Sh*t You Wish You Learned in Grad School with Jennifer Agee, LCPC

Episode 12: The Pucker Factor – Discussing and Assessing for Suicide Risk featuring Norine Vander Hooven

July 06, 2022 Jennifer Agee, LCPC Season 1 Episode 12
Sh*t You Wish You Learned in Grad School with Jennifer Agee, LCPC
Episode 12: The Pucker Factor – Discussing and Assessing for Suicide Risk featuring Norine Vander Hooven
Show Notes Transcript

During this episode, I talk with Norine Vander Hooven (she/her), LCSW, EMDRIA Certified and Approved Consultant, about how to discuss the topic of suicidal thoughts with clients and how to assess for suicidal risk. This is a topic most therapists feel nervous having, and we give you the language to use to begin having these conversations more comfortably.  

Norine served as the Youth Suicide Prevention Chair for the American Association of Suicidology (AAS) for three years (2017-2020). She is certified in EMDR therapy and is also an Approved EMDR consultant. Norine’s areas of expertise are complex trauma, suicide, EMDR Intensives, Intensives for CEOs and high-level executives, and consultation for therapists.

Norine is also the founder and owner of Westlake Trauma & Resilience. They provide EMDR therapy and Intensive EMDR Therapy. She is licensed in California and Nevada.


  • Facing the fear of asking about suicidal thoughts 
  • Active vs Passive Suicidal thoughts – how to explain this to clients
  • Confronting clients fear of involuntary hospitalization and getting “grippy socks”
  • When clients get quiet or animated, pay attention
  •  Recommended suicide risk assessments
  • Our language matters when talking about suicide. Here is what to say and not to say. 
  • Times of year when suicide risk increases


·       Norine’s offer: 6 hr Suicide Risk Assessment Course for $89 plus approx $36 for CE credit 

·       Jennifer Agee coaching page

·       Counseling Community Facebook community

·       Counseling Community Instagram

·       Alaskan Cruise: Experiential Therapeutic Intervention Training for Therapists June 3-10, 2023

·       Cabo, Mexico: Dreamer’s Retreat for Entrepreneurial Therapists October 6-8, 2022

Jennifer Agee: Hello. Hello, and welcome to Sh*t You Wished You Learned in Grad School. I'm your host, Jennifer Agee, licensed clinical professional counselor. And with me today is Norine Vander Hooven. She is a licensed clinical social worker with over 35 years experience. She is EMDR trained. She is an EMDR consultant. She works with high-level CEOs, does consultation for therapists, and she's also produced a six-hour online course for suicide risk assessment. So, you have a little preview of what we're probably gonna be talking about today. So, Norine's bio, I will leave it down below because it is pretty stinking impressive, but Norine, welcome to the show.

Norine Vander: Thank you. I am so happy to be here. I can always talk about suicide prevention. 

Jennifer Agee: Absolutely. So, tell me, what is one thing you wished you would've learned in grad school? 

Norine Vander: Oh my gosh. You know what, in grad school, cause I went like in the dinosaur age, um, I graduated, I think, in 1987, um, from grad school and there was not even one hour on suicide. It was like, there was crisis intervention, but that's not suicide. There was no suicide risk. And, um, even today that I'm still doing guest lecturing for classes, because there's just not enough that they talk about on, um, suicide risk assessment. 

Jennifer Agee: I, I couldn't agree with you more and it's so important. And honestly, I think it's one of those topics that gives therapists the biggest pucker factor when we think about it, right? Nobody wants somebody to die on their watch, kind of a thing, right? And so, there's a lot of fear around it and there's a lot of resistance to just being open with it, so I'm glad we're having this conversation today. 

Norine Vander: Yeah, absolutely. You know, the one big thing- So I, um, was the clinical supervisor of our county's, youth, uh, mobile crisis response team. And so, we would- there was a 24-7 hotline, and then we would go out into the community if necessary to assess for risk, if they need to be placed on a hold, or if you could just do a safety plan or whatever. But I cannot tell you how many times therapists would call our hotline, and they would be afraid to ask their client, like, are you feeling suicidal? So, they would call us and they'd go, I think my client wants to kill themselves, or I think my client, you know, feels like they're suicidal. And we're like, well, did you ask? And they're like, no, or, or I can't ask that. I'm like, of course you can, like, you have to ask that. But, you know, um... 

Jennifer Agee: If not us then who, right? 

Norine Vander: Yeah. It's just, it's really shocking. I think, you know, the biggest thing that I've found is that therapists are afraid that their client is going to say, yes, they're suicidal. And then they're not gonna know what to do. You know, that's kind of when they freeze. 

Jennifer Agee: This is the perfect spot to really springboard into really the first phase of the conversation, which is how do you bring it up to clients, and how do you share with clients? It's okay to acknowledge that you have suicidal thoughts.

Norine Vander: Yeah. So, the first thing is, is, um, in every assessment I do — and I have like an extensive suicide risk assessment — um, once the client's told you that they're having suicidal feelings, I have that. And then I have in my intake assessment, built in, you know, a specific suicide risk assessment. And you just have to be like, the more direct you are, the better, you know? Saying, are you having feelings like you wanna die, and do you feel like you wanna harm yourself, and do you feel like you wanna kill yourself, or you have feelings of suicide, are all different things.

Jennifer Agee: Mmm. 

Norine Vander: And so, I think that, you know, therapists think if they just ask, oh, you know, are you feeling like you wanna harm yourself? Well, they might want to harm theirself, but might not want to kill themselves, you know, and vice versa. So, um, I just ask it very directly. And I think the big thing is is that the more comfortable a therapist is with asking that, the more comfortable a client is gonna tell you. Because if they know that you're not comfortable, they're not gonna feel safe sharing that. And then they're gonna feel shame, or they're gonna feel like, you know, they're gonna wind up in a hospital or, you know, like something horrible's gonna happen, so they don't say anything. 

Jennifer Agee: I think you are absolutely right. One of the approaches I've taken with clients is when I know that there's depression there, I will, again, pretty directly asked the question. I'll say, I've noticed your depression has gotten, is continuing to get a little bit worse, and I think we need to have a conversation here. Have, um, have you been thinking at all about not being here anymore? You know, put it general first before I get specific. And sometimes I'll also explain that there's a difference between feeling actively suicidal and passively suicidal. 

Norine Vander: Yeah. 

Jennifer Agee: So actively suicidal is that thought or that feeling of, I don't wanna be here anymore, and I've really started to think of ways to make that happen, started putting some timelines in my head of how that might happen. And that passive suicidality is more of, I don't wanna be here anymore, but I don't wanna be the one that does it. Like, if I leave your office and I'm in a car accident, like, I'm okay with that, but I don't really wanna do anything. And the truth is the brain and the body's quickest way to get out of pain is to think of not being here, right? It's a life hack. Everyone has had a passive suicidal thought, if not an active thought before. It's super, super normal. 

Norine Vander: Yeah. Yeah. You know, and the other thing is like, I'll explain to little kids cause when I was on the crisis team, like, the youngest kid that we ever hospitalized was 5.

Jennifer Agee: Oh, wow. 

Norine Vander: And yeah. And you know, what we'll say is like, I'll say, you know, first the same thing is like, you know, do you, do you feel like you're in, you know, so much pain, things are so bad that you just don't wanna wake up? And they'll go, yes. And I'll say, well, but do you understand if you don't wake up, like, you're never gonna see your mommy or your daddy or your doggies or your friends, or- like, I just go on and on and on. They're like, no. You know, the majority of them don't really understand that. And even sometimes adults, when you say that to them, and then they take a second to think about it, they're like, yeah, no, like I just want my pain to end. I don't want to not ever, you know, see my loved ones again or whatever. So, you know, it's like, that's the point, entry point really, for when you can start talking about like a safety plan, but... 

Jennifer Agee: I agree completely. That's been my experience, as well, is when you are comfortable bringing it up into the room and also when you don't stigmatize it with the way that you present the question, then it just becomes a conversation between two people about real life hurt and pain and where that's taken us. And then based on that, we can decide what we need to do. 

Norine Vander: Yeah. Yeah. And the other thing is, like, even in my assessment, I'll preface it by saying, you know, I'm gonna ask you a question; it may make you feel uncomfortable, but I want you to know that, like, I'm comfortable with it. And so, I want you to be perfectly honest and then we can have a conversation. Um, because some people who feel like they say they're suicidal, then they go right to, oh, they're gonna hospitalize me. And so, if they say like they have any thoughts, I always scale them one to five. Because one to ten is, like, such a large gap that it doesn't give you accurate information. So, if you, you know, bring it in closer, one to five, and you ask them like, on a scale of one to five, where are you as, as far as feeling like you wanna kill yourself? One being, I have no thoughts, five being like, I have thoughts, I have a plan, and I'm going to follow through with killing myself today. And then they'll tell me where they are. Now, I'll say, okay, like, so a three, well, what does a three mean to you? And then they'll tell me, and then I'll make them write out — like I have a sheet — and I make them write out what's 1, 2, 3, 4, 5. So we're able to, like, really concretize it and know so that they're not always having to go through, you know, what every number is. Um, and some of my clients, I've had a lot of clients who are like a two constantly, like those passive suicidal thoughts. And they just never stray from that, and that's fine, you know. But it's like just checking in with them every session to see how they're going, you know, how they're doing with that. 

Jennifer Agee: Yeah. And sometimes you're able to specify what that number system looks like based on even the fantasy of suicide that the person has. I know I've worked with a lot of women who, water is a big one and, um... 

Norine Vander: Mm-hmm. 

Jennifer Agee: Going over a bridge is another one that has come up a lot, uh, for me. And so, based on their own language, we might be able to come up with, at what point in this vision of where you're at, how close are you to the water? How close are you to a guardrail? Is it time to call me? Like the two, I know that I live with that on, on a daily basis and we're working on that, and I'll keep doing my stuff. But if we're hitting a three, four, it's time to give me a call, cuz we need to, to intervene here.

Norine Vander: Yeah, absolutely. And in our county, we have a great crisis team. We're really fortunate that they come out generally within a few hours. Um, when I was on the children's team, we had a window of an hour that we had to respond. 

Jennifer Agee: Oh, wow. 

Norine Vander: And yeah, it was tough. And sometimes like we would make an hour and a half, but you know, whether it be the hospital or, you know, a school or home, wherever it was, the park, you know, we would have to go out and respond to that. And we would kind of go through those same things. 

Jennifer Agee: Mm-hmm. 

Norine Vander: Um, a lot of counties don't have that. Like, Los Angeles County is so big, they have a PET team, but their PET team could take days to respond. 

Jennifer Agee: Oh, wow. 

Norine Vander: Yeah. Yeah. I just had a client who, um, told me that someone they knew was in the hospital in Los Angeles County. And the hospital called the PET team, and it was gonna take them two days to respond. Well, by that two days, you know, the kid is sitting in the hospital, and the suicidal ideation is decreasing. So, it's good in some respects, you know, but in some respects, if they're really wanting to kill themselves, then they need to be hospitalized. 

Jennifer Agee: Yeah. 

Norine Vander: So, it's, you know, kind of a hit or a miss, but... 

Jennifer Agee: In the area that I'm in, uh, the police departments have, um, social workers that will travel with them for mental health calls. Because I know a lot of therapists are hesitant to call wellness checks in with the police because they don't- things can get dicey with mental health and law enforcement. Um, and that's no bash on anyone in the equation, but it can, it can get dicey and misinterpreted and, and a bunch of things. And so, I know a lot of us are hesitant to do that, and I'm thankful that more and more, uh, police departments are starting to understand that they really do need mental health professionals as a part of their team. And so, if you're listening to this and you don't know what's offered in your area, I highly recommend you take time and figure it out. If that's calling for a wellness check through the police department, do they have someone there? Is it someone like in Los Angeles County where there's a specific number you can call and they'll send someone out? 

Norine Vander: Yeah. 

Jennifer Agee: If you don't know that answer, find it out because that will also decrease your anxiety around receiving a call when you're not in the office or information where you're not exactly sure how to act. You'll have a resource available to you. 

Norine Vander: Yeah, absolutely. Like you don't wanna wait till the last minute and then go, oh, I don't, you know, know what to do. And it's kind of the same thing. Now, like, with telehealth, when I'm doing telehealth, I always start off by asking the client, okay, like, where are they right now, is there someone home with them, you know, and if not, what's the emergency number in case we either get disconnected, or, you know, you get escalated, or if we need to contact someone else, who can we contact right away, you know? And then they could at least be there if you need to then contact the police or, you know, whoever. Um, and then the other thing that's great in our county, we have, it's called CIT officers. So, they're crisis intervention trained. And they get 40 hours of mental health training. 

Jennifer Agee: That's wonderful. 

Norine Vander: Yeah. So, they're, for the most part, um, really much more sensitive to mental health and much more patient and, you know, helpful.

Jennifer Agee: This is a good reminder for all of us to take a look at our client's addresses as well, because a lot of people moved around during COVID because they could. You know, well, we all worked from home, and there've been a lot of changes. And sometimes people make changes or allude to the fact, well, I'm moving, but you don't exactly know when. It's good to make sure that your records are, are up to date because if you need it, you want to be able to use accurate information if you have to make a phone call. The other thing that you mentioned that, um, really struck me was a lot of clients' resistance to sharing with us is exactly what you talked about with, you'll send me to the hospital. You're gonna put me in a rubber room. You're gonna give me grippy socks. You know, I've heard all of those things before. And what are some of the ways that you destigmatize that or deescalate that so that the client is more comfortable? 

Norine Vander: You know, I let them know that like our goal is to keep them in the least restrictive environment, you know? So, if that's home or that's a friend's house or somewhere they could be safe, that's like really our goal, and to be able to do a safety plan with them. Then I, you know, take out the safety plan and I show them what that is and what it looks like, and if they can do that awesome. But I found that most people who are truly suicidal want to be in a hospital because they wanna be contained, you know? And some people, if they're really suicidal and they wanna follow through with it, they're just not gonna tell you sometimes. And that's part of, you know, the, like I think fear and terror that some people have, you know? I had a client once who, um, came in to me, I was just telling, uh, my associates this, that he came into me, and it was for anxiety, and when he came in, he hadn't slept in several days. And so, he was really like, his anxiety kept getting more ramped up more egged up. Of course, I asked him about suicidal thoughts, and he said, no. And, um, we did safety planning and did some visualization to help him, you know, like kind of calm himself and be able to hopefully get himself to sleep. And he did go home, and he did sleep, but then he tried to kill himself. And I didn't know this, like, for another two weeks until his wife called me asking, like, what's this charge on the credit card? She had no idea he even came to see me.

Jennifer Agee: Oh, wow. 

Norine Vander: So, yeah. And you know, thankfully she found him, um, and he was okay, but you just never know. You can only do your best, you know? And that's kind of what I always try and tell any clinician is there's never a hundred percent guarantee, but the more that we are comfortable with it, the better chance we are helping, you know, save lives. 

Jennifer Agee: There's this interesting dynamic, cuz I'm, I'm also been a therapist for a long time. Um, and there's this interesting dynamic I've seen play out a few times with clients who are suicidal, who we've had very good rapport with, um, have a good relationship, maybe we've worked together quite a while. Sometimes they get very quiet about it because they do not want you to take away that option, number one, and number two, in protection of you, as well, I think. They don't wanna put you in that position. And I've actually had some clients express that to me before, and I was very thankful for that, but I get most nervous when people get quiet.

Norine Vander: Yeah, or they get quiet, and then all of a sudden they're very animated for the next few sessions and you're like, hmm, like this is just not typical. Um, but one of the things I also ask is, um, of attempt survivors, and I learned this from a friend of mine — her name's, um, Dese'Rae Stage — and she actually just graduated with her MSW, so I was like, so thrilled that she went to school for this cuz for years she's been an attempt survivor, which is what we call lived experience. And that, she also has a website. It's called Live With This, and it's an amazing website. And she would go around interviewing other people with lived experience and then photograph them. And these photographs, it's like, you could just see inside their soul. It's unbelievable. But the one thing she would ask is, now that you've attempted, is suicide still an option in your future? 

Jennifer Agee: What'd they say? 

Norine Vander: Some people would say yes. And some people would say no. It like really depended on their life circumstance and kind of where they 


Um, and the ones that said yes would say, it's an option, but I don't think I would do it again. But like, kind of like you were saying, not wanting to take away that as their option. It's kind of, that's the one thing that they have control over. 

Jennifer Agee: Yeah. Um, it it's, it is fascinating because as someone who, as helpers, when we sit with people who are in intense pain, right, if someone is experiencing severe depression — and most of us listening, you know, have had that experience — it's palpable. You can feel it. 

Norine Vander: Absolutely. 

Jennifer Agee: And your heart just breaks for it. I totally get on a logical level while your brain and body would say, it would just be easier not to have to deal with this shit. Like I totally get that. 

Norine Vander: Hundred percent. 

Jennifer Agee: So, there's compassion. Compassion. 

Norine Vander: Yeah. Yeah. And I think that's the thing is, the more in tune you could be with your client and the more compassionate, they'll feel that from you, you know? And then it just becomes really genuine. So... 

Jennifer Agee: Are there certain assessments that you really like that you would recommend?

Norine Vander: So, it's interesting because, uh, in my course, I kind of talk about this, that you know, the Columbia Suicide Scale, um, rating for suicide, that's like evidence based. It's the assessment to use. I personally still don't use it. I don't particularly care for it. Like I like to have a conversation rather than just check boxes and then like yes or no. And then if yes, this go to this number, if no, that- so, um, and the CAMs though, I do have to say, by David Jobes, is a great assessment. Um, and it's really thorough, and I like using that. But I really, the reason I developed my own assessment, cuz I found holes in other ones, that I just kind of found they just didn't address some stuff. So, like my whole assessment is all conversational with the exception of asking that rating scale. But the rating scale, then they keep, you know, with them. And the other question I always ask, you know, moving forward is like, has your scale changed at all? Like, you know, are your numbers different? Do we have to redo this? Or... And most people say, no. So, you can just continue to ask them, just easily, like where are you on your scale? And then if it starts to get high, then you start to have that conversation. So, yeah. 

Jennifer Agee: Have you, um, have you heard of the, the two-day training that the military has? So, in our area, the us military has a two-day suicide prevention training, and they will do it for a group for free as long... 

Norine Vander: Is that the ASSIST? 

Jennifer Agee: ASSIST. Yeah. As long as you are willing to invite active or retired military members to the training, they'll put it on for free for you, the whole thing. And it is a darn good training. So yeah, if you're looking for something for a big group, um, or to put something on in your community, that, you know, that's certainly an option.

Norine Vander: Yeah, ASSIST is wonderful and they're always advertising it to do it, not just even for like military. In our community, they'll just put it on if you have a large group. And on Facebook. Sometimes you see advertisements, you know, for it from different therapists saying, hey, you know, we've got this training on, of ASSIST going on. Or ASSIST will post, and say, you know, we're happy to do training in your area, blah, blah, blah. But it is a great training. And especially for people who don't have any experience in risk assessment. 

Jennifer Agee: I completely agree. The other thing that it brings to mind is one of the things I've liked from the different suicide trainings that I've gone to is an experiential component. I like to be able to practice saying the words, using the words, thinking through, uh, things I don't know are going to come out of the other person's mouth, and getting that in-real-life experience with somebody. Or it helps for the real-life experience with someone because you've already practiced and rehearsed saying these words out loud and becoming comfortable. And especially earlier in your career, where again, I think suicide does have a strong pucker factor for people in their nervousness with, with that in the room, getting used to saying the words and your languaging around it, is very helpful.

Norine Vander: Yeah, a hundred percent. And you know, it's funny because before COVID, before the pandemic, I did, um, an in-person training for our county. And there were, like, a little over a hundred people there. And that's one of the things that I do is, I break people up into pairs of two and have them practice asking, you know, do you feel like you wanna kill yourself, or do you feel, are you having suicidal thoughts right now, or, you know? Because people just can't ask that. It's such a hard thing for people to ask. So, like you said, the more you can practice it, the better. And then during the pandemic, I did a couple for a couple organizations. And so, I would have breakout rooms into, you know, on zoom to have them do the same thing. And there are a couple other exercises, you know, I would do as well. So, I much prefer to do my course in person. Um, but one of the other things is, a big thing, is vicarious trauma that comes out of it and burnout. And, um, I'm actually doing a training for Casa Pacifica. They have community mental health, which is where I ran the crisis team from. And they have a residential facility. So, I'm going, and I'm doing a whole thing there for them on vicarious trauma because so many people, first responders and therapists and, you know, teachers, they're so affected by that. And then that becomes difficult to be able to function and be able to move on to even notice it. You just kind of shut down. 

Jennifer Agee: Mm-hmm. And I love that technology has kept up with us now so that you can have rooms where people can have that live interaction, and it's not just you on a screen, like the bobblehead for an hour. 

Norine Vander: Yeah. 

Jennifer Agee: I appreciate that. So, at the time that we're recording this, um, Naomi Judd has, has very recently passed away and I'd love your take on how the family has handled it, responded, their languaging around, um, her passing. I, I actually really liked the languaging around her passing. Um, said she lost a battle with mental illness, and I thought that was very dignifying, but give some of your thoughts. 

Norine Vander: Yeah, no. And that's the other thing that I had wanted to mention before that just kind of flew outta my head as I started talking, um, is one of the things that we talk about is that it's, you don't wanna say someone committed suicide because it's not like they committed a crime, you know, people don't commit cancer, right? So, we try and say died by suicide. But even at that, the Judds are not saying that. And I so respect them for how they want to handle this and saying she lost her battle with mental, you know, health, mental illness. And I think that's just so, it's horrible say, but it's like lovely to hear, that's how, you know, they are dealing with this topic, which is just so, you know, fragile for them. And that they're asking for people to leave them to, you know, grieve privately and, and haven't come out and said it's suicide, but everybody knows. But yeah, no, I think it's wonderful. Cuz during the time, um, of Anthony Bourdain and um — who's the other one, it was a- she also died by suicide around the same time, like two weeks later. Her name is escaping me. You know who I'm talking about? 

Jennifer Agee: Yeah. I know who you're talking about, but I can't, I cannot bring up the name. 

Norine Vander: Like, I wanna say Kate Spade, but it's not Kate Spade. 

Jennifer Agee: Not Kate Spade. 

Norine Vander: Um, no. Um, anyhow, so during that time, um, I was on the committee or the media committee for the American Association of Suicidology. And we put out all the press releases to the AP wires and stuff. So, it would go through, we'd have like the head of, um, communications. He would write the post, and then we would all go through it. But you would still find, even though we would send out this post, you would still find people in the media who would say committed suicide.

Jennifer Agee: Mm-hmm. We've got to update our language around it because, as you said, there's, there's a, um, finger wagging that comes with committed that I think lost a battle with mental health or mental illness. It's different. We all know what that means... 

Norine Vander: Yeah. 

Jennifer Agee: Without being explicitly told what that means. And anyone who has known someone that suffered knows that they are flipping battling. No joke. 

Norine Vander: Yeah. 

Jennifer Agee: That is a battle that they, some days are winning more than they're losing, and some days the other way around. 

Norine Vander: Yeah. Yeah. And I've worked with a lot of the, um, lost survivors. Um, so, you know, people who've lost someone to suicide. And one of the things with that is that they blame themselves. You know, a lot blame and shame and, and it's just so sad, and I've used EMDR with that to really help them to get through that trauma. But it's not just the trauma then of that; it's like all the grief that goes with that. And they, I have one client who would just get so mad when he would hear committed suicide. And so, he would always start to tell his friends, don't say that. You know, it's died by suicide. So, a lot of these people who are lost survivors are helping to change that conversation. But there's also, there's a great article by, um, Jonathan Singer and Sean Erreger, and I can send it to you to link it. It's called "Language Matters." 

Jennifer Agee: Okay. 

Norine Vander: And it talks about all the like positive language, especially, you know, died by suicide, that we'd like to see. It was probably written maybe three or four years ago, but it's a great article.

Jennifer Agee: Do you do any work with therapists who have lost a client to suicide? 

Norine Vander: Yeah. Yeah. And the same thing, there is so much guilt and, um, and just trauma around it and the grief. So, it's not just, you know, it's like the grief of losing a patient or a client, right? But then it's the trauma of what didn't I see, or what did I do wrong? And most of the time — I would probably like 99% of the time — people are asking the right questions and they're doing the right things of these people who, you know, end up dying by suicide. And I just really try and talk to them about, they really were in that much pain. You know, it's like, I was talking to one of my clients a few weeks ago, it's like, if you take a paper towel roll, you know, and you look down it like this, all you're going to see, you're gonna have tunnel vision. All you're gonna see is what's down this hole. You're not gonna see anything around you, you know? So, you're not going to see that you are gonna be leaving behind anybody. And you know, so when people say it's selfish, that's the other thing that just like, it grinds me. 

Jennifer Agee: That grind- it grinds me too. Mm-hmm. 

Norine Vander: Because it's like, they can't see anything else. And so, I try to explain that to the therapist too. It's like, they're doing the best they can, but it doesn't matter. That they obviously, they, they were in that much pain that they just couldn't see anything else. And it really, with a lot of people, just stays with them for, for years. But the numbers unfortunately have increased. I think it's like, it used to be one in seven, and now it's about one in five therapists will lose someone, maybe even one in four. And it's like one in three psychiatrists will lose someone to suicide.

Jennifer Agee: I'm also, so this is, this is like my hippy dippy self coming out, so just go with me here, but... 

Norine Vander: I got that hippy dippy self, so I'm good. 

Jennifer Agee: Okay, good. Um, I read an article a while ago, a scientific article that talked about how suicide spikes in the spring. Anywhere in the planet, whenever spring happens, suicide rates increase. And so, every time around spring, I always make sure that I'm a little more aware that my supervises put it on the radar screen to be aware and talking, talking with people about it. Whether it's the energy that comes with spring, some research is starting to, to go towards inflammation in the brain and the body that contributes. I don't know the answer to that, but I do know that research backs up spring heightens. Um... 

Norine Vander: Yeah. 

Jennifer Agee: And so, put that on your radar screen, I guess, somewhere in the back of your mind that especially in the spring, make sure that you're asking, make sure you're paying close attention to it. 

Norine Vander: Yeah. So, the crazy thing is yes, you're right. Not hippy dippy at all. You know, like on the crisis team, we found all the time that exact thing. Um, sometimes for adults it's different than for, for kids and teens. Um, but what I've found in private practice and we see the gamut, we see like 12 years and up, right, into late seventies. And, um, March and October are our busiest months. It just goes bananas. I mean last month, March. I probably made about a third as much as I did in April because my sessions increased, because people's, you know, mental health needs increased during that time, and they needed an extra session or two and, um, yeah. So, during the fall also, because what happens is, is during the spring and the fall, especially for like young kids, teens, they start getting back to school, and things start settling in, and that's when midterms happen. And that's when, you know, they start to go a little stir crazy and, you know? And seasons change and all of that stuff. So, um, and the same with adults, um, sometimes, you know, around the holidays, it's a spike for adults also, not consistently, but most, that's what we've seen. Um, usually because a lot of adults, especially with severe mental illness, don't have anybody.

Jennifer Agee: Mm. 

Norine Vander: And so that kind of, yeah, spikes it there. 

Jennifer Agee: Well, the other thing that's starting to grow and evolve in our culture is people are more open about their mental health than they ever have been before. I know when I was a kid, um, it was not really talked about. You might, might have known X, Y, or Z struggled in some way, but you didn't have a name for it. They probably didn't get help for it. The family didn't advocate getting help for it because uncle so-and-so was just that way. Um, and so I think media has a downside when it comes to mental health, for sure, and research backs that up. But one of the pluses, I've gotta give credit where credit is due, it has helped with destigmatization of mental health issues.

Norine Vander: Yeah. Totally. You know, it's so interesting you say that because I remember when I was maybe like a junior in high school, I had a friend who ended up in a psych hospital. And so, this other friend of mine who was best friends with this guy said, oh, we gotta go see him in this hospital. I'm like, well, what are you talking about? And she goes, well, he wanted to kill himself. I'm like, what? Like it was so horrid cuz nobody ever talked about it. And so, we went to the psych hospital, I have to say it was like the most upsetting thing to see, you know? And I've just kind of never forgotten. That has stuck with me. But even then, into the beginning of college, into my young adult years, nobody talked about suicide or mental health issues, you know? It's like, a few weekends ago, we went to go see my daughter in Oregon, and it was her birthday, her 22nd birthday. And so, we took her and some of her friends out to go wine tasting, cuz we didn't get to do it last year cuz of COVID, right? And I swear to you, all of them were talking about, oh, I am on Lexapro. Oh, I see a therapist. I... And they were just so open about it. And I'm like, okay. But it was just so interesting that this is like, kind of more the norm. Um, and I'm so thrilled that they're able to talk about it. 

Jennifer Agee: I am too. I am too, because I think, you know, I'm, I'm generation X, also known as X force to me, but, um, so as a gen Xer, a lot of us struggle and said nothing. Or even as adults, because we've learned that our mental health needs are, are something that is deprioritized, you push it to the side, and you keep on getting on. Um, we're not very good at that. So again, I've gotta give credit to the younger generations. They are definitely turning the tide in that, in that way. And I'm really thankful for it. 

Norine Vander: Yeah, absolutely. Absolutely. It, it makes such a difference. Um, cuz then it continues to get passed on to younger people and, and other generations. 

Jennifer Agee: I agree completely. Um, okay. This has been a good conversation. And this is a topic we could talk about for a very long time in a thousand different rabbit holes of conversation for sure. But, Norine, thank you for being on today. I really appreciate your time. 

Norine Vander: So happy to be here. 

Jennifer Agee: Oh, good. Um, how can people get in touch with you or attend one of your trainings? 

Norine Vander: Um, they can find me at, um, which is a mouthful, but, uh, I'll spell it really quick. It's N O R I N E V A N D E R H O O V E N L C S W .com. And I could be reached throughout the email. My trainings on there. Um, I actually have, I'm launching, um, on Monday, uh, several eBooks. And one is just my suicide risk assessment, just that standalone piece. And if your listeners want, they will get 20% off, they just have to put in AGEE20. So, A G E E 2 0, and they'll get 20% off on that. 

Jennifer Agee: Thank you. 

Norine Vander: Um, yeah, absolutely. And there is also a quick start guide on there, which is similar to my, um, risk assessment. And I'll probably put my risk assessment up also. Um, so same, it'll be A G E E 20. 

Jennifer Agee: Perfect. And I will put links, um, on the website as well, so that you can have all of that information in a clickity click click way. Um, if you would like to get in touch with me or attend one of our therapist retreats or trainings, You can also find us on Facebook, Instagram, and I can't believe I'll say it, TikTok. I'm doing it. I'm doing, I'm going in. Oh my God. [INAUDIBLE] We'll see what's gonna happen. Anyway, Norine, thank you again, and you all get out there and live your best dang life.