Transcription:
Suicide Prevention

Prakash Chandran (Host): Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This episode is sponsored by UM Upper Chesapeake Health. Through an unparalleled combination of high quality care and leading edge technology, UM Upper Chesapeake is improving the health of northeastern Maryland residents by providing an exceptional patient experience for every person, every encounter, everyday. Today's topic is suicide prevention. I'm Prakash Chandran. And my guest today is Jennifer Redding, the Executive Director of Behavioral Health at UM Upper Chesapeake Health.

Jennifer, thank you so much for joining me today. You know, it's a heavy topic. I think that most people know what suicide is, but maybe you can talk to us a little bit about what the official definition is and tell us a little bit more about why it happens.

Jennifer Redding, LCSW-C (Guest): Sure, thanks for having me today. Suicide is death caused by injuring oneself with the intent to actually die. The question of why it happens is much more complicated than the definition. There's no one real answer. It's typically a number of situations or occasions, but just to give you a brief summary of some of the main reasons individuals think about committing suicide and actually follow through. The first is having a severe depression or any other mental illness that, you know, there is a brain chemistry disruption and individuals are experiencing depression and that in and of itself can lead to feel like life is not worth living anymore, to feel hopeless. Another reason why someone might contemplate killing themselves is a chronic or a traumatic stress.

So, I don't know if your audience is familiar with adverse childhood experiences, or ACEs, but really anything that was as traumatic for a child. So, whether that was child abuse, domestic violence within their home, having a parent or a caregiver who was using or abusing substances, those are some examples of ACEs, being sexually assaulted or being a combat veteran. Those would be examples of chronic or traumatic stress.

Another reason why individuals commit suicide is through substance use. Oftentimes if an individual has a low level or a moderate level of depression and they use alcohol or other drugs, what that seems to do is increase their impulsivity to act on those feelings in the moment, you know, when they are under the influence of alcohol or those drugs. Another example of why people think about killing themselves or actually follow through is just that a feeling of loss or a fear of loss. So, maybe they're not doing well in school. Maybe they're a victim of bullying. Maybe they're having financial issues or a relationship has come to an end and just feeling like there's no sense of moving on.

And then finally, two other reasons why someone might think about hurting themselves or killing themselves would be having a condition that creates chronic pain or illness. Oftentimes, individuals just feel like there's no chance it's going to get better. There's no chance for recovery. A lot of times there's isolation or anxiety of feeling like they're going to be a burden to others. So, it would just be better off if they weren't here on earth and then last but not least, it's a cry for help. Maybe, you know, you don't really want to end your life, but you don't know how to ask for help. You don't know how to get help. So it's kind of, plea for please help me. Those are some of the basic sort of categories why an individual would either contemplate suicide or actually act on those feelings.

Host: Yeah. And I want to unpack the last thing that you mentioned. I think that, especially in today's society, with everything that we have going on with COVID, it is our responsibility as in like a broader society's responsibility, to be our brother and sisters keeper, meaning look out and be proactive for the signs that someone might need help. So maybe, could you talk to us a little bit about the warning signs or things that we can look out for that tell us whether a friend, a family member or someone in our community might be having suicidal thoughts and might need our help?

Jennifer: Sure. So I like to summarize it into three categories. It's talk, behavior and mood. So, what I mean by that specifically with talk; so if your friend or someone, you know, was talking about killing themselves, you know, that seems obvious, but I think a lot of us have anxiety when those topics come up. And so we have to take those topics seriously. If someone is actually saying, you know, I've really been thinking about killing myself; we need to take action and help that person get help. If they're talking about feeling hopeless, like there's no chance of things getting better in their life. If there's no reason to live, if they feel like they're a burden to others, they feel trapped. Those are what I mean when I say talk.

The next category is behavior. So, some examples might be an increase in using alcohol or other drugs, withdrawing from things that they used to be interested in. So, things, you know, maybe they were active in sports or, you know, maybe they were quick to go out to dinner with you as a friend. But now they're saying ah no, I don't really think so. I'm not really feeling up for it. If they're talking about a change in their sleep pattern, so they're sleeping a lot less or sleeping a lot more, the key is a change in their sleep pattern over a period of time. Sometimes folks act more aggressively, more angry in their behavior. They just seem tired all the time. And then finally, again, it seems obvious, but it's typically a hindsight sort of situation, but they start giving away some of their most prized possessions, you know, the things that they value the most they want to give to you as a friend or as a family member, we need to take notice of that.

And then the third category, like I mentioned is mood and so depression. So, depression, you know, we all feel sad at different times throughout life and with different situations, but we're talking about a prolonged period of time. Typically for adults, we're looking at, you know, about two weeks. For kids, adolescents about a week. But for adults, about two weeks, just consistent, low mood, really impacting their ability to function in everyday sort of way. Increased anxiety, loss of interests, like I mentioned before. Irritability and then something that gets a little bit tricky, and this is for folks that you know better than others, you know, whether they're a friend or a family member or coworker, but it seems like, you know, they've been really down in the dumps. They've really been depressed. And then all of a sudden, snap of a finger, everything is great. Everything is better. That's where we have to pay even more attention because oftentimes when someone has made the decision to kill themselves, there's a sense of relief. And so it seems as if they've gotten better almost overnight.

Host: Wow. That is something that I never thought to be on the lookout for. So, I'm so glad that you mentioned it. You know, if we see someone that is exhibiting some of these signs that you're talking about, how do we even go about broaching this topic? You know, I know just thinking about it for myself, it seems like I don't want to get it wrong. I may not even have the vocabulary, the right vocabulary to use. It seems something that's daunting, even though I want to help. So, how would you recommend going about taking action if you notice that someone needs our help?

Jennifer: Absolutely. And so sometimes I think we over-complicate things, you know, you don't have to have a degree in social work or psychology to be able to help someone that you know, or that you love that is experiencing some of these feelings. The number one, or one of the main protective factors against suicide is a feeling of connectedness. You know, just reaching out, having the courage to talk about some of those challenging topics, like mental health and feelings of suicide and depression, having the courage to put words to it. And you don't have to worry about having the right words, just the fact that you're reaching out and expressing care and concern, having that open and honest conversation about mental health and kind of the factors in life that influenced mental health.

I think that's what starts the conversation. I think, you know, obviously if someone is in real time talking about harming themselves or ending their lives, you do need to seek professional help. And so thankfully, in Hartford county, we have a phone number that you can call. It's 1-800-NEXT STEP and we have licensed counselors on the other end 24/7, that we'll be able to walk you through, you know, whether it's your friend who is feeling suicidal, or if it's you calling on behalf of your friend or family member; they can walk you through what needs to happen. You know, I always say you don't have to have it figured out, just make the phone call and we'll help you. We also have the Klein Family Hartford Crisis Center, and it's a crisis center that's here in Harford County. We have an urgent care walk-in center, that's open from 9:00 AM to 9:00 PM. Literally no appointment needed. You walk in, you're going to get in front of a licensed counselor who can help you navigate what's going on and get you linked with resources right away.

Host: Yeah. What a great resource to have, still though, you know, I know that someone that might be listening to this that is having a hard time, might feel scared about reaching out to a crisis center like this one. So, maybe you can talk a little bit about the disposition of the staff or what they can expect when they call in.

Jennifer: Sure. So, certainly it's scary and it takes a lot of courage to reach out and ask for help that first time, especially. And so we here at the Klein Family Hartford Crisis Center really come from all walks of life. We have licensed therapists, we have psychiatrist and nurse practitioners, but we also have peer recovery specialists, folks that have lived experience. And that can really, you know, help you understand what's happening. Maybe some of the things that you're feeling and most importantly, to help you recognize you're not alone. There are lots of people that are feeling very similarly, you know, as you are in, in this moment. And so really working hard, you know, to come from a place of openness and empathy, no judgment whatsoever here. We simply are here to help you figure out what's going on and get you the best support that's possible.

Host: You know, you kind of touched on this earlier, but are there risk factors that make someone more susceptible to commit suicide? You know, one of the things that you mentioned was when there is trauma in someone's life, when they're younger, but are there any other risk factors that are worth mentioning?

Jennifer: There are some risk factors. And so certainly I want to stress that although these are risk factors, they're not destiny, if you will. There's no sort of absolute that if you've experienced, you know what, I'm going to talk about that definitely your at one point in your life, going to become suicidal or have suicidal feelings, but there are factors that you have to pay attention to that might put you more at risk.

So, the first is if you have a mental illness, you know, such as depression, like I talked about earlier or any of the mood disorders. So, depression, bipolar disorder would be two examples. If you have an anxiety disorder, those, again are some examples. Again, it's not a done deal. There's no absolute, but you have to just be, you have to pay attention, because it does put you more at risk for the potential of having thoughts of harming yourself.

Another risk factor is having a family history of someone that has committed suicide. The chances or the risk goes up if it's your parent or caregiver. So again, not a destiny sort of situation, but you know, you certainly have to pay attention, if you've had a loved one in your family, especially immediate family, that's been successful and committed suicide.

The other two examples that I think are probably the highest risk factors amongst the other two that I mentioned are having some sort of history of trauma. So, like I mentioned before, an adverse childhood experience, such as child abuse, domestic violence, having a parent that abused drugs or other substances while you were growing up, if you've been the victim of sexual assault. And then finally, if you've had a previous suicide attempt.

Host: Okay, understood. You know, one of the things that I wanted to ask you about is about how parents can speak to their children about this. As a parent, myself you know, I've read things on the internet and in news publications that say that, you know, kids or teens that are between the ages of 12 and 24 are like the most likely to have thoughts or actually go through with committing suicide, which is so very scary to me. So, how can we have this conversation with our children? And what age is it appropriate to broach this topic?

Jennifer: Well, this is a soap box of mine. I feel like, you know, there are topics, you know, as a parent myself, you know, that sometimes we get nervous about talking, you know, with our kids about, you know, some examples would be drugs and alcohol or even sex. But when we talk about suicide, we talk about mental health. I am an advocate of talking, you know, from the youngest of ages, you know, even little ones as young as two have feelings.

And so oftentimes, you know, with two year olds, we're always talking about the terrible twos and the tantrums. A lot of that comes from their inability to put words to what they're feeling. And so even as early as two, helping our little ones put words to what they're feeling. And, you know, we talk about mental health and we think that's this big sort of thing that's mental health. We're helping, our kids articulate what they're feeling. And so hopefully we're reducing their frustration. And when they're feeling all of these big things, we can help them understand and how to process those feelings. So, I am an advocate of talking to kids as early as you can, even, you know, even when they're babies, because I think it's important for them to understand feelings. Now, as they get a little bit older, obviously it's important to use age appropriate language so that they can understand.

You're not going to even probably use words like suicide, but you're going to talk about sometimes you might feel sad. Sometimes you might feel really nervous and have butterflies in your stomach, you know, when you're trying something new or when you're, you know, when you're scared. And so again, in everyday sorts of language, you're already building blocks into having those talks as they get older and, where they might be experiencing more true symptoms if you will, of depression or anxiety. So you're building a foundation. You know, as kids get older, what I will say is, you know, even though it seems like the rates of suicide are increasing for our younger kids and adolescents, still across the gamut, seniors are probably our most at risk for suicide.

So, folks who are 65 years and older, and then second to that, probably the fastest growing group, what we're seeing in the past year or so is middle aged folks, 45 to 64 years old. But what's reassuring for parents, in my mind, is that, you know, there are lots of things that we can early on, to help our kids understand that, you know, mental health as a part of our lives, just like physical health and we have to take care of it.

So, giving them words for their feelings, helping them understand if it seems like things are just a little bit more than what you would expect to be normal. So, kids are sad. And like I said before, for adults, it's usually about two weeks. For kids, it's about one week where it seems like nothing, cheers them up. They just can't kind of move themselves forward. Then it's talking about brain chemistry, just like if they had a physical disorder, depression is about brain chemistry. And that's why we go to the doctor. That's why we seek help from counselors. And so my first suggestion would be, if it seems like, you know, after about a week, and there's really no moving them along, reaching out your child's pediatrician and just saying, you know, this is what I'm seeing.

Maybe you should take a look. Second to that, I would recommend, you know, talking to a counselor. We have tons of counselors here in the county, certainly at the Klein Family Hartford Crisis Center, and just helping, you know, oftentimes with kids, it doesn't have to be a long drawn out plan of care. Usually a couple of sessions is all that's needed, but what I will stress for kids, as well as adults, let's be proactive. Let's not wait for a crisis, you know, as a parent or a caregiver or a teacher or someone else in a child's life, you start to see things that just don't seem to be their typical behavior; reach out, talk to the parent, talk to, you know that, that caregiver and say, you know, this is what I'm noticing. And as the parent and caregiver, don't be afraid to reach out. Even, you know, the number I referenced before 1-800-NEXT STEP, you can call as a parent and say, this is what I'm seeing in my kid.

I'm a little nervous. Should I, you know, am I overreacting or should I reach out? And that, that licensed counselor on the other end can direct you. The beauty also of the crisis center urgent care walk-in center is that we can see kids five and older. So, if you have a little one and you're just not sure, bring them in, we can meet with them and we can help you as a parent or caregiver to kind of navigate, you know, and saying, you know, this is what I would suggest. Maybe try some of this or maybe you should see a counselor, you know, they can kind of reality check it for you so that, we can prevent a crisis, prevent, you know, things escalating to feelings of suicide.

Host: Well Jennifer, I really appreciate all of this advice today. And I think something that you have emphasized and is so critical is the importance of reaching out and recognizing that if someone is struggling or having a hard time that it is okay and in fact, encouraged to talk with them about it. Jennifer, I want to give you the last word here. Is there anything else that you want to share with our audience for regarding suicide prevention or how they might get involved to be helpful around this topic?

Jennifer: I think it's just important to, you know, if you are the person that is feeling hopeless and feeling like things are not going to get better, I'm here to tell you that it can. And I know it takes a lot of courage, but you know, making that phone call to 1-800-NEXT STEP can really make all of the difference.

If you're a family member or a caregiver or a loved one of someone who is experiencing depression or suicidal thoughts, again, you're not alone. And we have help these folks in our lives feel connected and help them feel like they're not alone. They don't have to have it all figured out in a moment. We're here. There are people there to help. And that's what we're here to do at the Klein Family Hartford Crisis Center.

Host: Well, Jennifer, thank you so much for joining us again. We truly appreciate it.

Jennifer: Thank you so much for having me.

Host: That was Jennifer Redding, the Executive Director of Behavioral Health at UM Upper Chesapeake Health. Find more shows just like this one at umms.org/podcasts. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.