends; sleeping too little or too much; giving things away; and searching online for suicide methods.

Another big warning sign is an increase in drug or alcohol use. This is important because drugs and alcohol lower a person’s inhibitions, including the natural instinct we’re all born with to preserve life.

Finally, there are some moods that may signal that someone is in crisis. These include: depression; anxiety; agitation; or irritability. Pay special attention to a sudden, dramatic change in someone’s mood, as this may indicate that a crisis is imminent.

For instance, if someone is usually very happy and outgoing, but suddenly becomes very depressed or withdrawn, this is cause for alarm. Also, if someone has been very depressed and suddenly seems very elated or relieved, act quickly! They may have a suicide plan in place and may be preparing to execute their plan. The source of their relief may be the belief that their pain will soon end.

A friend of mine once told me about a coworker who had seemed very depressed at work. One day he came to work in a much more positive mood, with no sign of depression. His coworkers were all happy to see this change, and they assumed he had worked out whatever had been bothering him. However, the next day they learned that the man had taken his life.

What they had perceived as happiness was actually a signal that the man had reached a decision and was relieved that he would no longer have to deal with his pain. If the coworkers had known about the warning signs for suicide and what to do in a suicidal crisis, they might have saved the man’s life.

This is why I’m so passionate about raising awareness about suicide and encouraging people to get trained in suicide prevention. The more people who are trained, the more lives we can save.

You don’t have to be a psychiatrist to help prevent suicide. You just have to care and know the steps to follow in a crisis. In my next few blogs, I’ll be sharing resources that will help you know what to do.

Sources for suicide warning signs:

https://www.sprc.org/about-suicide/warning-signs

https://afsp.org/risk-factors-protective-factors-and-warning-signs

Suicide Risk Factors

 One way of helping to prevent suicide is to educate yourself and others about the risk factors and warning signs of suicide. I will address the risk factors in this blog, and I will cover the warning signs in my next blog.

Suicide is a very complex issue, and there is no one thing that causes someone to take his life. Most suicides result from a sort of “perfect storm” of risk factors and circumstances that build on each other until the person can see no other way out than to kill himself.

There are three types of risk factors related to suicide: health-related factors, environmental factors, and historical factors.

One of the biggest health-related factors is mental illness, especially if it is untreated. The illnesses with the highest risk for suicide are depression, substance use disorders, bipolar disorder, and schizophrenia. Chronic, painful illnesses can also increase the risk of suicide.

Environmental factors include access to lethal means (guns, prescription drugs, household chemicals, etc.); prolonged stress at work, home, or school; and exposure to another suicide in the family, at school, in the community, or in the news.

The biggest historical risk factor, as I said in my last blog, is a previous suicide attempt. Other historical risk factors include a family member’s suicide and a history of abuse, trauma, or neglect in childhood.

To prevent suicide, we must learn to identify and help mitigate these risk factors in a person’s life. There are many things we can do to help reduce the risk from these factors. These are called protective factors. To reduce the risk of suicide, we must work to reduce the risk factors and increase the protective factors.

For one, we can take the steps outlined in my earlier blogs to reduce the stigma of mental illness and to provide better access for mental health care. Also, the support of loved ones is critical when someone is feeling overwhelmed. People who are experiencing a crisis need to know that they’re not alone and that someone cares about them.

We can help others deal with stress by helping them to develop coping and problem-solving skills. It’s also important to limit access to lethal means, for someone who seems to be at high risk for suicide, by locking up things like guns, drugs, and chemicals.

Finally, we can help reduce the effects of historical factors by encouraging people to seek counseling for their trauma or abuse.

To learn more about risk factors, protective factors, and warning signs, see this page on the American Foundation for Suicide Prevention’s website: https://afsp.org/risk-factors-protective-factors-and-warning-signs

A Silent Epidemic

 The steady increase in suicides between 1999 and 2018 led many to call this phenomenon a "silent epidemic." According to the National Institute for Mental Health (NIMH), the age-adjusted suicide rate in this country increased by 35.2% in 19 years, from 10.5 deaths per 100,000 in 1999 to 14.2 per 100,000 in 2018. The rate declined slightly in 2019 to 13.9 per 100,000, but it's too early to tell whether this is a true downward shift.

There were over 47,500 deaths by suicide in this country in 2019, making it the tenth leading cause of death in the United States and the second leading cause of death for individuals between the ages of 10 and 34. An even more disturbing figure is the number of suicide attempts.

According to the Centers for Disease Control and Prevention (CDC), for every death by suicide in 2019 there were as many as 29 attempts, totaling about 1.4 million attempts in 2019 alone. This doesn't even take into account the millions of Americans who thought seriously of suicide or made a suicide plan without following through. These figures are especially troubling because one of the biggest risk factors for death by suicide is a previous suicide attempt.

Given these figures, I think it's clear that suicide is a problem in our society. What, you may ask, can I do about it? That will be the subject of my next few blogs.

Sources for this blog:

https://www.nimh.nih.gov/health/statistics/suicide

https://www.cdc.gov/suicide/facts/index.html

The "Week from Hell"

 Imagine, if you will, that you are having a really bad week. On Monday, a very dear friend was diagnosed with a terminal illness. On Tuesday, your teenage son got in trouble at school and was suspended. On Wednesday, you had a blowout on the highway, at rush hour, on your way home from work. On Thursday, your air conditioning unit at your house gave out and it’s August in Texas! Finally, to top off the week, on Friday, you got laid off at work!

That’s quite a week, isn’t it? How do you think you’d feel by the end of this week?

I recently had a couple of weeks like this, and I can tell you how I felt. My stomach was in knots, and I felt like I was carrying about 30 extra pounds on my shoulders. My head felt like it was going to explode, I had trouble concentrating, and I had very little motivation or energy. Can any of you relate to the feelings I’ve described?

These feelings were brought on by a number of very stressful events in my life. Imagine, though, that you experienced these feelings of anxiety and stress, of being crushed under the weight of your problems, but no stressful events had occurred.

Imagine that same level of stress and feeling overwhelmed was caused, not by big problems, but by the little everyday things that most of us take for granted: things like getting out of bed, brushing your teeth, showering, or driving to work. This is what it’s like for people with major depression, a serious mental illness that affected over 19 million adults in the United States alone in 2019.

People with chronic depression are often told to “think positive thoughts” or “just snap out of it.” Unfortunately, these well-intentioned suggestions only add to their pain. They’d like nothing more than to “just snap out of it,” but they can’t.

Perhaps you have a family member who sleeps all the time or a neighbor who can’t seem to hold down a job. Rather than judging the person as lazy or weak, try reaching out to him and asking if everything is okay or if there’s anything you can do to help. If you’re tempted to tell this person to “just snap out of it,” remember this scenario of “the week from hell.” Think about how you would feel, and offer a listening ear rather than judgment or advice.

Source for statistics on depression: https://www.nimh.nih.gov/health/statistics/major-depression