How to talk about suicide with friends, loved ones

We can all do our part to prevent suicide, communicate first

Ashlea McMartin explains how to talk about suicide with friends, loved ones

Episode Transcript

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 Ashley McMartin, MS, LPCC, who is a clinical manager of community-based mental health services in Bemidji, Minnesota.

Ashley, thanks so much for being here.

Ashlea McMartin: Thanks for having me.

Courtney Collen (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.

Courtney Collen (Host): It sounds like a┬álot 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.

Courtney Collen (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.

Courtney Collen (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.

Courtney Collen (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.

Courtney Collen (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.

Courtney Collen (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.

Courtney Collen (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.

Courtney Collen (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.

Courtney Collen (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.

Courtney Collen (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.

Courtney Collen (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, Ashley. Thanks so much for your time.

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

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

The National Suicide Hotline phone number is 1-800-273-TALK. You can also text the crisis text line ‘HOME’ to 741-741.

Posted In Behavioral Health, Children's, Family Medicine

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