Tag Archives: suicide prevention

Men and mental health

In my practice, the majority of my clients are male. Overall, three times as many men as women die by suicide, according to a World Health Organization (WHO) comprehensive report from 2018. The American Foundation for Suicide Prevention also cited 2018 data, similarly noting that in that year alone, men died by suicide three and a half times more often than women in the United States.

Mental Health America, a community-based nonprofit, collected data suggesting that more than 6 million men in the U.S. experience symptoms of depression each year, and more than 3 million experience an anxiety disorder. Despite these figures, the National Institute of Mental Health (NIMH) reported that men are much less likely than women to have received formal mental health support.

In a study from Canada, published in the Community Mental Health Journal, in 2016, more than one-third of the participants in the study admitted to holding stigmatizing beliefs about mental health issues in men. Significantly more male than female respondents said that they would feel embarrassed about seeking formal treatment for depression.

BIPOC men face additional challenges when it comes to looking after their mental health. According to the American Psychological Association (APA), in the U.S., Black and Latinx men are six times more likely to be murdered than their white peers. Indigenous American men are the demographic most likely to attempt suicide in this country and Black men are most likely to experience incarceration, based on statistics gathered by the American Psychological Association. The consequences of these disparities on the mental health of people of color and of diverse ethnic and racial backgrounds is exponentially challenging.

Depression symptoms often manifest differently in men than women, perhaps based on these disparities. Some men with depression hide their emotions, and may seem to be angry, irritable, or aggressive, while many women may seem overtly sad or express sadness verbally.

For men, some symptoms of depression are physiological, such as a racing heart, digestive issues, muscle tension, bodily aches and pains, or headaches, and men are more likely to see their doctor about physical symptoms than emotional symptoms. Additionally, self-medicating with alcohol and other substances can be a common symptom of depression among men and that this can exacerbate mental health problems and increase the risk of developing other health conditions.

It is not easy for men to be open with others about mental health struggles. In fact, many of the male patients that I see have never spoken about their struggles until they come to my office, often not until they have experienced dire difficulties. Often, their pain is palpable.

As a mental health community, and as a society, we have to teach men to not mask their emotions. Instead, we need to encourage men to speak up, not man up. Talking saves lives; let’s normalize mental health.
(statistics from the American Psychological Association and NIMH). 

Indigenous Americans, youth, and mental health.

Indigenous/tribal communities face significant behavioral health challenges and disparities. For Indigenous Americans, multiple factors influence health outcomes, including historical trauma and a range of social, policy, and economic conditions such as poverty, under-employment, lack of access to health care, lower educational attainment, housing problems, and violence.

These disparities have important consequences. Suicide is the second leading cause of death among Native American youth ages 8 to 24. Also, while there is general awareness that Native Americans experience higher rates of alcohol and substance use, the scope of these behavioral health problems is not fully understood.

With 564 federally recognized American Indian and Alaska Native (AI/AN, is the designation currently used by the Census Bureau) tribes, 100 state recognized tribes, and over 200 languages, there is a great need for the development of mental health programs aimed at AI/ANs that center culture as a dominant aspect of treatment. The deficit in culturally relevant treatment programs aimed at Indigenous Americans people living with mental illness is glaring. These communities cope with intergenerational trauma which has a historical context, occurring when exposure to trauma takes place in an earlier generation and continues to affect subsequent generations. The stress of intergenerational trauma contributes to the erosion of family structure, tribal structure and even spiritual ties. It can affect one’s identity, relationship skills, personal behavior, transmission of traditions and values, and attitudes and beliefs about the future. The stress of these traumas combined with the complex and ongoing mistreatment of AI/AN citizens contributes to the rates of mental illness in AI/AN communities and can manifest in a high rate of substance abuse disorder, PTSD, anxiety and depression.

Additional stressors such as a lack of access to health insurance, pervasive poverty and unemployment, and higher suicide rates exacerbate these issues.

I have compiled this list of resources for indigenous clients. Please note that the hours of availability may have changed, but they are all in service at the present time.

Mental Health Resources For Native And Indigenous Communities:
–  Indigenous Story Studio creates illustrations, posters, videos, and comic books on health and social issues for youth.

–  Suicide prevention.
–  National Alliance on Mental Illness.
–  One Sky Center: The American Indian/Alaska Native National Resource Center for Health, Education, and Research; mission is to improve prevention and treatment of mental health and substance use problems and services among Native people.
–  WeRNative: a comprehensive health resource for Native youth by Native youth, promoting holistic health and positive growth in local communities.
–  Ask Auntie: similar to an advice column – type in your question and it will pull up similar ones; if none answer what you’re asking, Auntie Amanda will write up an answer and notify you when it is posted.
–  StrongHearts Native Helpline: The StrongHearts Native Helpline (1-844-762-8483) is a confidential and anonymous culturally-appropriate domestic violence and dating violence helpline for Native Americans, available every day from 7 a.m. to 10 p.m. CT.

How to help a loved one who is having mental health problems

We all go through tough times and people help us through them. Other times we have been worried about other people’s mental health. Whether they are a friend, family member, significant other, neighbor, or colleague, there are many ways to support somebody you care about.

1 in 6 people experienced a common mental health problem such as anxiety or depression in the past week.

Talking about mental health
If you are worried about someone it can be difficult to know what to do. When you are aware there is an issue, it is important not to wait. One of the saddest components of depression is that it is immobilizing. You can simultaneously know that you desperately need help, and have absolutely no energy or desire to seek it.

Waiting and hoping others will come to you for help might lose valuable time in getting them support. Openly talking with someone is often the first step to take when you know they are going through a hard time. This way you can find out what is troubling them and what you can do to help.

Eight tips for talking about mental health:

  1. Set time aside with no distractions. It is important to provide an open and non-judgemental space.
  2. Let them share as much or as little as they want to. Let them lead the discussion at their own pace. Don’t put pressure on them to tell you anything they aren’t ready to talk about. Talking can take a lot of trust and courage. You might be the first person they have been able to talk to about this.
  3. Don’t try to diagnose or second guess their feelings. You probably aren’t a medical expert and, while you may be happy to talk and offer support, you aren’t a trained counsellor. Try not to make assumptions about what is wrong or jump in too quickly with your own diagnosis or solutions.
  4. Keep questions open ended. Say “Why don’t you tell me how you are feeling?” rather than “I can see you are feeling very low”. Try to keep your language neutral. Give the person time to answer and try not to grill them with too many questions.
  5. Talk about wellbeing. Exercise, having a healthy diet and taking a break can help protect mental health and sustain wellbeing. Talk about ways of de-stressing and ask if they find anything helpful.
  6. Listen carefully to what they tell you. Repeat what they have said back to them to ensure you have understood it. You don’t have to agree with what they are saying, but by showing you understand how they feel, you are letting them know you respect their feelings.
  7. Offer them help in seeking professional support and provide information on ways to do this.
  8. Know your limits. If you believe they are in immediate danger or they have incurred injuries that need medical attention, you need to take action to make sure they are safe. More details on dealing in a crisis can be found below.

How do I respond in a crisis?

People with mental health problems sometimes experience a crisis, such as breaking down in tears, having a panic attack, feeling suicidal, or experiencing a different sense of reality (dissociation). This may include even losing a sense of time and place. You may feel a sense of crisis too, in response, but it’s important to stay calm yourself.

There are some general strategies that you can use to help:

    • Listen without making judgements and concentrate on their needs in that moment.
    • Ask them what would help them.
    • Reassure and help point them to practical information or resources.
    • Avoid confrontation.
    • Ask if there is someone they would like you to contact.
    • Encourage them to seek appropriate professional help.
    • If they have hurt themselves, make sure they get the first aid they need.

Seeing, hearing or believing things that no-one else does can be the symptom of a mental health problem. It can be frightening and upsetting. Gently remind the person who you are and why you are there. Under extreme stress, people can dissociate. Don’t reinforce or dismiss their experiences, but acknowledge how the symptoms are making them feel.

How do I respond if someone is suicidal?
If someone tells you they are feeling suicidal or can’t go on, or if you suspect they are thinking of taking their own life, it is very important to encourage them to get help.

National Suicide Prevention Lifeline
Hours: Available 24 hours. Languages: English and Spanish
1-800-273-8255

COLLEGE STUDENTS AND MENTAL HEALTH

According to 2018 and 2019 student surveys from the American College Health Association (ACHA), about 60% of respondents felt “overwhelming” anxiety, while 40% experienced depression so severe they had difficulty functioning.

A 2019 Pennsylvania State University study noted that demand for campus mental health services increased by 35-40% during a period that saw only a 5% increase in enrollment.

Anxiety and depression represent only some of the prevalent mental health issues experienced by college students. Others include serious problems like suicide, eating disorders, abusive relationships, and addiction. Mental health professionals stress the importance of talking about such issues, but students may lack the time, energy, will, and/or money to seek the support they need. Outreach and education are vital.

DEPRESSION
Here are some signs of depression to look for in friends:
They are not enjoying activities they once loved
They no longer attend classes or social outings are experiencing extreme anger or sadness over a relationship in their life
They react negatively or with apathy to most things
They often talk about death or suicide

Words of encouragement show your friend you are a source of support. Avoid telling your friends to “cheer up” or “snap out of it.” Many people experiencing depression are aware of their condition, and telling them to get over it is not helpful.

If you feel your friend is at risk, gently encourage them to seek help and offer to accompany them to a student health center or a doctor’s appointment. While talking through their issues with you may be helpful, it is not a substitute for treatment.

People who have depression often feel as if they are alone and have no one to turn to. But it’s important to understand that isn’t the case, as people care and want to help. People with depression also have resources at their disposal that they may not know about.

For example, the following organizations are dedicated to providing resources for those living with depression.

ANXIETY AND DEPRESSION ASSOCIATION OF AMERICA
This organization promotes the prevention, treatment, and cure of anxiety, depression, and related disorders. Its website offers insight into understanding depressive mental illnesses, provides links for those seeking help, and identifies mobile apps designed to help people living with depressive illnesses.

ULIFELINE
This online resource is for college students seeking mental health wellness. It provides tips on how to help friends in crisis and ideas for developing better wellness habits.

AMERICAN COLLEGE HEALTH ASSOCIATION
ACHA promotes healthy campus communities and is a principal leadership organization for advancing the health of college students. The organization’s website provides helplines, brochures on different types of depression, and external links.

THE JED FOUNDATION
This foundation offers online resources designed to promote emotional health and prevent suicide among college students.

HELP A FRIEND IN NEED
This initiative identifies warning signs through social media. The Half of Us campaign promotes mental health awareness nationally through on-air and live events and connects students with healthcare providers.

ANXIETY DISORDERS
Your friend may have an anxiety disorder if they display these behaviors:
Have experienced a tragic event and do not develop healthy coping habits
Appear to live in constant fear of failure — academically or socially
Are uncomfortable and extremely anxious in social atmospheres
Have trouble concentrating or seem to have a blank mind
Seem plagued with guilt or stress
Have visible panic attacks

Avoid criticizing or belittling the severity of your friend’s symptoms and encourage them to try coping strategies that avoid causing further anxiety. Encourage your friend to visit a campus healthcare or counseling center and discuss their troubles with a professional. With their permission, you might be able to contact their parent. Some of the college student referrals I receive come from friends and roommates who got worried and told their friend’s parents about their concerns.

The following organizations are excellent resources for students with anxiety disorders.

ANXIETY AND DEPRESSION ASSOCIATION OF AMERICA
ADAA promotes the prevention, treatment, and cure of anxiety, depression, and related disorders. The association’s website offers insight into how to better understand depressive mental illnesses. Additionally, it suggests several mobile apps that cater to users with depressive illnesses.

AMERICAN PSYCHOLOGICAL ASSOCIATION
APA is dedicated to advancing the creation, communication, and application of psychological knowledge to benefit society. Its website offers insight into the differences between anxiety disorders and depression, as well as tools to help you locate a psychologist.

ANXIETY RESOURCE CENTER
ARC is a nonprofit dedicated to offering assistance to those who have anxiety disorders. Its website features a lengthy list of education materials, a newsletter, and a blog to help visitors stay updated on breakthroughs in research and trends.

SOCIAL ANXIETY ASSOCIATION
This nonprofit maintains resources for people with social anxiety. Its website provides links to support groups, information on how to find health professionals, news and updates on the disorder, and extensive information on treatment options.

STUDENTS AND SUICIDE
Suicidal people may talk about feeling trapped, feeling as if they are a burden to others, feeling like they have no reason to go on, and ending their lives.

What to watch for if you feel your friend or roommate is at risk:
If a person talks about:
Being a burden to others
Feeling trapped
Experiencing unbearable pain
Having no reason to live

Specific behaviors to look out for include:
Increased use of alcohol or drugs
Looking for a way to kill themselves, such as searching online for materials or means
Acting recklessly
Withdrawing from activities
Isolating from family and friends
Sleeping too much or too little
Visiting or calling people to say goodbye
Giving away prized possessions
Aggression

People who are considering suicide often display one or more of the following
Depression
Loss of interest
Rage
Irritability
Humiliation
Anxiety

ADAA recommends these steps to take if you suspect someone you know is suicidal:
Ask them directly, “Are you considering killing yourself?” This may seem blunt. However, according to ADAA, studies show that this question does not increase the likelihood of suicidal thoughts, and it’s an important foundation for the next steps.

Make safety a priority. If they answer positively to step one, ask them if they have a plan. While it may not be easy, removing lethal objects and items in the dorm or home, such as guns, can also make a big difference.

Be there for them. Sometimes the most you can do for someone is simply to be there for them when they need you. Listen to what they have to say. Acknowledge and talk to them about the realities of suicide. According to ADAA, this can reduce suicidal thoughts.

Give them the tools to help themselves. Save the National Suicide Prevention Lifeline’s number — (800) 273-8255 — in your phone. If possible, also save this number in your friend’s phone.

Remain in contact. Staying in contact makes a big difference and can potentially save the life of an at-risk person.

On Grief and Grieving

Loss is a universal experience. Grieving takes many forms.

Many people truly want to help a friend or family member who is experiencing a severe loss. Words often fail us at times like these, leaving us stammering for the right thing to say. Some people are so afraid to say or do the wrong thing, they choose to do nothing at all. Doing nothing at all is certainly an option, but it’s not often a good one.  While there is no one perfect way to respond or to support someone you care about, here are some good ground rules.

Grief belongs to the griever.
Grief is personal.  You have a supporting role, not the central role, in your friend’s grief. This may seem like a strange thing to say. So many of the suggestions, advice and “help” given to the griever tells them they should be doing this differently, or feeling differently than they do. Grief is a very personal experience, and belongs entirely to the person experiencing it. You may believe you would do things differently if it had happened to you. We hope you do not get the chance to find out. This grief belongs to your friend: follow their lead.

There is no timeline.  And grief is not linear.
Everybody has their own time frame for grief. There are no rules and there is no need for them.  Some people describe waves of pain. Some people don’t think about it until there is a reminder. Often, there are anniversary reactions on important dates that elicit memories.  As a therapist I have found that many people have a deep fear of forgetting.  When they want to speak about their loss or their relationship with a loved one, give them the space to do so.

There is culture, and there is personal culture
From wanting to be quietly alone, to craving the presence of loved ones. Wanting to talk. And not.  Crying, or not.  Wanting to talk about spirituality and loss is also personal.  There is no formula.

Stay present and state the truth.
It’s tempting to make statements about the past or the future when your friend’s present life holds so much pain. You cannot know what the future will be, for yourself or your friend — it may or may not be better “later.” That your friend’s life was good in the past is not a fair trade for the pain of now. Stay present with your friend, even when the present is full of pain.

It’s also tempting to make generalized statements about the situation in an attempt to soothe your friend. You cannot know that your friend’s loved one “finished their work here,” or that they are in a “better place.” These future-based, omniscient, generalized platitudes aren’t helpful. Stick with the truth:  this hurts. I love you. I’m here.

Do not try to fix the unfixable.
Your friend’s loss cannot be fixed or repaired or solved. The pain itself cannot be made better.  Do not say anything that tries to fix the unfixable, and you will do just fine. It is an unfathomable relief to have a friend who does not try to take the pain away.

Be willing to witness searing, unbearable pain. 
To do so, while also practicing  the above is very, very hard.

This is not about you.
Being with someone in pain is not easy. You will have things come up — stresses, questions, anger, fear, guilt. Your feelings will likely be hurt. You may feel ignored and unappreciated. Your friend cannot show up for their part of the relationship very well. Please don’t take it personally, and please don’t take it out on them. Please find your own people to lean on at this time — it’s important that you be supported while you support your friend. When in doubt, refer to #1.

Do not impose your personal spirituality or religious beliefs on another.
I believe in prayer and spirituality.  My beliefs are highly personal. Telling somebody that you will be reunited in a better place and how a loved one is in a better place may not be helpful. Let them guide you.

Anticipate, don’t ask.
Do not say “Call me if you need anything,” because your friend will not call. Not because they do not need, but because identifying a need, figuring out who might fill that need, and then making a phone call to ask is light years beyond their energy levels, capacity or interest. Instead, make concrete offers: “I will be there at 4 p.m. on Thursday to bring your recycling to the curb,” or “I will stop by each morning on my way to work and give the dog a quick walk.” Be reliable.

Do the recurring things.
The actual, heavy, real work of grieving is not something you can do (see #1), but you can lessen the burden of “normal” life requirements for your friend. Are there recurring tasks or chores that you might do? Things like walking the dog, refilling prescriptions, shoveling snow and bringing in the mail are all good choices. Support your friend in small, ordinary ways — these things are tangible evidence of love.

Please try not to do anything that is irreversible — like doing laundry or cleaning up the house — unless you check with your friend first. That empty soda bottle beside the couch may look like trash, but may have been left there by their husband just the other day. The dirty laundry may be the last thing that smells like her.  I have a strand of hair from a loved one from years ago, carefully wrapped.   Do you see where I’m going here? Tiny little things become precious. Ask first.

Tackle projects together.
Depending on the circumstance, there may be difficult tasks that need tending — things like casket shopping, mortuary visits, the packing and sorting of rooms or houses. Offer your assistance and follow through with your offers. Follow your friend’s lead in these tasks. Your presence alongside them is powerful and important; words are often unnecessary. Remember to bear witness and be present.

Run interference.
To the new griever, the influx of people who want to show their support can be seriously overwhelming. What is an intensely personal and private time can begin to feel like living in a fish bowl. There might be ways you can shield and shelter your friend by setting yourself up as the designated point person — the one who relays information to the outside world, or organizes well-wishers. Gatekeepers are really helpful.

Respect privacy and boundaries.
In the event of loss, and faced with our own mortality, one of the first questions we ask is: what happened?  We have a need to search for and find meaning. Again, this is not about us. What someone chooses to tell us, or others, is up to them.

Educate and advocate.
You may find that other friends, family members and casual acquaintances ask for information about your friend. You can, in this capacity, be a great educator, albeit subtly. You can normalize grief with responses like, “She has better moments and worse moments and will for quite some time. An intense loss changes every detail of your life.” If someone asks you about your friend a little further down the road, you might say things like, “Grief never really stops. It is something you carry with you in different ways.”

Love.
Above all, show your love. Show up. Say something. Do something. Be willing to stand beside the gaping hole that has opened in your friend’s life, without flinching or turning away. Be willing to not have any answers. Listen. Be there. Be present. Be a friend. Be love. Love is the thing that lasts.

Sources and resources:
https://www.refugeingrief.com/blog/
https://suicidepreventionlifeline.org

Scattering CJ: A New Documentary on Mental Health Awareness

This weekend is the world premiere of Scattering CJ, an important new documentary on mental health and suicide awareness, scheduled to coincide with National Suicide Prevention Week and Suicide Awareness Month.

It’s heartwarming to see this important topic get a bit more attention. Speaking of which,  The American Foundation for Suicide Prevention did a feature on the film and the filmmakers Andrea Kalin and David Lobatto,

Could you tell us about your documentary “Scattering CJ”? What is it about, and what initially interested you in telling this story?

“Scattering CJ” follows the amazing story of Hallie Twomey, a heartbroken mom from Maine who lost her elder son CJ to suicide in 2010. To honor CJ’s memory and his love of travel, Hallie put a request out on social media for help in scattering his ashes in as many places of beauty and meaning as possible.

Hallie’s request resonated beyond her wildest dreams, fostering a worldwide community across social media that was galvanized to scatter CJ’s ashes in a thousand different locations, and accompanied by a vast array of stunning imagery and moving testimony. The “Scattering CJ” initiative raised awareness about suicide, and encouraged support among the many people following the project, many of whom had been affected by suicide or struggled themselves.

The overwhelming response Hallie received from strangers from around the globe has been a massive part of her family’s healing journey.

Our belief in this inspiring, profoundly moving story’s capacity for positive social change — and its need to be seen by the widest audience possible — is what has driven us in making this film.

In what ways has your understanding of mental health and suicide changed or been impacted by your working on the film? Did anything surprise you?

We went into this with some intellectual understanding of suicide, and we’d seen the statistics. What those numbers don’t reveal, and what making the film has laid bare to us, is that for every one person who takes their own life there are countless others who are seismically affected by that action and the subsequent absence of that person in their lives. This effect needs a spotlight as much as the death itself, because loss is often a trauma with lifelong repercussions. An unpleasant but eye-opening surprise for us was the number of people involved in the making of the film and its outreach who have lost someone close to them to suicide. It seems that everyone knows someone affected.

Read more here

Scattering CJ (Extended Trailer) from Spark Media on Vimeo.

Can We Talk About Suicide?

I really struggled with this blog post. I first sat down to write it weeks ago, in anticipation of Mental Health Awareness Month. But it was hard and I was busy with so many other things, and so I kept putting it off.

Suicide is something that’s so hard to talk about, often even for mental health professionals. But it is absolutely essential to have the conversation.

And so, if we’re going to talk about suicide, let’s start with some stark facts.

Suicide is the 10th leading cause of death in the United States across all ages.

There is one death by suicide in the US every 12 minutes.

An estimated quarter million people every year are suicide survivors.

There is one suicide for every 25 estimated attempts.

Suicide is the second leading cause of death in the world for those aged 15 through 25.

Lesbian gay and bisexual kids are three times more likely than straight kids to attempt suicide at some point in their lives.

Females are more likely than males to have suicidal thoughts.

African-American, Latino,  Asian-American, and Native American individuals who are lesbian, gay, transgendered, or bisexual have the highest rates of suicide.

Suicide rates among the elderly are highest for those who are divorced or widowed.

Males over 50 have the biggest increase in suicide rates in recent years.

*****

If you, or someone that you know is experiencing suicidal thoughts, please contact National Suicide Prevention Lifeline: 1-800-799-4889 or 1-800 Suicide. Another great resource is 211 for essential community services,  including disaster assistance, utilities jobs and support for veterans, housing, meal plans.

Sources: Center for Disease Control (CDC); National Institute of Mental Health (NIMH); National Alliance on Mental Illness (NAMI).

 

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