Suicide Prevention is Everybody's Business

It was my first Ground Rounds meeting at Elizabeth General Medical Center (now Trinitas Hospital) which was a part of the pre-doctoral internship. The topic was on patients who lost their life to suicide, and several psychiatrists were on the panel.  Although I had externships where I was trained to address clients with thoughts of suicide and had to contract for safety, I wasn’t fully prepared for the conversation on that day. One by one, each panelist discussed patients who were in their care when they died of suicide. I can vividly still remember one psychiatrist who was emotionless as he spoke. Others appeared much more troubled during their presentations. I left the meeting a bit shaken and prayed I would never be in a similar position. In the last two decades that I’ve served as a licensed psychologist, the topic of suicide is a common conversation. In fact, it's a part of the job description for mental health professionals. Therefore, I’ve treated clients who have expressed suicidal thoughts, lived through suicide attempts, or lost someone to suicide. There is always a mix of emotions in the room on both sides of the couch, but I can say that I value holding the space, sharing the memories, embracing the laughter, respecting the tears, and facilitating the work of emotional healing. 

 For the next few minutes, we’re going to drill down on the reality that SUICIDE CAN BE PREVENTED. We’ll look at the statistics from a global perspective and in the United States to hear suicide speaking and commit to being a part of the suicide prevention plan. We’ll talk about the recent changes made to access suicide and mental health crisis services in detail so we have knowledge that can be used in moments of distress whether it’s for you or someone you’re supporting. We’ll be introduced to two phenomenal women who will help us put a name and face to suicide and allow us to learn about their work in suicide prevention. They will also provide useful information about warning signs, facts about various groups, and how suicide can be prevented. We’ll wrap up by leaning into the concept of community to keep suicide prevention going in our perspective corners of the world. 

Discussions about suicide can be extremely uncomfortable but they are necessary. Too often people find themselves unprepared for unexpected moments of transparency from a friend, family member, associate or stranger who admits, I no longer want to live. For some the voice that they hear will come from the person in the mirror. There may come a time when an unspoken question about how someone else is doing surfaces, or a split second of wonder about another person’s state of mind based on a comment or facial expression. Therefore, knowing how to respond in a time of crisis will make all the difference. Let’s add some perspective to this conversation. September is Suicide Prevention Month. This time each year the government, health organizations, mental health professionals, public health officials, and the general public, speak up and out to bring awareness of suicide in hope to stop it in its tracks. 

 Suicide can be viewed as a hidden epidemic. An out of sight and out of mind experience not discussed at dinner tables or in office cubicles. The silence fosters a stigma and denial that costs lives and the livelihood of those left behind.  Even if we don’t talk about suicide, the statistics speak loud and clear.  The World Health Organization (WHO) reports, worldwide, more than 700,000 people die from suicide each year and in 2019, suicide was the fourth leading cause of death among 15- to 29-year-olds. The Centers for Disease Control and Prevention (CDC) reports that, in the United States, suicide is the 12th leading cause of death in adults; 2nd leading cause of death in ages 10 – 14 and 25-34; and 3rd leading cause of death in ages 15 to 24.  The CDC also reports, in 2020, 21.2 million adults seriously considered suicide and there was approximately 1 suicide every 11 minutes. The agency also noted that suicide rates increased 30% between 2000 and 2019 but fell 3% between 2019 and 2020. However, questions remain about whether the long-lasting effects of the pandemic will change the numbers. The 988 Suicide and Crisis Lifeline reported that the suicide rate in Black youth is increasing faster than in all other racial/ethnic groups and the LGBTQ+ community is disproportionately at-risk. The Lifeline reports other disturbing statistics for Native Americans and Alaskan Natives, veterans, and youth. 

Can you hear the voice of suicide screaming to be heard? Now that it has our attention, let’s make space for suicide to speak about ways it can be prevented.  Prevention is key because women, men, boys, and girls who died of suicide, often, suffered in silence. Since experts believe that people don’t really want to die but instead are desperate to end their pain, timely alternatives and supports are needed to address personal challenges that are intense, complicated, and real. In addition, professionals see that people who die of suicide, in a moment of despair, take a permanent measure to solve a problem that’s too overwhelming to bare. Therefore, there’s a need for those who are isolated and in crisis to have human connections that are concerned, candid and compassionate. I know that is us because we’re here. We’re reading this article. We want to be equipped to manage these difficult moments. We’re ready to be a part of this suicide prevention team. So, let’s jump in!

Let’s begin our suicide prevention plan by joining with a proven partner and reliable resource found in the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline). In July 2022, 988 became the new national number to access suicide and mental health crisis services. The number can be reached by calling, texting or using the chat on the website. Trained counselors are available 24/7 by phone in English and Spanish and use a translation service with access to over 250 languages. The text and chat feature is available only in English at this time. The change over to 988 was made to make it easier to connect with support because we only need to remember a three-digit number. The former National Suicide Prevention Hotline number will not go away for those who have committed that number to memory and are more comfortable using it, and anyone who reaches out that way will reach 988. The Suicide and Crisis Lifeline is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and has been in existence since 2005 where it’s responsible for saving lives. In fact, in 2020 they answered more than 2.1 million calls and serviced 234,671 online/text message chats . Using 988 for yourself or someone you’re working with puts you in touch with trained individuals who have experience in suicide and mental health crises and can address concerns confidentially and professionally. Keep in mind that 988 was created to be different than 911. 911 is for physical health emergencies, fires, and all situations where police are needed to respond. On the other hand, 988 is for suicide and mental health crises and assists by listening to our concerns and providing feedback and support, and connecting us to immediate local help or services that can be accessed after the call has ended. 

 Now that we know where to go when a crisis arises, let’s drill down on some of the signs of suicide and considerations for various groups. I had the pleasure to interview Kalisha Smith, LCSW . She is a therapist, the owner of Wise Counsel Services LLC , and a consultant for the Society of the Prevention of Teen Suicide. Ms. Smith has a wealth of knowledge and shared many nuggets that exceeded what could be included in this article. She broke down the signs of suicide into 1) risk factors and 2) warning signs. More specifically, Ms. Smith identified the risk factors as: a) individual (mental health concerns, substance use); b) family and/or community (family history of suicide, community violence, lack of resources); and c) societal (racism and oppression, unsafe messaging about suicide). 

Regarding warning signs, she described them as “the flashing lights” which are “scary but means you still have time” to get help. They include but aren’t limited to:

·       communicating thoughts of suicide

·       having a preoccupation with death

·       searching suicide on the computer (check search history)

·        concerning social media posts

·       saying it would be better if they weren’t around

·       giving away important items

·       saying goodbye

·       significant changes in appearance and behavior 

·       noticing overwhelm, hopelessness and purposelessness

·        high-risk behaviors that are not typical (changing friends and using substances)

During the interview, Ms. Smith spoke about how suicide impacts different populations. She referenced a study done that was spearheaded by Congresswomen Bonnie Watson Coleman and the Black Caucus which found the rate of suicide, alarmingly, has continued to increase for Black youth. She also reported that we’re seeing Black children as young as 5 thinking about suicide. Ms. Smith talked about senior citizens that are isolated being at risk and to watch for giving things away, being hyper-focused on their end of life, or when medication is missing. She also spoke about faith communities and how stigma around seeking therapy can be a barrier for the groups; however, once in services speaking about suicide is a relief. Ms. Smith ended with some words of wisdom. She stated talking about suicide is never comfortable but having the conversation is “courageous;” talking about suicide doesn’t put thoughts of suicide in someone’s mind but “identifies you as a safe person;” and suicide prevention is “more than asking but also caring and advocating.”

We know that suicide does not respect color, age, geographical boundary, or socio-economic status. It often goes nameless and faceless which can make us less sensitive when it’s already challenging to think about. I want to introduce you to Leslie Weirich who I became familiar with on LinkedIn after she posted about her son who loss his life to suicide. She agreed to be featured in this article to bring awareness to suicide prevention and reminds us that there are names, faces, families, and friends associated with suicide. Leslie’s son, Austin, was a junior in college. He was on the football team, strong in academics and a high achiever. In her LinkedIn post, Leslie shared her memories of the day Austin passed away and there was nothing out of the ordinary. They talked about his upcoming weekend activities and plan to go out for burgers with his friends later that night. Then the unthinkable happened when the police showed up at her door at 2:30am. One of the things that stood out to me in Leslie’s post was her statement that “just because they look good on the outside… doesn’t mean they’re not hurting on the inside.” She then encouraged parents to ask the difficult but direct question: “have you ever thought about killing yourself?” and “then pull up a chair and just listen.” Leslie has gone on to become a suicide prevention trainer, mental health youth advocate and public speaker.  Her words “just listen” after asking the question about thoughts of suicide echo. "Just listen" leads the way for us to hear suicide speak and become that compassionate human lifeline who can go on to connect others to lifesaving supports.  

A community of concerned prepared advocates is key to prevent suicide. If you're reading this article and follow me on social media, you know my passion to publicly promote the idea that Healed People Heal People. Healed people who heal people have difficult conversations, ask difficult questions, and respond in difficult situations. Healed people who heal people walk through life with an awareness, openness and curiosity about the welfare of others. Healed people who heal people have a belief that they are their brother’s and sister’s keeper.  Healed people who heal people remind me of Marianne Williamson quotes that “in every community there is work to be done. In every nation, there are wounds to heal. In every heart, there is the power to do it.”  It speaks to the reality that we as healed people who heal people are powerful agents in our communities, nations and hearts.

Since you’ve taken the time to read this article, you’re in a good position to seek help for yourself or someone else who has thoughts of suicide. We agree that suicide is everybody’s business and know suicide can be prevented. We’ve looked at the statistics that served as a voice of suicide. We spoke in detail about the recent changes to the 988 Suicide and Crisis Lifeline and understand it’s our lifeline in times of crisis.  We met two phenomenal women who educated us and put a face and name to suicide. We ended our discussion by leaning into the concept of community and saw how healed people heal people in the work of suicide prevention. 

We’ve came to the end of this article, but the work goes on. If you want to learn more about local community programs and events, you can look into some organizations (below) involved in the work of suicide prevention. 

*the list is not exhaustive or an endorsement of certain organizations over others

American Foundation for Suicide prevention (www.afsp.org) 

National Alliance on Mental Illness (www.nami.org)

Society for the Prevention of Teen Suicide (www.sptsusa.org) 

The Trevor Project (www.thetrevorproject.org)

Be Well!

#SuicidePrevention #MentalHealth #HealedPeopleHealPeople #KeynoteSpeaker

Dr. Carla J. Cooke is a global psychologist who partners with women to create healing spaces where emotional wellness and wholeness becomes a transformative process and a priority that is continually practiced. She is the visionary of the Healed People Heal People Movement and available as your next keynote speaker. You can join her on a Journey to Wholeness and get a free copy of her audio project the On Being Well Experience (a Stress Management Resource to Refresh, Recharge, and Reset) by subscribing to her email list at www.drcarlajcooke.com