Disclaimer: I am not a licensed therapist, psychologist, or social worker. Please seek professional help and advice if you know someone or are someone struggling with thoughts of suicide. The information in this blog has been taken from the CDC, NIMH, National Suicide Prevention Lifeline and Mental Health First Aid course. References are listed at the end of the blog.
Why Should we Talk About Suicide?
I get it. Talking about suicide is hard. Largely people don’t want or know how to talk about it. It’s uncomfortable and there is so much misinformation out there that people are afraid they are going to “say the wrong thing” and do more harm than good. The reason we should and must start having open conversations about suicide is because it happens. It’s real and there’s a high rate of individuals taking their own lives in our profession. We need to educate ourselves and others and have open, brave conversations about suicide.
Breaking Down the Myths
Myth: Talking About Suicide Will Put the Idea in Someone’s Head
Truth: This is unfounded and not true. Unless someone is having suicidal thoughts then you will not cause them to consider it. More importantly, it is imperative that if someone is having suicidal thoughts someone talks to them.
Myth: Someone Who is Suicidal Will Always Find a Way to Kill Themselves Eventually
Truth: This is not true. There are plenty of individuals who thought about and planned to kill themselves who never went through with it. Many people have received help, gotten better and never had a suicidal thought again. Recovery is possible.
Myth: Most People Who Threaten Suicide Are Attention Seeking
Truth: Those that threaten suicide need help. Whether they intend to kill themselves or not is irrelevant. They are in extreme distress and need help. All threats should be taken seriously. It’s better to act and call 911 than to have any regrets later. If an individual has threatened to take their own life, hurt themselves or you fear they may commit suicide then you must call 911. Anyone who makes such a threat, regardless if they are planning on going through with it or not, needs help.
What is Mental Health?
Your mental health is your state of mind, your psychological and emotional well-being. Right now, my mental health is well engrossed in writing this blog. Earlier my mental health was happy running a trail with my dogs by my side. Mental health doesn’t always have to be in bad shape. For many their mental health is in tip-top shape. That said, mental health is one thing that every single human being on planet Earth has struggled with. Every person has had mental health breakdowns, crises, and real struggles, myself included.
Too often the focus is placed on one’s physical health, but there should be an equal emphasis on one’s mental health. What do we do or say when we see someone struggle with their mental health? Often the action taken is nothing. It’s not because of a lack of compassion or empathy, but rather a fear of failing or a requirement to fix someone or a problem.
How To Start a Conversation
In veterinary hospitals, breaking down the stigma surrounding mental health starts with leadership. Promoting a healthy workplace environment means giving permission to having conversations about mental health. Having a conversation about how mental health is equally important as physical health at a meeting is a great place to start. Talk about the hospital’s commitment to a healthy workplace environment, form a wellness committee, or bring an outside specialist to facilitate a healthy conversation around the importance of caring for one’s mental health.
Too often people worry about how to start the conversation, when in reality it’s as simple as, “How are you feeling today?” This is a different question than the “How are you doing” which many people take to mean their physical health. If you want to be even bolder start asking, “How is your mental health today?”
"You Don’t Need to Solve the Problem"
One of the barriers of starting a conversation is the common misconception that when someone opens up about a struggle or problem they are experiencing, the person listening must provide solutions or help solve their issue. Unless the individual asks your opinion on the concern they are sharing, it’s actually best you don’t provide yours.
Most people need support, not solutions. They need kindness and to know someone cares about them, not a superhero who swoops down and rescue them. Most people have the ability to sort their problems out all by themselves and when they do need help, they will seek the opinions of others. Unfortunately, most people want to help by providing their thoughts and opinions about the concern being discussed. While well-meaning their interjections can cause the other person to have more self-doubt, fear, anxiety or concern about the issue at hand.
What to Say
Listen to someone who is sharing a concern or struggle without judgment. Let them talk through their feelings. Unless they ask for your opinion, don’t give yours. If you feel your opinion may be of benefit, ask permission to provide it. “I’m sorry for what you are going through. Do you need any help, thoughts or opinions on how to get through this?” Most of the time the answer will be, “No, I know what needs to be done, but it’s just so hard.”
If they have expressed they are struggling with their mental health, are in a dark place, are depressed, or they say they are considering suicide or that life is not worth living assure them that help is available. While you may not be able to solve their problem, everybody has the ability to get assistance for another person. Help is always available to someone who is in need.
Let them know that the feelings they are experiencing are treatable and educate them that suicidal feelings are temporary. They can move past them. Just like physical ailments, mental health ailments are treatable with many people moving past them for achieving a full recovery.
What Not to Say
Don’t minimize another person’s problems. Their struggle is real and it’s theirs, not yours. Too often the individual listening shames the person sharing their concern. “That’s not a big deal. I don’t know why you are so upset.” You are not them and minimizing their struggle will cause the individual to shut down and shut up. The healthiest thing for the individual is to feel supported, loved and cared for.
When the listener lectures them on, “You just need to move on. It’s not that bad,” they will likely feel shame and struggle more. If the individual has talked about having suicidal thoughts or suggested killing themselves don’t interject your feelings by telling them suicide is wrong or right. Instead, refer back to the paragraphs above on what to say. The feelings they are experiencing are temporary and treatable. “I’m here for you. Together we’re going to get the help you need.”
What to Do
If you think that someone has thoughts of killing themselves, ask them. In my Mental Health First Aid instructor training we were taught to ask, “Have you made plans to kill yourself” or “Are you planning on killing yourself.” While these questions are shocking, they are direct and cannot be confused with more subtle questions like, “Are you thinking of hurting yourself” or “You’re not thinking of doing anything silly, are you?” Studies have shown that asking the direct question ensures there is no confusion on what you are asking.
When you ask, “Are you planning on killing yourself” there are a few ways the individual may reply. For someone who is suicidal they will often answer after a hesitation, or say statements like, “not today,” “why not” or “why would you care?” For individuals who are not considering suicide they are often offended, shocked, and upset by the question. “Why would you ask that!?” It’s a shocking, but important question to ask. “Have you made plans to kill yourself?” “Are you planning on killing yourself?” Get comfortable with the uncomfortable. These questions are important life savers.
It is not your responsibility to fix the problem, but it is everyone’s responsibility to get help for someone who is thinking of killing themselves. “I’m here for you. Let’s find you help.”
Not in Immediate Danger: Mental health concern, but has not expressed they may kill themselves
Most health insurances have Employee Assistance Programs. These programs have the ability to connect individuals who are struggle at any stage with mental health to trained professionals.
Offer to go to an appointment with them.
Suggest they talk to a loved one, friend or family member. The more support the better.
Immediate Danger: Someone who has confirmed or you highly suspect may kill themselves
Stay with the person.
If you are not with them stay on the phone, keep texting/messaging, and find out their location by keeping them engaged with you in the conversation. Do not hang up or stop the conversation. Get all the information you can and keep telling them you are there for them, you care and that with the right help what they are feeling is treatable.
Getting Information into Your Hospital
One of the best ways to get information into your hospital is to hold an in-person meeting about mental health and suicide prevention. Hire a licensed social worker, counselor, or therapist to facilitate the discussion. There are also plenty of online classes, TED talk videos or other resources on how to have a healthy conversation around such a difficult topic. QPR Training is an excellent free training that hospitals can require their teams to take. It is centered around educating individuals on how to approach someone to talk about mental health and suicide. The link to this training is HERE as well as in the resources listed below.
Consider creating a one-page poster that contains information around suicide prevention. Place the life-saving poster in the bathroom. The bathroom is a great place to post the information because if someone needs the information, they can gather it in private. There is no judgement from others in a bathroom. If someone needs information on how to start a conversation about mental health or suicide the poster is there for them. And for those who have never considered they may one day need information on how to talk about suicide, the poster will be in their face and unavoidable.
I’m proud of my hospital group Veterinary Emergency Group (VEG) for creating such a poster to be displayed in their hospital’s bathrooms. VEG has allowed their poster to be included in this blog to serve as an example of how to create such a poster for your own hospital. Click the below PDF link to view the poster so you can start creating your own.
Better yet, CEO and founder David Bessler got uncomfortable and addressed the issue of suicide to the employees, also known as VEGgies, in a video message to them. You can view his message HERE. It’s important that all hospitals and companies start getting a little uncomfortable so we can become more comfortable on the subject of mental health and suicide. By leadership initiating the conversation it gives permission to follow.
Now more than ever is the time to talk about suicide prevention and mental health in our hospitals. Too often I see hospitals hang up posters or send out a website, but that’s where the resources end. To get this information out there and for everyone to be more comfortable we need to talk about it. It needs to be discussed face to face at meetings in our hospitals. These conversations are just, if not more, important than a conversation on the continued staffing shortage or the fact that there was an increase in client complaints. Have these conversations and center education around mental health throughout the year. A one-time meeting isn’t going to make an impact. Be brave, be heroic. Step into the uncomfortable so we can save lives. Below is a list of resources to empower and educate you around this very important topic.
National Suicide Prevention Lifeline: 1-800-273-TALK (8255): https://suicidepreventionlifeline.org/
Crisis Text Line’s Text Number: Text HOME to 741741 to be connected to a Crisis Counselor who will help them or find help for them: https://www.crisistextline.org
QPR Training: https://qprinstitute.com/
Mental Health First Aid: https://www.mentalhealthfirstaid.org/
National Prevention Suicide LifeLine: https://suicidepreventionlifeline.org/
National Institute of Mental Health: https://www.nimh.nih.gov/health/topics/suicide-prevention
CDC Workplace Health Resource Center: https://www.cdc.gov/workplacehealthpromotion/index.html
Not One More Vet: https://nomv.org/
Coping with Stress & Burnout in Vet Med Book: Buy on Amazon