Scott Webb (Host): Suicide is not an easy topic to discuss, but I'm going to do that today with Sarah Bemish. She's an advanced practice registered nurse (APRN) who specializes in general psychiatry with the Elliot Hospital, and a point of emphasis in our conversation today is going to be on how we can offer hope to those who may be feeling like suicide is the only answer. 

Host: This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Sarah, thanks so much for your time today. We're going to talk about suicide, which is sometimes a difficult conversation to have. And certainly, we don't want folks listening if they don't feel prepared to listen to it today. Maybe it's something they come back to later. And as I mentioned to you, you know, suicide has touched my life recently, so I have a different sort of perspective on things, a different sort of level of understanding, unfortunately.

And I'm really appreciative to have your expertise today. So, let's just start here. How prevalent is death by suicide and how much should we be concerned about this?

Sarah Bemish: Yeah. Thanks so much for having me on this program, Scott. It's a really important topic. And as you mentioned, I mean, it touches so many lives, more than people realize, and the Center for Disease Control and Prevention has actually done a lot of statistics, and they've looked at a lot of the numbers, and it's much more prevalent than many people might realize. 

In 2021, 48,183 people ended their lives by suicide, which is a pretty significant number. And overall, the number of deaths from 2021 to 2022 actually increased by 2.6%. So, it's a real concern. It's something to really be aware of, and there's a fair amount of organizations that have started working on addressing some of the concerns and where this might stem from, and how we might be able to help. 

Just to give kind of a broad understanding, it's 12.3 million people seriously contemplated ending their life by suicide. And 3.5 million people actually had a plan to make that happen; 1.7 attempted to follow through with that plan that they had actually made. So, just to kind of give a grasp of how significant death by suicide is, the last statistics done by the Center for Disease Control and Prevention indicated that it was the second leading cause of death for individuals 10 to 34. It's the third leading cause of death for individuals 35 to 44 years old. For those who are 45 to 54, it's actually the fourth leading cause of death. And it's the seventh for those 55 to 65. It's the 17th leading cause of death for those over 65, but that's generally because individuals who are over 65 tend to have so many other medical concerns. Individuals who are over 85 are actually at the highest risk for ending their lives by suicide.

We can identify individuals that are more at risk for this. There is hope, there are things that we can do. There are resources out there. So, being able to talk about this may help individuals get help, but it may also help others recognize that somebody may need some help and may not necessarily feel like they can talk about it. 

Host: Yeah. We're definitely going to do that. And I think that there's this sense, and I'd say this just anecdotally, I don't have any scientific evidence behind this, but it feels like many of us think or feel that once somebody reaches that point in their lives, that there's not much that can be done. That we can't prevent people from attempting suicide. And I think, you know, speaking for you and having spoken to other experts, that's probably not true, that there's a lot we can do. But I think we need to start by talking about the populations or groups of individuals that we should be more concerned about, right? Having a sense, I guess, Sarah, from you of what to be on the lookout for, who to be listening more carefully to, and so on. So, let's talk about populations and groups of individuals that we should just be more concerned about. 

Sarah Bemish: For individuals that are 10 to 34, it tends to be the second leading cause of death. But those who are over 85 are actually more at risk and have the highest rate of ending their life by suicide. When you look at males versus females, males tend to complete suicide more than females. But if you're looking at the statistics of individuals who attempt to end their life, it's about equal. More individuals have ended their lives by firearms than any other means, but looking at death by poisoning, cutting, they're also pretty high up there, but ending one's life by firearms is usually the most common means. 

People who are first responders, military members, veterans, people who live in high-stress situations or have high-stress jobs, all tend to have higher rates of suicide as well. If you have high stress for a long period of time, that can really cause a lot of increased risk. More medical conditions, feeling overwhelmed, being isolated, not getting enough sleep, and whether that's related to work or medical conditions or the high stress that you have, that can really exacerbate the increased risk for suicide as well. Add on to that, if someone tends to be a little bit more isolated, that can certainly increase one's risk as well because those individuals tend to feel a little bit more overwhelmed and may not necessarily feel like they can problem solve as well, or may not be able to problem solve on their own as well.

 And, you know, one of the things, Scott, that we see a lot in the field of mental health is individuals try and process through some of the depression, the anxiety, mood dysregulation that some people may have. A lot of times, people may not know where to turn to, and so they may turn to different substances because it may help them feel better initially, right? I mean, that's one of the things that we see with some individuals. But what people don't realize is that if it helps them feel better initially, one of the things that we see happen is substances can actually increase your risk as well. Whether it's while the substance is active in your system, that can sometimes increase your risk. Or if you're going through the withdrawal when it's not quite so active, that can sometimes increase your risk too.

 Host: Let's talk then about some of the ways that we can both decrease the risk for suicide, and most importantly, as you were saying earlier, increase hope for those who may be feeling suicidal ideation, that that's their only option, whether it's ourselves, loved ones, friends, whomever. How can we decrease the risk and increase hope?

 Sarah Bemish: I typically like to focus on five things that really we can identify and increase hope. And the first one is recognizing it. Sometimes it's pretty evident. People may start saying that they're not sure that they want to live anymore. They might make statements about wanting to end their lives. They may make statements that are a little bit more subtle,"I'm feeling overwhelmed. Nothing else can be done. It's not worth it." Sometimes individuals may say that they're feeling hopeless or trapped, or they may start talking about medical concerns that could be coming up, and they just feel like nothing's being done, or even saying that they feel like they've got no purpose left in life. One of the things that we also see is that they just kind of quietly withdraw to the background and don't really socialize or interact with other people at all. And that's one of the things that we see. They might start sleeping less. They might start drinking alcohol a little bit more or whatever they may do just to help kind of numb the pain that they're experiencing.

 The second thing besides recognizing it, is talking about it, right? One of the big myths that's out there regarding suicide is that if I talk with somebody about suicide, they're going to be more likely to engage in suicide. But the real truth, Scott, is that if you're talking with somebody about suicide, they may feel like they are struggling with this on their own. And when you ask them if that's something that has been on their mind, it invites them to share, "Yeah, I'm struggling. This is really hard," and they may be able to talk about it. It gives them the opportunity to talk about it when they otherwise wouldn't.

And then, being able to problem solve. If you can get them to be able to talk about it, maybe we can problem solve, find out what's going on. There are so many reasons out there people can come up with. "Why did it happen?" That's one of the biggest things that many people kind of struggle with after someone that they love has ended their life by suicide, is the whys, right? And you could try and find out what the why is, what the truth is, that there's no one thing you can pinpoint for the why's. Sometimes, it's feeling more isolated or overwhelmed. Sometimes, it's the stress that somebody's feeling. Being able to try and reduce some of that stress or getting them connected to a medical provider that might be able to say, "Hey, I know that all of these have been really overwhelming for you as far as a medical concern goes. Let's see if we can work through it."

Developing a safety plan is the fourth one that I often talk with people about. Safety plans are, "Let me sit down, talk with you, and let's talk about what some things might be to help." Especially if you know someone's feeling a little bit overwhelmed or hopeless, sometimes if they're in that frame of mind, they might not be able to think about, "Oh, I know when I've called this person, it's helped me feel better. If I've gone to this particular location, it's helped me be in a better space. If I've worked on this activity, that helps decrease stress, that helps me feel a little bit better." Sometimes sitting down and talking with somebody about what a safety plan might be when they're feeling in that space can be helpful for them. Sometimes, if you know that an individual is more likely to end their life by suicide, being able to remove some of those access to means of suicide. As I mentioned earlier, individuals tend to end their lives by suicide with firearms the most, so being able to get the firearms out of the house. If there's concern that someone might overdose on medications, being able to have those locked up or have a loved one hold onto them and make sure they're still getting the medicine that they need, but maybe not have all access to the medication. 

And the fifth one, this is a really important one, is being able to offer hope. When you're talking with somebody and you're able to engage them in a conversation in a way that you can say, "I care about you. You mean enough to me that I want to sit down, and I want to talk with you about this, and I want to be able to identify some things that will help. Let's see if we can work on this together." Just having that connection and being able to talk about that can make a huge difference.

 Host: Yeah, definitely. And things like we're doing today, right, Sarah? Just having these conversations, right? Saying the word suicide out loud is not going to push someone, we don't believe anyway, to attempt suicide successfully or otherwise, that we need to educate, we need to talk, we need to connect. I'm sure we all needed that during COVID, and we could probably do an entirely separate podcast on just how bad COVID was for people who were feeling trapped and isolated and disconnected from people in the world. I mentioned earlier that one of the things we want to do today is to share some resources, right? We want people turning to the right people, the right resources. Let's do that here at the end. Let's share some resources for either folks who may be feeling overwhelmed or depressed or if they know of family members and friends that they could sort of maybe subtly or not so subtly share these resources with them. What can we give them today? 

Sarah Bemish: Being able to connect with the community really is huge. Primary care provider, being able to connect with the school nurse or a counselor for those kids between the ages of 10 to 18 that are still in school, and for them to be able to say, "I'm really worried. I'm really struggling. This is what's going on." Or being able to connect with somebody who specializes in helping individuals struggle with mental illness, anxiety, depression, feeling overwhelmed, and those mood dysregulations. Sometimes a primary care provider's office can help someone get connected to the specialization services. Many times, individuals are looking for, "Where can I find somebody that helps specialize in someone that is struggling with depression?" Insurance companies often have resources that they can offer to individuals to help with that.

There's another website not affiliated financially with them, but PsychologyToday.com is a great resource because it lists a lot of counselors and psychiatric care providers. You can actually see a picture of a lot of these individuals and how they work. The National Alliance for Mental Illness, I love their website and here's why. They have a list of access for resources for peer supports for family members whose loved ones have attempted or completed suicides. They actually have support groups and links for those support groups right on that website, which can be great because a lot of times after someone has attempted to end their lives or you have someone in your life that you love dearly who has completed it, having resources, having individuals that have also struggled through it can be really helpful just to be able to connect with that. And you may not necessarily be able to find the answers why, but having that support around, "All right. Where do we go from here," can be really helpful. What I also like about their website is that they actually have links on how to talk with someone about suicide. A lot of times, what individuals will struggle with is, "How do I talk to my teenager about suicide? Sometimes, I can't even get them to come out of their room and be able to talk with them."

Host: Yeah, I have a 15-year-old, so I understand completely. I can't find anything to talk her about where I am not the bad guy in that conversation, right? 

Sarah Bemish: Right. And so, one of the struggles is like, "How do I talk with them about this, what seems like a nebulous topic?" And they actually have some resources and guides right on the National Alliance for Mental Illness website that you can click on, and it goes through each of the different age groups on some resources as far as that goes, because you're going to talk with someone who's 10 to 13 a little differently than someone 13 to 16 and so on. So, that website is actually NAMI, N-A-M-I, newhampshire.org, and it's a really great resource for individuals, whether they're looking for support groups from themselves, whether they're looking for, "How do I talk with somebody?" It's a great website. 

And the really important number that I really wanted to mention is 988. And they have somebody ready and waiting to talk with you. If you're hard of hearing, they've got somebody to talk with you in that regard. Last I checked, they had over 250 different languages that they could have for translation 24/7, whether you're having thoughts of not wanting to live anymore. If you're in a crisis, they have trained professionals who are ready and waiting to be able to talk with you. 

Host: Well, as I told you, Sarah, prefaced today that, you know, unfortunately, suicide has touched my life recently, and I really appreciate this today, both professionally, of course, as the host of the podcast, but also personally. I feel like we could talk all afternoon. But I really appreciated this today. Nice to meet you; nice to have this conversation. And you stay well.

 Sarah Bemish: Likewise, Scott.

 Host: And for more information on mental health services at the Elliot Hospital, go to elliothospital.org and search behavioral. and if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well, and we'll talk again next time.