Ashlea McMartin, MS, LPCC - Sanford Health News

Sober curiosity can inspire better relationship with alcohol

Mindy Broden (guest):

Overall though consumption still remains up, binge drinking is also higher, much higher than what it was I would say 10 years ago. And the most notable change in that is that women actually are drinking more frequently, consuming more alcohol than in previous times.

Cassie Alvine (announcer):

This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is about sober curiosity and the rise of a sober generation. Our guests are Mindy Broden and Ashlea McMartin with Sanford Health Bemidji. Our host is Alan Helgeson with Sanford Health News.

Alan Helgeson (host):

Welcome Mindy and Ashlea. Why don’t you guys introduce yourselves and your roles. Mindy, let’s start with you. What is your title and what is your role?

Mindy Broden:

My name is Mindy Broden, and I am a licensed alcohol and drug counselor. I have been for the last 15 years and I’m also a licensed professional clinical counselor, which is the last two years. I am the clinical lead over our substance use disorder services, including our medication for opioid use disorder clinic.

I’ve been with Sanford for seven years. I’ve got the great opportunity to work residential prior to coming to Sanford and then now do a lot of outpatient education, working on prevention, all of those fun things. So this is kind of the vein of what I do is substance use.

Alan Helgeson:

The stuff you talk about every day, right, Mindy?

Mindy Broden:

That is correct.

Alan Helgeson:

All right, Ashlea, go ahead and talk about yourself and your role with Sanford.

Ashlea McMartin (guest):

Absolutely. So Ashlea McMartin, I am one of the directors of behavioral health for the Bemidji region. Similar to Mindy, I’m a licensed professional clinical counselor. Been with Sanford since we merged back in 2017, but really technically been with them since 2013. Then when we were Upper Mississippi Mental Health Center. I am not a licensed alcohol and drug counselor, as Mindy had mentioned that she is.

But really in mental health we see in our region a huge crossover, co-occurring disorders, which means both mental health needs and substance use disorder needs are present at the same time. And so my service lines, I work closely with those that are experiencing urgent or emergent mental health needs, and drugs or alcohol are often included in those experiences when someone’s having a mental health crisis. And so see the work ancillary through the work we do through our crisis services, but then also our long-term ongoing services as well.

Alan Helgeson:

Well, Mindy and Ashlea, again, glad to have you as part of this program today. And we’re talking about “sober curious.” It’s one of those terms that it seems like you didn’t hear anything really about. It’s one of those newer things, kind of a phrase that has come about here the last few years in regards to alcohol and alcohol addiction.

So Mindy, let’s start with you. Can you maybe share a few of those current trends in regard to alcohol consumption?

Mindy Broden:

Absolutely. Current trends per capita really are actually down compared to 2022, which is kind of the last statistics that we have. And the most notable ages of that are actually that 18 to 34. And part of that is some of that sober curiosity. And I would also say the incredible increase during COVID overall though consumption still remains up. Binge drinking is also higher, much higher than what it was I would say 10 years ago.

And the most notable change in that is that women actually are drinking more frequently, consuming more alcohol than in previous times. There’s been an increase of persons that are totally abstinent from alcohol overall as well in more recent time here.

But just in terms of what people are drinking, there’s a lot of craft drinks, health drinks, organic drinks. There is some mixing now currently, especially I would say in the state of Minnesota with the legalized cannabis. So there’s THC and alcohol drinks that are being produced. And so there are some trends I would say, just in terms of what people are consuming. But overall in the last couple years we have decreased, especially since COVID.

Alan Helgeson:

So Mindy, you talked about as it’s kind of gone down, which is good news, but those rates increased during the pandemic. Let’s talk a little bit about that and why that was and what was going on there?

Mindy Broden:

We talk about addiction being a disease of isolation and when the pandemic came, isolation was a huge factor in the increase of alcohol consumption as well as the decrease in activities, which I think Ashlea, I’ll reference after a little while here.

But the other part too was liquor stores were essential businesses. They remained open and increasing the amount of people that were drinking at home. So when people drink at home, sometimes they might not be as cognizant of how much they’re consuming or how often they’re consuming as they would be in a social setting like say a bar or a lounge or something, even out to dinner or something. So when working from home, having isolation, possibly boredom, lack of activity, the increase of consumption was the outcome.

Unfortunately for those who have a propensity for drinking, it moved the progress forward much quicker than if they were not isolated. For many, with the lifting of the restrictions and the return to normal life, their drinking did decrease to pre-COVID rates. But for others it began to become a problem, which we’re seeing now, and I suspect that we will still see an uptick in alcohol use disorder diagnosis based on the trends that we’ve been seeing in the treatment setting, kind of as the fallout from the pandemic.

Alan Helgeson:

And then the good news that we’re starting to see things trend downwards, which is again, great news. Ashlea, let’s switch to you now. It’s reported that binge drinking rates are highest in the Midwest, which is in Sanford Health’s footprint. Can you speak to that a little bit?

Ashlea McMartin:

We find that in the Midwest we’re very rural, right? So we have smaller communities very far apart. I think about, you know, the community of Bemidji that’s just shy of 15,000 is probably one of the bigger cities within a two-and-a-half-hour radius.

And so we have to Mindy’s point about her piece of isolation, we have communities that don’t have a lot going on. So I think sometimes drinking comes as a result of boredom and then it becomes part of the culture. And so we have this combination where alcohol is present at many different events and it just becomes part of what we do and who we are.

We also have in the last couple decades seen this increase in the craft beer and the brewery and the pub idea. And so again, it’s become this trendy, enjoyable social activity. And so it is something that brings people together. And so there’s that delicate balance between engagement and connection, but ensuring that it’s in a healthy venue, and alcohol is typically present at many of the different social activities that we see.

Alan Helgeson:

We do see that as kind of a foundational thing for getting together with the social thing. You go out with friends and you have that – it’s much like food, right? We always have that around and we have it present.

So let’s pop back to you Mindy. Let’s talk about binge drinking for men. What does that look like for men?

Mindy Broden:

Binge drinking for men is actually defined as having more than five drinks on one occasion. And then heavy drinking would be defined as having 15 drinks or more per week. And for women it’s more than four drinks per occasion or eight drinks per week.

The only thing that I would add to that is that back to that cultural context of the Midwest or we talk about with young people, binge drinking is a really common thing. I don’t think if we went out and did a kind of a poll of our college campuses, most people would not think that five drinks was anywhere near a binge. But nationally that is what we identify as binge drinking is five for men and four for women.

Ashlea McMartin:

I think it’s important to note, and Mindy correct me if I’m wrong, but like there’s binge drinking and then there’s also what maybe the medical field would suggest as excess. And women shouldn’t drink more than one drink a night and men shouldn’t drink more than two for the health components of things. So she’s mentioning binge drinking and how people would be like, what? Five? No, that’s not binge drinking, but if we talk about just overall health impact, like more than one a day is more than likely having a negative impact on her health.

Mindy Broden:

And our sleep and our emotional wellness and all of those things too. I agree with you Ashlea. Like I said, when we talk about this, there’s different kind of schools of thought with it. From a substance use kind of context or perspective, it’s not necessarily how much a person’s drinking. It is how it’s impacting their life.

So we can’t give a substance use diagnosis on how much a person drinks by itself. There has to be other components. It has to be negatively impacting their life in some way. And so a lot of times while we do binge drinking is part of kind of the way that we assess, it also includes is it impacting you emotionally, physically, relationally, socially, employment wise? Because that’s really what determines whether a person’s having a problem.

Alan Helgeson:

Alcohol is a depressant. So then what does that mean for those who might not know? Let’s take that a step further then.

Mindy Broden:

There’s three different drug categories. We have depressants, we have stimulants, and we have hallucinogenics. And alcohol falls into the depressant category and it acts just as the name implies, it slows the central nervous system down, slows breathing, slows heart rate. The challenge is that a lot of people experience what might be called a buzz or euphoria that they feel when they start to drink, but that isn’t because the alcohol isn’t still depressing the central nervous system. It’s because alcohol also impacts the brain, primarily the prefrontal cortex that has to do with judgment and reasoning.

So when that judgment and reasoning is skewed for a person, it gives people the feeling of feeling relaxed, of not caring what other people think. And that is a lot of times the feeling that people look for when they, especially when they’re in social settings.

Alan Helgeson:

So as you talked about that then, how does alcohol affect us emotionally?

Mindy Broden:

When a person usually starts to drink, it enhances positive emotions, decreases anxiety when they’re drinking, but when alcohol begins to wear off, there’s a boomerang effect. So people often will experience heightened anxiety when they are sobering up or when the alcohol’s coming out of their system. Sometimes they might be unable to sleep, have an increase of heart rate, breathing, racing thoughts, worry, et cetera.

As a person’s drinking often continues down the road, they will maybe have more, when I say like heightened emotions, so they might have a little bit of sadness, but then when they drink they might get uncontrollably sad. Or like what Ashlea talked about, a lot of the people that we see presenting in crisis situations have maybe alcohol or drugs on board is that will take maybe a little bit of a thought and it just blows it up.

And so somebody might be sad, once they drink, now they’re experiencing suicidal thoughts and because the prefrontal cortex is impacted by this, they now don’t have the reasoning or judgment not to do it. And so that’s a lot of times where Ashlea’s service lines will get involved with our patients as well.

Alan Helgeson:

So then let’s switch over to the physical side then Mindy.

Mindy Broden:

Sure. One of the reasons why men can drink more than women is because men have an enzyme in the stomach that starts breaking down alcohol prior to it reaching the large and small intestines. Women don’t have that same enzyme and so women are more greatly impacted because of that, plus usually the weight difference between men and women, muscle mass, all of those things.

But alcohol is broken down through all those various internal mechanisms. But namely the liver’s impacted by alcohol use, especially over time. Long-term effects have resulted in liver failure, kidney problems, stomach, digestive problems, and we often do see that in the medical field as well. The negative impacts of how alcohol is affecting a person physically.

Alan Helgeson:

Mindy, let’s talk next about those warning signs that someone might have a problem with alcohol.

Mindy Broden:

Absolutely. I think some of the of the greatest warning signs are increased use, needing to have drinks more frequently, more often maybe you started with having one to two drinks and now you’re having two to four drinks. That’s usually the first indicator.

Obviously some of the concerns would be use in which it’s physically dangerous. So if you do have a medical condition or driving under the influence, being unable to control drinking blackouts is something we see, especially with binge drinking. Some of the younger crowds possibly would be experiencing blackouts. That’d be a pretty good indicator there could be a problem.

But more than anything we talk about is it impacting your relationships? Are you not being able to fulfill obligations? Change in friend group is a pretty good indicator or you’re not hanging out with friends that used to be really important to you and now your friend group’s changing to people who maybe drink more. Relationship problems due to drinking. Legal problems. Those are some of the first signs that we see that somebody might be having a problem with alcohol.

Alan Helgeson:

So knowing about these warning signs when someone might have a problem with alcohol, we’re hearing a lot these days about sober curious, Dry January and awarenesses about paying attention to maybe overuse of alcohol. Let’s talk about sober curious and what is it Ashlea?

Ashlea McMartin:

Ironically, Alan, you mentioned at the kickoff that it’s a relatively new term, right? Just in the last couple years and there’s accuracy in that. Sober curious has its roots going back to the late 2010s. That sounds so strange to say, right? The 2010s (laugh).

In 2018, Ruby Warrington wrote a book called “Sober Curious,” sober curiosity. She started a podcast around it, really a millennial push around this content or context of mindful approach to alcohol use. And so what that looks like is being curious or questioning what our alcohol use is having an increased awareness of what our drinking habits look like, maybe taking a break from drinking during certain times, and then doing more sober activities, engaging with others that are taking maybe that sober curious approach.

Mindy Broden:

I would just add one thing too, Ashlea, and I absolutely love that answer. The additional piece I think is that there used to be a pretty harsh judgment on people who were maybe practicing sobriety or practicing abstinence, and it was very kind of almost shameful.

And so this shift of the sober curious movement I think has just brought in just a non-judgmental stance of you don’t have to be an alcoholic to go to a meeting or you don’t have to be an alcoholic to practice sobriety. It brought in just a totally different feeling to the idea of choosing not to drink.

Alan Helgeson:

Give us your expert opinion on putting some labels on different things like this in raising these awarenesses.

Mindy Broden:

I think that just these different campaigns that have came out have really done a lot to exactly what you said, raise awareness that these are issues, these are things people are doing, in some ways almost make it popular to maybe practice a month of the year that you’re going to not consume alcohol or use any substances.

But I think that the normalization of it has actually decreased the stigma as well because when you see these different campaigns for different months, I think we have a suicide awareness month, we have, like you said, Dry January, we have a sobriety month, we have all these different things and it just brings more normalcy to it and it gets people talking about it and puts out resources into the communities, which I think are just fantastic to be able to kind of all come around and reduce that stigma and judgment.

Ashlea McMartin:

I think it gives permission to, right, like when we talk about the Midwest having higher rates of binge drinking and why that might be, and with it being boredom and part of our culture, sometimes we need permission to be anti-culture.

And so picking maybe a month to say, can we collectively do this or try this, gives people the OK and a reason that if someone’s going to ask, oh, why aren’t you drinking at this event? Someone can say, I’m, well, it’s Dry January and I’m trying my hand at this. It can almost create a ripple effect where it creates greater curiosity around that. Right now we have the chance for someone, our acquaintance to say, tell me more about Dry January and why you would be committed to doing that.

Alan Helgeson:

Well let’s talk more about those specific tips for living a sober or sober curious lifestyle. Ashlea, can you share some of those?

Ashlea McMartin:

Yes, Alan, great question because as people are listening, maybe they are thinking, how can this even look? What would this even be? And so I oftentimes tell people, find your people, right? If the folks that you’re hanging around aren’t welcoming to the idea of you choosing to be sober curious, maybe it’s an opportunity to branch outside that initial circle that you have and create a wider net or a greater support system that would be willing to say, “Hey, that’s cool. That’s all right. Yeah, like, you know, maybe we’ll keep drinking. But you don’t have to.”

If you are running into people that are tearing you down or continuing to reinforce that you should be, it might be time to look a different direction to find support.

Coping forward is another strategy where maybe you’re working on. I really want to commit to Dry January, but I’m also going to this work event, or I’m going this family birthday party, sports event that I know there will be alcohol at.

And coping forward means that we just plan for that. So how do I want to approach that? Maybe I even practice what I’m going to say to people in the mirror to gain confidence in explaining why I’m not going to be participating in drinking or drinking to the same extent that others might be.

And then the last piece is don’t give up. When we start to change culture, it takes time. And I just recently read that there is a section yellow at the Green Bay Packer stadium and the section yellow is a sober curious or sober section where people go to celebrate the Packers. How incredible, right? Green Bay Packers are an NFL football team, very well decorated. And there are fans that have come together that have said, we want to support a community that doesn’t want alcohol to be part of football. And we can still come and be present around other people that are doing that. We’re also going to support each other. And they have a section, they have a color, they actually hand out pins. That’s one game at a time.

And if you’re familiar with AA, NA, they talk about one day at a time, one hour at a time, one minute at a time, and have laid that over top of football to say one game at a time. And I just think that’s fantastic. And it goes to show how this movement is growing and how it’s impacting people in positive ways.

Mindy Broden:

You know, we look back 40 years even, there was never a non-smoking section in a restaurant and then we started almost like the non-smoking movement. You know, you can’t smoke in any restaurants anymore. And I think about that and how when we look at the kind of trends of people who smoke, that has decreased exponentially because it normalized that not everybody smoked. So that is so cool to kind of usher in the sober curious generation.

Ashlea McMartin:

And I don’t remember if you guys recall when smoking was banned from restaurants and bars, there was a huge uproar, right? There was like, people were like, what are we going to do? People aren’t going to go out to eat, they’re not going to do these things.

And then we adjusted, right? And people, some people stepped away from smoking, others made adjustments so that it wasn’t as negatively impacting other people, children, people that didn’t have a choice whether they wanted to inhale secondhand smoke.

And so our culture evolved and I’m hoping with this sober curious movement, we’ll see this continued growth exponentially of people being curious about their use habits.

Alan Helgeson:

Mindy, let’s turn now to younger people like those middle school, high school and college students that maybe try new things. What are a few things to look for in someone that might be going through some of these changes and experiencing those changes with alcohol, and in a harmful way that they may not have previously? And how can we help a person?

Mindy Broden:

That’s a great question and I think something that every parent has struggled with and maybe a lot of different friends have struggled with. If they see some things, I’d say some of the number one things to look for if a person’s having some difficulty is you’re going to see a change in behavior. Might be a lack of interest in the things that they had before. A significant change in friends, sudden drop in grades, sudden drop in friends, all of those things. Kind of that idea of isolation over time, that’s what will happen is that isolation will kind of step in there.

I think one of the hardest things with youth is it’s much more difficult for youth to recognize that there might be a problem, even if someone that is watching them can see that it is. A lot of times youth have kind of that 10 foot tall and bulletproof mentality, not me, I can handle this, this isn’t a problem, this is normal.

And so I always just think communication is the starting point to connection with them, being cautious, not to accuse or shame and so on. Instead, using phrases like, “I’m really concerned for you because this is what I see,” or “Help me understand what this is doing for you.”

One of the greatest challenges with youth is that they’re not likely to experience the significant consequences that maybe somebody that’s further into their use disorder would, and then they also compare themselves to others. And so maybe somebody else was able to drink the same amount but didn’t have the same outcome. Like I said earlier, if a young person is blacking out from using alcohol, that’s always a pretty significant sign that they might need some help.

Alan Helgeson:

Well, as we switch now talking to both of you, which we know are great resources, what other resources does Sanford Health have?

Ashlea McMartin:

I think there’s many different starting spots for patients that are receiving care at Sanford or maybe they haven’t ever received care at Sanford. First and foremost, reaching out to your primary care provider and just asking questions and seeing what referrals that they can make for specialized care if you’re concerned about your drinking or really any substance use habits. And that can include things like binge eating, gambling, different addiction habits.

I know oftentimes we think of addiction as just alcohol or drug related, but really we have a wide spectrum of what addiction can look like. Many of our regions have specialty care in the form of behavioral health services, and that can include mental health services, but also substance use disorder services. It might be outpatient, it could be residential, it could be inpatient. And so really kind of getting a good lay of the land of what is close to you or what services are offered virtually.

We’re talking about rural health care, right, where we know that it might be a long drive in and a lot of resources for someone to receive inpatient or in-person care for a substance use disorder. And so also recognizing that we have virtual options that can help support people living anywhere to receive services that might be vitally important to their well-being.

And then the last resource I want to call out that isn’t Sanford specific, but that has been a huge push in the last two years since its rollout in 2022, is the phone number 988. 988 mimics 911 in the sense of when someone is in need of emergency services, whether it be an ambulance or law enforcement, you can call 911 and they will respond. 988 is linked to the national suicide hotline, so someone calling 988 can receive support as it relates to mental health services, mental health crisis, and that includes substance use disorder services as well. This is a national number, so you can call it from any state at any time. It’s answered 24 hours a day. And when people are like, where do I even just start? 988 is a great starting spot.

Alan Helgeson:

Someone listening today that might be struggling with alcohol, those final thoughts to share with them?

Ashlea McMartin:

I think we can mirror the one game at a time concept and say, let’s take it a minute at a time. And that’s relative to maybe sobriety, but also trying to figure out what your next steps are. When we have difficulty or a problem present, we don’t have to solve the whole thing today. And so breaking it down into bites that we feel like we can digest is very important. And so what is in the next minute or hour, something that you can do to support yourself?

And then along that same line, don’t hesitate to reach out for services, whether that’s formal or informal. There are many people that want to support you in this process. And hopefully as this sober curious culture shift takes hold, people will find more and more places to connect with others to say, I think I want to change my alcohol use habits.

Mindy Broden:

I was just going to add in addition to that too, and what Ashlea said is absolutely accurate, and we do have a lot of resources. But I think sometimes a person might be scared. “Well, maybe I’m not ready to quit. Maybe I just want to cut down,” or whatever. And most places – I can speak specifically for our teams – we really meet patients wherever they’re at.

And so if somebody’s having a problem, they just want to have a conversation about it, or maybe they just want to identify, am I having a problem or what am I getting from it? Or what is it giving to me? Alcohol isn’t prejudiced. It impacts any person, any color, any age, any culture. Some people’s bodies are more primed to have issues of substances than others. That’s a fact.

Like I said before, addiction thrives in isolation. So we have a saying in SUD (Sanford substance use disorder team) that says, you’re only as sick as your secrets. So the number one thing is to talk about it with someone. So just like Ashlea says, 988, talk to your primary care provider, case manager if you need to, but just talk to somebody about it. That is the number one thing.

Alan Helgeson:

Well, let’s move on to somebody that may have a loved one, a family member, friend, coworker that is struggling. What would you say to someone that’s listening that might be going through that?

Ashlea McMartin:

I think reiterating what Mindy said, that addiction doesn’t discriminate. When we look at supporting people that are experiencing addiction, some of the best ways to do that are to set really healthy boundaries for ourselves as those that aren’t experiencing addiction, to keep ourselves healthy for that other person oftentimes.

And Alcoholics Anonymous even has a parallel group for children of alcoholics because it’s not uncommon for a loved one colleague to feel responsible or like they did something or should have done more to help someone through addiction.

And addiction is just, it’s beast. And it takes many different people, a lot of different connections. And so keeping yourself healthy through self-care and also setting boundaries with that loved one or that colleague is very important. And even though it might feel at times like those boundaries are harsh or that person with that addiction is responding with words that are hurtful, knowing that maintaining those boundaries are extremely important for our own well-being because we can’t help those when we’re ourselves are unwell or struggling.

Alan Helgeson:

Wonderful information that you’ve both shared today. Mindy and Ashlea, we so appreciate your time and being part of this podcast and talking about sober curious and living a sober curious lifestyle.

Cassie Alvine:

This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, find us on Apple, Spotify, and news.sanfordhealth.org.

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How to talk about suicide with friends, loved ones

Courtney Collen (Host): Hello and welcome. You are listening to the Health and Wellness Podcast brought to you by Sanford Health. I’m your host Courtney Collen with Sanford Health News. This series begins new conversations and continues the important ones, all designed to keep you well, physically and mentally featuring our Sanford health experts on the podcast. Today is Ashlea McMartin, MS, LPCC, who is a clinical manager of community-based mental health services in Bemidji, Minnesota.

Ashlea, thanks so much for being here.

Ashlea McMartin: Thanks for having me.

Host: We would love to know more about your role and what you do in Bemidji.

Ashlea McMartin: Sure. As a clinical manager, I have probably five or six programs that fall underneath my leadership. And one of them that’s really pertinent to the efforts to kind of prevent suicide and work through mental health crises is our mobile crisis team, which is a 24 hour a day, seven day a week program that meets people in the community, in the home, wherever they’re at. That’s experiencing a mental health crisis and that’s defined by the individual that’s calling in. So it’s not defined by us as saying, Oh yeah, you check the mark. You check the boxes for these criteria. So we get a wide range of reasons that people call into our crisis line. From, you know, I I’m working on my distraction skills and my, you know, my internet went out and that’s the most frustrating thing.

Really, the tipping point right now to people that have been actively involved in steps of working towards suicide. And so we see a lot of different things that people bring forward to us. Some of the other service lines that fall underneath my leadership are working with individuals with serious mental illness and also kiddos with high mental health needs. And so again, from, from zero to kind of the aging population, we see prior to my role as a clinical manager I’ve also acted as an outpatient therapist. So working individually with one-on-one with families and individuals that might be experiencing mental health symptoms, and that includes suicidality at some times. And then I also serve as a mental health professional on the crisis team. So I still act in that role at times where people consult with me on helping keep individuals safe, hopefully in the community.

Host: It sounds like a lot of this is about education. Let’s talk about outreach for a moment and what you do to take this work out into the community,

Ashlea McMartin: Do outreach, to be able to notify people of our services through the crisis team. And then we also do the active engagement assessment intervention and post stabilization. So people call us when they’re concerned about having a mental health crisis and we can intervene at that time. So we’ll do an assessment. So we look at the different risk factors associated with suicidality, and then we can make recommendations, recommendations up to inpatient hospitalization and down to being able to stay in the community and provide wraparound services and referrals to other resources within the community.

Host: Are we seeing a rise in numbers of mental health concerns this year and maybe an increase in the number of people who have either thought about or attempted to take their own life?

Ashlea McMartin: So it’s yes. The short answer is yes. The longer answer is we’ve statistically seen rises in those suicide rates and mental health concerns over the past couple of decades. And so to say that it’s just unique to COVID I think would be inaccurate. I think COVID adds an extra layer and maybe the percentages, and we don’t know the numbers right now because we’re living them. But that the percentages of people needing help is probably higher than ha than they’ve risen in the past.

Host: Give us an idea of, of some of the trends lately that you’ve seen, are people more willing to come forward and say, Hey, you know, I’m really struggling with this.

Ashlea McMartin: The unique things with crisis is, is because we serve the broad spectrum. We often see trends vary by age. And so when school’s in session, lots of times we see the pressures related to school and the added responsibility to kids like having a set bedtime and having to get up at a certain time having homework that they have to engage in that those extra stressors. We often see a spike in mental health crises and for the younger ages, we often see it in the form of maybe behavioral needs in the schools. And so we often see the trends with kids that when summer comes around, service needs drop, because there’s a little bit looser of a schedule during the summer. There’s less people involved to have eyes on to notice concerns. There’s less social pressures. So oftentimes a big component of the stressors of life for a student is going to be the interactions with classmates.

And so in the summer or during winter break, we see some of that stuff kind of fall away at times. Now technology adds added component to that where if people aren’t socially unplugging we can see some difficulty with social media, but so we often see the summer being a lower, lower need, time for services in general, but crisis services as well for kiddos. And then we see a spike in that with school starting because now we have people trying to adjust their schedules. There might be a change in expectations right at home. There might be certain expectations and then kiddos are trying to adjust and behave differently at school. And that the change, the difference in expectations create some discomfort at times that might look behaviorally inappropriate. So in the fall we usually anticipate and expect to see an increase in contact with kids, which is pretty similar this year.

I would say that that’s, that’s kind of on par and on pace that we typically see. I would say the population that we’ve engaged more with, and this is just anecdotally, I haven’t necessarily been able to run our numbers completely. But the statistics and data show it from, from Samsung and some of the research they’ve done, but that late teen, early adult population has been utilizing crisis services more. And I think I can’t speak towards their numbers and outpatient, but I would imagine the follow-up services or the services provided through the universities, like their counseling centers may see a spike. You know, we have this population of people who either haven’t had the chance to kind of go through the closure process of high school, right? So we had graduates last year that didn’t get their final prom. They didn’t get to necessarily do the graduation ceremony like they’re used to, they didn’t get to do grad parties.

They there’s a lot of things that kind of abruptly ended. And now we have another class coming through that hasn’t been able to start as quote, unquote normal. So there may be doing hybrid models or online the things that they, you know, my senior year of cheerleading or football or drama, like those things just aren’t available to them because of the circumstances. So we have this, this group of people that haven’t had good closure on major life experiences, and then they’re transitioning into greater independence. So they’re, they’re kind of being told like, okay, well, this is when you go get your own job and you move into your own place and you go to college and you do these different things. And it’s disruptive in that regard too, right? Like colleges are not, some colleges have moved students back home because of the risk of exposure.

We’ve seen some outbreaks from that population for COVID. And I think it’s because of, maybe they’re not we know statistically they’re less likely to be symptomatic and have severe enough symptoms to be hospitalized. They have low, lower death rates. They might not take it as serious. They might just be asymptomatic and not know they have it and spreading it. And then we have this world of unemployment now for this age population. So there’s just a lot of different things that are impacting that age range. The other thing to think about too is actual brain development. So we know that contrary to old science, old science said that our brain fully developed by the age of 25 and that we were done learning and we, we couldn’t develop any more neural pathways. That’s not true. The beauty of our human body and brain is that we can develop new neural pathways and connections all the way through the end of life.

But we do know that our, our prefrontal cortex, which is the front frontal lobe of our brain, that is really responsible for some of the executive functioning and understanding consequences doesn’t fully develop until later into the twenties. And so that ability to recognize a consequences, right? If I, if I’m getting together with this big group of people, I might have COVID and be spreading it, but also be that concept, that concept of if this then, so like being able to understand that life is hard right now because I don’t have, I don’t get to experience the things that I anticipated or planned on experiencing, but I’m still going to be okay, that age range a, the brain, maybe isn’t fully developed to be able to do that. And B hasn’t had a lot of really difficult life circumstances yet to recognize I’m going to be okay, I’m going to survive. I’m resilient. And so it’s, it’s just really hard space to be in. So we have seen a rise in that kind of that 16 to probably 30 age range. And that’s really reflective as well from the the information that the SAMHSA has kicked out around. That one in four from that age range, I believe of 18 to 25 has experienced suicidal thoughts. When you think about, you know, sitting in a, sitting in a room or a coffee shop and you look around and think about that, that’s pretty incredible.

Host: So, if we’re a parent and we have concerns for the mental well-being of our child or our loved one or friend, if we suspect that they may be thinking about taking their own life, where do we begin?

Ashlea McMartin: Yeah, great question. So as a parent, as a friend, as a loved one you know, the biggest thing that I can encourage is to ask the question, you know, a lot of times people are like, well, if I, if I ask them, like, are you having suicidal thoughts? Like that would, that would plant the seed. Cause then if they do it, that means I said it and they weren’t thinking about it beforehand. And research shows that’s inaccurate. It actually research actually shows that when we ask the question, are you having suicidal thoughts? Are you thinking about in your life that the person more often than is honest and that there’s actually relief that comes with the fact that it’s being asked and that it can be talked about now. Yeah. Yeah. And so it’s not going to plant the seed for someone.

It’s actually going to welcome the conversation and we, wait, we talk about, when we talk about stigma breaking, that’s a big part of it is just being willing to say the words out loud and to acknowledge that it might be going on. Yeah. so talk about it, ask those questions and ask with the intent to listen and, and hear what they’re saying. You don’t have to have the answers. If someone tells you that they’re experiencing suicidal ideation, you, you don’t have to tell them that it’ll be okay. You don’t have to tell them that it’ll get better. You know, you just need to stop thinking about that. Really? Just listen to hear what they’re having to say and validate where they’re at in that moment. So powerful. Yeah. Yeah. So that they know that they’re not alone, man. I hear what you’re saying. That is a really hard time right now. And all these things are contributing to sometimes not wanting to wake up in the morning.

Host: What about the teenager who might be reluctant to say anything or claim he/she is ‘fine’? How do we get past that?

Ashlea McMartin: It all depends on, you know, the each individual person and how comfortable they feel sharing that information. Right. And so one of the things I try to encourage people is as a parent, they might not be, they might not feel the most comfortable speaking with you, but maybe by asking the question and they might not be truthful, or they might not feel comfortable sharing the truth with you, but maybe it, it opens the door for them to recognize that I am feeling this way. And I, I might need to tell someone one of the ways sometimes to approach the conversation is to acknowledge maybe the things that you’re concerned about. So as a parent, I might say something, you know, it could be very straightforward and say, you know, I’m concerned that you’re maybe having some suicidal thoughts or I might also approach it from the perspective of, you know, I noticed that you don’t enjoy or you haven’t seemed to enjoy the things that you have previously enjoyed or, you know, I’ve asked you if you wanted to come do things with me the last couple of days, and you’ve really seemed down, and that’s not really who you are necessarily that I’ve seen in the past.

And it makes me think maybe that you’re struggling more than, more than what I recognize and, and kind of sharing, maybe the things that they’ve seen, you know, it seems like you’re maybe sleeping more, are you feeling okay? And just like, we would check in around physical health, right? Like, Hey, are you physically healthy? You know, do you have a cold? And they might say, well, why do you ask that? Well, you know, you’re coughing more and your sinuses sound like they’re kind of plugged up. Yeah. We can give those same kinds of to kind of share what we’ve noticed. And it also sends a message too, that we are noticing, right? Like, I, I do notice, I do care that these things are different and I want to support you and what that next step is.

Host: If someone is listening right now and they might be struggling with their own mental health, and maybe they don’t have a loved one or a friend who can check in periodically, where do they begin to find that support?

Ashlea McMartin: Yeah. So the mental health world can be so so intricate at times, and it can be very, very overwhelming. And so I tell people that a place, if, if you have no idea where to start, you can always, you know, pull up the old Google and just type in, you know, behavioral health services in wherever your location is in the next year. The nation is talking about developing a nine one, one number for mental health crisis. And so legislative legislature rolled out on it recently. They’re talking about making nine, eight, eight a national mental health crisis line that would roll over to your local community crisis lines. So just like you call nine one one, and it dispatches to your local this nine one one dispatch. So hopefully in the future that will help streamline your question to, to really be community based. There’s also a national suicide prevention lifeline, and that number is 1-800-273-TALK, or +1 800-273-8255.

Host: Let’s talk about some of the programs or efforts in place at Sanford to put an emphasis on suicide prevention and education. Tell me about the suicide task force. Yep.

Ashlea McMartin: Yeah. So the suicide prevention task force is an enterprise wide stance in recognizing how Sanford as a whole can engage in services that would help prevent suicide. And so that’s enterprise level with four different subgroups that are working on different interventions. As a parent, as a loved one as a friend or a family member zero suicide, if you Google zero suicide they have a website there’s also a website for suicide prevention resource center. Those two websites have fantastic resources on understanding suicide. There’s a great free training. That’s offered through suicide prevention resource center called calm, which is stands for counseling on access to lethal means C a L M. Again, you can Google counseling on access to lethal means free training will pop up. Suicide is extremely difficult to, to predict. They’ve done a lot of research on different factors that might, might indicate that someone is at high risk of suicide.

And those things include like the idea of helplessness, hopelessness, disconnection from people, but the ability to plug in risk factors into the computer and it to compute out a number that says, Oh, you’re at this percentage risk of dying by suicide doesn’t exist. So one of the greatest methods of prevention is actually preventing access to means of how the person would kill themselves. So when you’re talking about, as a parent, I have these concerns about my kids. Like, no, no, no, no, no, no, mom, I’m fine. One of the best ways to actually prevent suicide is to prevent the access to means 50% of people that die by suicide use a firearm. So when we’re talking about means restriction, making sure that our guns are locked up in safes, that our ammunition is stored away from the actual firearm that we just like we put safeguards in place, right?

We like, we put the little sticker on the toxic substances under the, under the sink and we probably lock those up nowadays. We probably have greater technology than just the little poison sticker. We put them in a room that we maybe lock. We can do that with the different methods that someone might use to harm themselves. So we know 50% of people killed themselves using a firearm. We know statistics in 2018 show that 13% of people died by poisoning intentional poisoning which would be similar to like a drug overdose. So those that died by suicide, 13% died by poisoning. So considering how we would arrange our medicine cabinets to not have full bottles of prescription medications available, maybe we have a pill reminder that we put three days worth of meds in.

So there’s different ways that we can address the environment to ensure it’s safe. Obviously we can’t guarantee it a hundred percent, but we can put some space. And here’s a really, really interesting statistic. There’s been some research that’s been done between how long from when a person decides that they are going to die by suicide. How long between when that thought pops into their head to when they act on it. And when I learned this statistic, it really, really blew me away. They’ve got, they’ve done it in a couple of different settings. The first first report was a Houston study in 2007, 24% of the 153 survivors of nearly lethal suicide attempts between the ages of 13 and 34. So those that were hospitalized with near lethal attempts, 24% said that there was less than five minutes between when they thought about killing themselves.

So nearly 50% of people said that it was less than 20 minutes between when they thought about it and they acted on it, which means if we can create space between those two things, right. If we can create space between I’m thinking about killing myself, I want to shoot myself and actually having access to the firearm. We, we can, we can, we can get people outside of that window because here’s the other thing, typically what happens is if someone experiences strong, suicidal ideation with the intent to die, typically that amount of distress lasts for a short period of time. What happens during that timeframe though, is we get in our emotional mind and we’re unable to rationalize things. So our problem solving skills are very, very small at that time.

So when we put, when we put barriers in place between the means that someone has decided to use and them, we actually create, we force them either to get out of that window of distress. So maybe they’ve exceeded that 20 minutes. And now they’re like, you know what? I can’t find what I’m looking for. I’m really tired. I’m gonna go take a nap. So we’ve either moved them out of that, or we’ve forced them into a rational state of problem-solving, right? So let’s say, I’ve decided I’m going. I want to die and I’m going to go get my gun. And I go in the safe as locked. And I don’t know, I can’t figure out what the PA the code is to get in. Or maybe I, I grabbed the gun and the bullets had been removed and in a rational state, I would say, okay, well, I’m going to drive to the store and buy more bullets, but I’m not in a rational state. So I’m at this place of, I don’t know what to do next, because I can’t find the bullets. I don’t know where they are. They’re hidden.

Host: If there are small things that we can do to make a huge difference, literally between life and death. And how often do you actually say that when you mean it literally, then why not, you know, take those small steps to do that and increase the time and then maybe save a life.

Ashlea McMartin: Yes. When we go to that study, right? Where they looked at those nearly full suicide attempts, only 13% of people said that they had thought about suicide for a day or more before acting on it. When I asked my kiddo today, they’re not thinking about it, but that doesn’t mean it’s a checkbox question. And we say, okay, I asked it, I’m done. It means that we continually have the conversation because we know that these thoughts can be abrupt and impulsive. And so it’s okay to ask again. And it’s okay to ask again, because statistically we know that they might not have them for seven days before they act on them. They’ll probably actually only have them for seven minutes.

Host: Those numbers are, are incredibly. Eye-Opening so thank you for sharing some of those reports. And you talked about the task force. Is there anything else in place?

Ashlea McMartin: The suicide prevention task force is actually partnering with zero suicide. Zero suicide is an entire framework for organizations, communities to implement, to look at many different areas of where many different areas that could impact suicide prevention. So from the from a, an agency standpoint or a department or an enterprise level standpoint, we’re looking at is leadership aware are people trained? Do we have the right techniques in place? And so this task force is looking at the evidence-based interventions that have been noted at helping people when they’re experiencing suicidal ideation or post hospitalization. And so a couple of those different interventions include things like caring contacts. So research has shown that sending non-demanding caring contacts to people to let them know that you care can help improve someone’s mental health. So it’s something as simple as let’s say, someone discharges from the hospital.

And a week later, we send them a letter that says, Hey, it was great to interact with you. We’re here for you. If you ever need anything, here’s our phone number. Non-Demanding, doesn’t require a call. Follow-Up doesn’t require them to fuel feel good, right? Like, I, we don’t put the, I hope you’re doing well. And that seems really strange, right? Like, because that might be the language that we use, but it can also put a demand on that person that if I’m not feeling well, that means I’ve failed. So that’s one aspect is the caring context idea. Another aspect of involved with suicide care within Sanford is care management. So what we find is oftentimes people navigating the mental health system is hard, right? You ask the question like who should I call and how terrible in the 21st century is it that I, that my response is Google, but it’s the reality.

We don’t have a centralized way of connecting people with resources. I can give you ours in our region, but I can’t speak to some of the other regions. And so CA care team approach care coordination is extremely important in helping people address mental health, because it’s really getting their entire treatment team on the same page. And when I say treatment, I mean, you know, who is their primary care provider? Who is the nurse that’s helping, who is maybe the specialized doctor, is there an integrated health therapist involved? Is there an outside therapist involved and making sure that everyone’s on the same page so that they can speak and really be working towards the same goals? So care coordination is another area that there, that we’ve identified as a space that we can make improvements and tests run some new ways of doing things.

And then the third area is crisis planning. And I really see this as also being an area that’s very transferrable to friends and family, just like we teach our kids what we would do. If there’s a fire, or if there was a tornado or what to do. Now, we teach our kids in our region. At least we teach our kids what to do. If you get stuck outside and it’s cold, we can also crisis plan for when someone experiences a mental health crisis. So you can have those conversations, even when people are well around the idea of how would, what type of care would you like? We do this as people age and we create health care directives, right? We can do the same thing as it pertains to our mental health as well.

Host: It sounds like Sanford is very equipped to serve the population on this topic. What else do you want us to know about the work that you do? The work that your team does?

Ashlea McMartin: It’s a delicate balance. I want people to know that to support someone that’s experiencing mental health struggles, doesn’t take a magic, a magical box of skills. So at the ground level, we can all listen to each other. We can all validate each other, be kind and have grace, right? As a parent, as a friend, I can do those things. And when the need of the person exceeds those things, Sanford is absolutely equipped to be able to walk alongside a person and their family and support them through the process of recovery. And that just like we would recover from a hip replacement, just like we would recover from a broken bone. And there’s a lot of different services available to the Bemidji region and across the enterprise that can help with those different steps. The world right now is chaotic. And so know that when our environment is unstable, where we, as people are going to experience instability.

And so if you’re noticing a change in your own mental health, that would absolutely make sense to the time of the world right now. In fact, I might be more concerned if you’re not noticing changes in your mental health because of how chaotic the world is. So know that you’re not alone, know that there is help. And that sometimes the, the thing that we want to do the most in disconnect with people is the thing that probably won’t move us forward. And so don’t be afraid to reach out and make that connection with the person.

Host: Well, it was a pleasure talking to you today. Thanks so much for all of your information and insight into this topic of suicide. As we look to break that stigma and provide information for our own communities, that Sanford is here. Yes. And ready to care for you, Ashlea. Thanks so much for your time.

Ashlea McMartin: Yeah. I appreciate the opportunity to, to speak about it. Thank you.

Host: This was another episode of the Health and Wellness Podcast series by Sanford Health and Courtney Collen. Thanks for being here.

If you or someone you love is having suicidal thoughts, get help now by contacting any of the following:

• SAMHSA National Helpline: (800) 662-HELP (4357)
• Suicide & Crisis Lifeline: 988 or (800) 273-TALK (8255)
• Crisis Text Line: Text HOME to 741741
• SAMHSA Disaster Distress Helpline: (800) 985-5990

Visit sanfordhealth.org to find resources, risk factors, warning signs and steps you can take to help a loved one.

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