Suicidality: Warning Signs in Teens vs. Adults (Part 2)

Thoughts of suicide are not uncommon and can be a part of the human experience for many individuals at various points in their lives. In Part 2 of this series, host Terry McGuire welcomes back Dr. Sara Kohlbeck, PhD, a public health researcher specializing in suicide. This conversation focuses on the "invitations" people send when they are in distress and how to navigate the spectrum of suicidal thoughts with empathy and evidence-based tools.

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Dr. Kohlbeck explains that warning signs in teens often manifest as impulsivity or reckless behavior, such as dangerous driving or taking unknown substances. She introduces the "Assist" training framework, which views these behaviors as "invitations" to explore the underlying pain a person is carrying. This episode also clarifies the reality of "passive suicidal ideation"—thoughts like wishing to go to sleep and never wake up—which are valid experiences that require support even without an immediate plan.

Dr. Sara Kohlbeck, PhD, provides a rare, firsthand account of her own experience driving herself to the emergency department during a crisis. She details the medical triage process and addresses the common fear that seeking help will lead to immediate restraint or being "locked up". By normalizing these conversations and teaching listeners how to create a "Safety Plan," Dr. Kohlbeck empowers communities to become a foundation for wellness.

⏱️ Chapters:
00:00 – [Intro] Normalizing Thoughts of Suicide
02:50 – Warning Signs in Teens: Impulsivity and Risk
07:15 – Identifying "Invitations" for Help
09;12 – Sudden Calmness: Why It Can Be a Danger Sign
14:10 – Understanding Passive Suicidal Ideation
28:52 – How Long Does a Suicidal Crisis Last?
29:29 – Restricting Access to Lethal Means
33:22 – How to Create a Safety Plan
41:08 – Walking into the ER: Triage and Treatment
45:24 – Will My Therapist "Lock Me Up"?

❓ Questions the Video Answers:
How do warning signs in teens differ from those in adults?
What is the "Assist" training framework for suicide intervention?
What are "invitations" for support and how do I spot them?
Is a sudden improvement in mood always a good sign?
What does "passive suicidal ideation" feel like?
Can the option of suicide act as a "safety valve" for some?
How long does a period of imminent suicidal crisis typically last?
Why is "limiting access to lethal means" critical for safety?
What is "means substitution" and does it actually happen?
What words should I use when walking into an ER during a crisis?
What medical tests are performed during a psychiatric ER visit?
Will I be handcuffed if I admit I am suicidal at a hospital?
How do I tell a therapist I have a plan without being hospitalized?
What are "coping cards" and how can they help?
How can communities better support those with suicidal thoughts?

#suicideprevention #mentalhealth #teenmentalhealth

Transcript

SPEAKER_04 0:00

Suicide is actually, from the perspective of a suicidal person, is actually the opposite of selfish. Sarah Colbeck is a public health researcher specializing in suicide. Again, what needs to be done to keep that person safe for now? Not safe tomorrow or next week. What do we need to do to keep this person safe for now? What's the answer?

SPEAKER_02 0:23

Welcome to Recoverable. I'm your host, Terry McGuire. So today we continue our discussion about suicide, suicidal thoughts, and how to protect yourself and the people in your life when they rise up. As rare as these conversations are, you probably have not had or heard them. So be aware that feelings might come up. And you might want to step away from this and take it in chunks, not listen to the whole episode at once. You might want to skip it and just come back next week when we're talking about a different topic. And also, if you do want to talk to somebody, remember that in the US and the UK, there is the 988-247-365 days a year lifeline that you can call and talk to somebody. Dr. Sarah Kolbeck, welcome back. I'm so glad you're here. Yeah. Thanks for having me. We get to continue this conversation. Yeah. So last week we did a deep dive into the top five questions that are asked on the internet about suicide. And we'll get to the sixth through 10th plus a million other questions that I'll have. But before we do, for somebody who maybe didn't let listen last week or needs a reminder, what are the things that we need to really understand about suicide and suicidal thoughts so that we can protect both ourselves and the people in our lives who we care about?

SPEAKER_04 1:34

Yeah, I would say two main things that I would want people to know. First of all, thoughts of suicide are not uncommon. They are and can be part of the experience for many of us at one point or another in our life. And the more that we sort of talk about these feelings, the more that we make space for this conversation, the better off we're going to be in terms of supporting folks who might be having these thoughts or when we're having thoughts ourselves. I think the second thing that's really important for us to know and to acknowledge is that when we talk about suicidal thoughts, these thoughts happen on a spectrum. And so it might be just occasional passing thoughts with no real intent behind them, or it could be thoughts where there is real intent and a plan and there's immediacy. And then there are thoughts along that whole spectrum in between. All of those thoughts are valid. All of those thoughts are part of someone's experience. And I think when we understand that, that really helps us kind of grasp the nuance of this issue and helps us to better support folks.

SPEAKER_02 2:37

Thank you. This question, we're going to sort of pivot to teens for a bit.

SPEAKER_03 2:42

Okay.

SPEAKER_02 2:42

And the sixth most asked question about suicide on the internet. What are the warning signs of suicide in teens and how are they different than in adults?

SPEAKER_04 2:50

So we talk about warning signs as things people say, do, or kind of the moods that they that they share. And so teens show or share, demonstrate many of the same kind of warning signs that adults do. However, with youth and young people, what we tend to see is more impulsivity and engaging in reckless behavior without regard for their own well-being. So we might see things like reckless driving. We might see things like engaging in risky sexual behavior. We might see things like going to a party and taking pills. They have no idea what they are. They know that these pills are dangerous and might be fatal, but they're going to do it anyway. So there's kind of that engaging in those reckless activities again without really having any regard for what impact that's going to have on their life moving forward. So again, we're looking for those things that are impulsive, those things that are, you know, out of character. We also know with teens that oftentimes they are not talking to their parents or their teachers or their coaches about these things. They might be talking to their friends. They might be posting things on social media, things that we don't typically think of or necessarily think of with adults. So really important for us to equip our young people with an understanding of what those warning signs are in case they see these things in their friends, they can get a trusted adult to help navigate that situation.

SPEAKER_02 4:18

I don't think I've ever talked to a teen who had a friend who was in crisis who was not told that fact in secrecy. Don't tell anyone. I won't be your friend anymore if you tell anyone.

SPEAKER_04 4:32

Yes, that is something that comes up a lot. And I think we need to, again, educate our teens to know to say, I'm going to do my very best to keep this a secret. But if there's something that you tell me or something that comes up in this conversation that makes me worry about your safety, I'm going to have to get an adult involved. Um, I I don't want to keep the secret if it's gonna result in you harming yourself. So I would say in that situation, don't make a promise that you can't keep. Be open with that person and say, I'll keep the secret the best I can. But if I'm worried about you, we're gonna have to get some help.

SPEAKER_02 5:07

I had a school school guidance counselor tell me that she tells her students was that exact phrasing, right? I I won't be your friend anymore if you tell someone. She said they might not be your friend anymore if you don't.

SPEAKER_04 5:19

Yeah.

SPEAKER_02 5:20

And I was like, oh, that makes sense. So she told them to just write so-and-so is in, you know, really dark place and not sign it and stick it under her door. You've communicated it, you've sit made the person safe, and maybe you can convince yourself you kept your promise or something, but it it would be it might be an easier move for a teen.

SPEAKER_04 5:38

I like that idea. Yeah. Yeah. I think taking the pressure off the young person as much as we can is really important.

SPEAKER_02 5:44

I've raised three teens and I know that the angst and the moodiness, and there are a lot of things that in one situation you could say, oh, this person is really struggling, really in crisis, maybe suicidal, or wow, teen, those teenagers are rough. Yeah. How do you know the difference between the two?

SPEAKER_04 6:01

Yeah, I think really watching out for changes in mood that are out of the ordinary. Um, yes, there's moodiness. We can be moody at all ages. Um, honestly, it's definitely uh, we definitely you talk about kind of the the stereotype of the moody teenager. And I think in those spaces, again, being really being an expert noticer um in the space of, again, if things are really off, if things are ramping up, if we notice, again, substance use maybe coming into the picture, those are typically warning signs that need to be addressed.

SPEAKER_02 6:32

I really appreciate you bringing up the phrase changes in behavior, because I, as an adult who really cares and is um is somewhat informed on this topic, when I look at the risk factors of suicide, I'm not sure I can really internalize those in a way that I would be watchful for them.

SPEAKER_00 6:51

Yeah.

SPEAKER_02 6:51

But if you tell me somebody's different and you notice it, and you say, hey, you used to really enjoy swimming. You know, you used to do this in high school, you used to have friends over, those changes you do notice. You can't help but notice, and they're easier to name maybe than you seem to be struggling psychologically, which is like, you know, a really not well received product.

SPEAKER_04 7:15

Yeah, I agree. And there's a a training framework that I am aware of, um, assist training, if anybody is interested, that talks about this in the space instead of risk factors, invitations. And these invitations are these changes in behavior that we talk about. If we tend to think within the scope of risk factors, we can miss things, right? Because, oh, this person isn't having increasing substance use. This person doesn't have a history of mental illness. They maybe haven't experienced uh trauma. These people can still have suicidal thoughts. And so, again, looking for those invitations, um, looking for those changes in behavior, again, can be, I think, easier for us to sort of hold in our heads. And I think it also those changes in behavior can sometimes even trigger kind of those physical feelings that we might have, this feeling in our gut that is that cue to reach out to somebody.

SPEAKER_02 8:04

Tell me what you mean by invitations.

SPEAKER_04 8:06

So an invitation is a person inviting us to explore the thoughts that they might be having. Okay. So when we think about invitations, we might think of things that are uh maybe kind of like fishing. People are kind of tossing out these invitations, uh, maybe saying some of the indirect things that we talked about in the last episode, maybe saying things like, I don't see a way out of this, or this is just too much, or maybe they're tossing out an invitation that looks like giving away possessions, or they're tossing out an invitation around drinking more. Those are invitations that the person is sharing with us to start to explore with them. Um, that might be a conversation starter. Like I have noticed that you've been drinking a lot more than usual. Sometimes people, when they're really stressed out, start to drink more to help them feel better. What's going on? Um, exploring that a little bit more can help open that conversation. Invitations. That's a really interesting word. Yeah. Yeah. That's the assist framework. I would highly recommend it for anyone who's interested.

SPEAKER_02 9:06

I assume it's an acronym and that the I is the invitation.

SPEAKER_04 9:09

No, uh, assist is applied suicide intervention skills training.

SPEAKER_02 9:13

Is a sudden improvement or calmness after a depressive episode actually a danger sign?

SPEAKER_04 9:19

It can be for sure, especially if someone's had a prolonged period of depression or anxiety. Um, that sudden shift in mood, um, that sudden happiness, that calmness, maybe a sense of relief or um kind of outward signs of relief could be a sign, again, that a person has settled on um a decision to attempt suicide, has decided on a plan, and they're starting to maybe feel that relief that they are gonna feel better. Um, and so again, that is a change in behavior that is sudden, that is out of the ordinary from kind of what we've seen in the recent context for this person. And it is again an invitation to have a conversation.

SPEAKER_02 10:01

I'm deciding if I'm gonna ask a question and I might edit this out because I had a was hosting a panel on suicide prevention, and um, for some reason, I got up in the middle of it to get some water for the panelists. And as I passed a woman, she grabbed my arm and said, make it clear that not everyone dies. And I just I had to turn around and go back because I was leading the panel. But I remember feeling like I'd been punched and I just thought, who are you taking care of and what is their condition? So when you say they're gonna feel better, there's no guarantee. And they're not if they if they do end their lives, they're not gonna feel anything, not gonna feel better. They're just not gonna feel bad, they're not gonna feel bad anymore. But is that something that we should talk about?

SPEAKER_04 10:44

Yes. I think that I think it is because when a person is thinking about suicide, that seems like the answer to this whatever is going on in my life. That is the answer that this is going to be over. This horrible thing that I'm feeling that I can't see any way out of is going to be over. Um, and I think it is important to talk about because I think that is and can be front and center in the mind of a suicidal person. And so I think this is where a conversation with that person can be so important to help them see other solutions to this issue. This is not the only solution to this issue. Let's talk about other potential solutions. What is going to keep you safe? What is the solution right now to keep you safe? So I think it is important to talk about that, that a person might be thinking that. And that's why they might be feeling this calmness, this sudden happiness, this relief, because this is going to be over. This is the solution. And it's our job as people who care for and support this person to help them think about these other solutions that are out there that they might not see in this tunnel. We should support them in being able to see the light at the end of that tunnel, other lights at the end of that tunnel that don't involve them taking their own life.

SPEAKER_02 12:02

So you use the word tunnel, and that's the phrase tunnel vision and blinders, you know, that the metaphor of like a horse is blinders. You really can't. Yeah. It's it's not that I mean, what is unresourced is is a word that I've started to use a lot because you really can't come up with any other solution to what you see as a never-ending problem.

SPEAKER_04 12:22

Yeah. Yeah. It does, it does feel like that. Um and, you know, we talked about this, I think, in the last episode, that uh it doesn't take much sometimes to move that blinder just a little bit back or to expand that tunnel just a little bit so that you start to see a glimmer of something else. Um, and again, this is a really powerful thing that we can do as somebody who's supporting a person who is suicidal, is to help kind of expand that view, to help remove those blinders a little bit, um, to introduce hope into the conversation. Um, because again, that is going to bring other solutions in that, oh yeah, I don't really want to do this right now. Like I want to stay safer right now because of this thing.

SPEAKER_02 13:10

All right. So talk about hope. Because when you lose it, you lose it, right? You do. And if you're in this little confined, unresourced space and someone's saying, you won't always be there, you're loved, does it get in?

SPEAKER_04 13:23

I don't think it always gets in.

SPEAKER_02 13:24

Yeah.

SPEAKER_04 13:25

Um, I think it can be really difficult to break into that space in some in some situations. And unfortunately, we do still lose people to suicide. And I think it's important that we name that that sometimes, despite our very best efforts and all the following up and all the caring and all the warm meals and the support, we do lose people to suicide. But I think, again, in in most cases, that message does eventually come through. And there is eventually that recognition that this is not the only solution in this situation.

SPEAKER_02 14:03

I'm glad to hear that. The seventh most searched question on the internet about suicide is what is passive suicidal ideation?

SPEAKER_04 14:10

Yeah. I love that question because again, it talks about that spectrum that I mentioned right at the beginning. So passive suicidal ideation is can look can look a couple of different ways. It might be uh not even necessarily a thought about dying, maybe just thought about morbidity or what we might think about like hurting, hurting yourself, like, oh, like this, this might help me to feel better. Um, so sort of that not even thought of mortality, but maybe of morbidity and just and you know, harming yourself. It might look like, you know, thoughts of I can't do this anymore. I wish I would go to sleep and never wake up, or I would be okay if I went to sleep and never wake up. But there's really no sort of intent to kind of follow through with any of those feelings. That's what we might consider passive. Passive can also look like I want to die. But again, there's not a plan. There's not that intent, there's not that immediacy. Um, those are more sort of passive thoughts of suicide that are, again, totally valid and part of that experience.

SPEAKER_02 15:10

And for some people, it could almost feel like a safety bell. Right. It's like I I always and I've heard therapists say you've always got the option. And I'm like, don't say that to people. Yeah. But they must know more than I do that there might be some comfort in thinking there's an option. There's the option.

SPEAKER_04 15:29

Yeah, the option is there. If we take that off the table, I think that can be really scary for people. And I agree with you. When I heard therapists kind of and and social workers kind of talking about this, and when I've heard people with lived experience talking about this, I that kind of was like counterintuitive to what we think about in the space of suicide prevention. But for some people, like you said, it might sort of be that safety valve. Like I just need to know it's there. Like I'm not necessarily going to do anything about it, but I just need to know it's there. And that's fine.

SPEAKER_02 15:58

That's valid. Are there common situations or triggers to use that word that would tip something from being passive to active?

SPEAKER_04 16:08

Yeah. I mean, I think again, we talked about this last episode. Suicide is complex. And so it's never, you know, just one specific thing, but there are certain life stressors that happen that are associated with increased suicidal behavior. We think about loss in this space. So that could be, you know, loss of a job, loss of a relationship, loss of a person through death or suicide. Um, certainly loss of independence, loss of identity. I think those are big, particularly when we talk about suicide in older people. Um, so loss or a certain type of loss can certainly is associated with increased suicidal behavior. Um, another thing that I don't think we talk about enough in the space of suicide prevention is lack of access to basic needs. And the way that I like to think about this, and I don't know if listeners, viewers are aware of kind of Maslow's hierarchy of needs. When we think about kind of all of the needs that a person has in order to be sort of what we might call well, um, at the very bottom of Maslow's hierarchy of needs are kind of our physiological and physical needs. If we don't have shelter, if we don't have clothing, if we don't have food, if we don't have safety, it is very hard for us to be mentally well. And so that lack of access to basic needs, especially if this is a person that doesn't see uh any sort of improvement in this, can certainly be a tipping point. Um, so we think about, you know, eviction, when we think about intervention points for prevention, people who are about to be evicted, for example, people who are about to lose their job and therefore access to insurance can be a really important kind of tipping point.

SPEAKER_02 17:54

When you brought up the bottom of Maslow's hierarchy, I want to make clear that it's not the pinpoint bottom, like insignificant. It's the base, it's the widest piece of the triangle and the most important.

SPEAKER_04 18:07

I'm so glad that you mentioned that because yeah, when we think about a pyramid, the base is the foundation. And so these physical, physiological safety needs are the foundation for wellness. And if we don't have that foundation for wellness, it's really hard to get there. And so uh basic needs need to be part of that conversation.

SPEAKER_02 18:27

So you've done a really good job of pointing out that it's not just, well, that person was mentally ill, which is the immediate assumption. And the Venn diagram has a big crossover. It certainly does. And somebody who lives with depression, I know that those thoughts can be a symptom.

SPEAKER_04 18:46

I I'm really glad that you mentioned that because so I'm a public health person. So I tend to think big sort of uh community society policies. And I don't want to minimize the importance of mental health and the relevance of mental health in this conversation. My own suicidality was rooted in anxiety and generalized anxiety disorder. When we talk about mental illness and suicide, as you mentioned, there is a pretty strong overlapping Venn diagram. We know that depression is the most common mental illness in our society. Depression is also the mental illness, the mental health challenge that is most associated with suicide. And so when we think about that Venn diagram between mental illness and suicide, a big portion of that overlap is depression. And so, again, really, really important for folks that are experiencing a mental health disorder, that live with anxiety, depression, you know, other uh major depressive disorder, et cetera, are really important for those folks to have the support they need.

SPEAKER_02 19:50

So the next question from the internet addresses one of the many misconceptions, um, but very common about suicide. Is suicide selfish?

SPEAKER_04 20:00

That is a very common misconception that we hear. And I would push back on that and say suicide is actually, from the perspective of a suicidal person, is actually the opposite of selfish. Um, as I talked about in the last episode, many people who think about suicide are or maybe one of the factors that contributes to suicidal thinking is feeling like you're a burden to other people in the sort of the field we call it perceived burdensomeness. And it's a major component of that desire to die and what can make up that desire to die. And so, and so when we think about suicide in the context of selfishness, it's actually the opposite. Typically, people who are thinking about suicide and are feeling that burden feel like taking their life will make life easier for other people. Um, so again, it's it's selfless, not selfish, because taking myself out of this equation is going to make things better for other people. So you really aren't thinking about yourself. You are thinking about other people and how you can make things better for those other people. So suicide is not selfish. Oftentimes, people who think about suicide feel like a burden. And so one thing that we can do is to remind people that they're not a burden. I don't mind being here for you. I care about you. I love you. I want to support you.

SPEAKER_02 21:15

And it is, I think, important to point out that that's distorted thinking. It is distorted thinking.

SPEAKER_04 21:20

Yes. Yeah, feeling like you're a burden to other people. Yes. I think that's really important, is that is distorted thinking. It's our minds and our brains kind of lying to us about the burden that we place on other people. And so in reality, you know, again, I wasn't a burden to my family. Um, people who are suicidal are not burdens, um, but it does absolutely feel that way in your brain when you're suicidal.

SPEAKER_02 21:43

While you were speaking and I was listening, but I was also calling to mind um the exact verbiage that survivors or people who attempt were going to attempt, have said to me that, you know, it's I was removing the burden that is me. Everyone My life, including my pets, would be better off without me. I mean, it is, it is, I don't know that I've talked to somebody who didn't say that.

SPEAKER_04 22:07

Yeah. Yeah. I think it's a pretty common experience for folks who, in fact, it's it's such a common experience, that distorted thinking around perceived burdensomeness, that it's part of what we sort of teach about reasons people die by suicide. So it's it's quite common.

SPEAKER_02 22:23

So another of the things that people pretty commonly believe is that if someone does bring up being suicidal or having these thoughts, they're just doing that to seek attention.

SPEAKER_04 22:34

Uh it can be very, I think, tempting to sort of think that, especially if someone is bringing up those thoughts often. Um, there can sort of be this, oh my gosh, it's this again, you know, sort of thing. They're just looking for attention. And I would encourage folks to kind of shift your thinking around that. If someone is at a point where they're talking about suicide, there's some distress going on in their life. Um, this is not something fun that people go around and talk about, right? And so if someone is bringing up suicide, if they're talking about this, there is something going on that needs attention.

unknown 23:08

Yeah.

SPEAKER_04 23:09

So not necessarily about seeking attention, like I want to get your attention when I say this, but this person is in need of support. Whether or not it ends up actually being about suicide, we care about each other. We should care about each other. And if a person is saying this, they're in a space where they they actually need attention.

SPEAKER_02 23:28

I would actually push a little further, not challenging you in any way, but if someone has to say that to you to get attention, maybe you need to be a little self-evaluative and say, like, oh, like how many signs before this am I have I missed?

SPEAKER_04 23:45

Yeah, I think that's such a good point. Because again, as we talked about, I think in the last episode, this is a really hard thing to admit, to say out loud to somebody. And so if a person is at that point, again, there may have been things that um, you know, uh we need to think about um ourselves as a person that's receiving this information. And again, this person is at a point where they are are needing support. Yeah.

SPEAKER_02 24:10

So not seeking attention, but letting you know, hey, I need some something, something needs attention.

SPEAKER_04 24:16

Yeah, it's about those invitations. Yeah.

SPEAKER_02 24:18

Oh, the word. There's someone I follow on social media, and honestly, if you saw my feed, you'd be very concerned about me. I get the like, are you okay? Quite, you know, which is good. I'm glad to see them, but um, it's it's quite a feed. But there's somebody, and I don't know how to say his last name, it's M-E-L, Mike J, I'll say Meal. And I want to get your reaction to this quote because it's one of the thousands I have screenshotted on my phone. He writes, people don't die by suicide due to depression to hurt you. They do so to keep themselves from hurting. They want to protect you from having to endure someone they believe to be worthless, unlovable, and a burden.

SPEAKER_04 24:54

Wow, that's powerful. Yeah. And I think absolutely speaks to that, that distorted thinking that leads to that perceived burdensomeness that we talked about a little bit earlier. Um, there is so much pain in this experience. Sometimes it's it's physical pain, it's it's mental and psychological pain, but there's so much pain that is wrapped up in this experience of um suicidal thinking. And one of the things that I like to say is the antidote to pain is connection. And so, how can we meet that pain with connection?

SPEAKER_02 25:26

And I don't remember thinking everybody'd be better off without me. I'm a burden. I do remember thinking nobody would give a damn. Nobody would care. Yeah. Like would they even notice, you know?

SPEAKER_04 25:34

Yeah, I definitely felt the burdensomeness, especially in my role as a mother. Um, you know, feeling like I I I'm gonna feel this way forever, I'm not gonna be able to pick my load back up, my my portion of the load. And of course, this again was distorted thinking. Nobody was making me think this. This was in my brain. Yeah. So the burdensomeness was definitely there for me. But again, I think you raised an important point. This can look different for every individual, and all of it is valid.

SPEAKER_02 26:02

If burdensomeness is so common, it's such a weird word. It's like I've only used it in this kind of conversation. Would asking someone, do you feel like you're a burden to me, be a helpful question?

SPEAKER_04 26:14

I think so. I mean, I think it could at least be a starting point for a conversation. Like, are you feeling like you're a burden to me? And exploring that. Um, I think again, anything that we can do to broach this conversation. And if you're hearing things that might lead you to believe that someone thinks they're a burden, asking about that can open that door.

SPEAKER_02 26:35

Okay. As a parent, I gotta be honest and say that if you are dealing with someone who is whatever they might be, that has, you know, and including depressed, frequently suicidal, any of those things, it can be a lot. And you can look and feel exhausted and spent and and tired of it. You can be tired of it, it's a it's an okay thing to be. But doesn't mean you want it to end by their life ending, right? It means you would like the situation to end because it would be nice to think about something other than that. So if you're actually feeling and maybe exhibiting that you are just buried in this, yeah, how do you communicate?

SPEAKER_04 27:14

I'm willing to feel this way if it helps you, or what's the so I think, and I I love that you brought in your experience as a parent because I am also a parent and um have had similar experiences in my own life and my own family. And it is exhausting. And I think um there's a bit of a both and here. I think we do need to, as caregivers, allow ourselves space to feel the things that we're feeling. I think we as caregivers need to have our own support. We can't do this alone. And I think we need to know when it's time to get other people involved so that the burden is not on us. As mothers, and I'm sure as fathers, um, you know, you I think we may have a tendency to feel like this is my job. I have to do this. Like I'm I'm the parent, I should be able to do this. Or the partner. Yeah, or the partner. Um, we're human and we can't. And so I think relying on um knowing when I've I need to tap out here. And, you know, being willing to bring other people into that support network for that person is so important.

SPEAKER_02 28:26

Yeah, I'm really glad you said that because I I know that it could be difficult if somebody's dealing with this. Um, I had a interview guest say, you know, my sister was chronically suicidal and have made several attempts. It would be hard not to show somewhere. Yeah. And even in patience or whatever it might be, whatever it might be, because we're also humans. So yeah. Okay. The ninth most searched question about suicide on the internet is how long does the suicidal crisis last?

SPEAKER_04 28:52

Great question. And what we know from research is that some of these crises can be very, very short, minutes. Um, and again, in in when we think about the space of prevention, what are we doing in those minutes to get that person past that crisis? Some people can be in crisis for longer periods of time, but really that point of imminent crisis can be incredibly short. And so, again, what needs to be done to keep that person safe for now? Not safe tomorrow or next week, what do we need to do to keep this person safe for now? What's the answer? It depends on the person. It depends on the person. One of the things, though, that we do talk about that is evidence-based in terms of safety and security around suicide is limiting access to lethal means, which is a researchy term for saying, um, making sure the person doesn't have access to something they can use to harm themselves. Um, that includes things like firearms, medications, um, other uh potentially dangerous substances. One of the things that we can do in the moment for someone who is suicidal if they're in a crisis is to make that environment as safe as we can. Lock up firearms, lock up medications. Another thing that I like to talk about, especially in Wisconsin, is removing alcohol from the environment. Alcohol can kind of be like uh pouring gasoline on a fire in some of these situations. And so again, what can we do to make that environment physically safe for the person in the moment? That's something all of us can do.

SPEAKER_02 30:27

Um, this may be a Wisconsin comment too, but people really like their guns if they have guns. And I know that, you know, when we say, we'll lock up your gun, that that is going to be like there are gonna be some people listening saying, Don't touch my gun. Oh, yes. Can also lock up their ammunition and say, give it to me until you are past this. Yeah.

SPEAKER_04 30:44

Yeah. I think that's real. Um, I do a lot of work around firearm safety in the context of suicide prevention in Wisconsin. There are so many different attitudes out there around what safe storage looks like, what it means, what responsibility means. And so it could be give me your ammunition. Um, it could be um, let's store that gun separately from the ammunition. Sometimes it could be something like, hey, I'm just gonna keep these at my farm for you for a couple of weeks until we get past this point. Um, so safe storage, secure storage can look differently, but really the point is interjecting time and space between a person and their chosen means to end their life. Even minutes between a person and their chosen means can make a difference.

SPEAKER_02 31:34

So it'd be very easy to listen to that and think take my gun, I'll just use blank. But that's not what research shows.

SPEAKER_04 31:42

It's not. Um, so that's what we call mean substitution. Um, mean substitution is a concern for people. And I'll give you an example. So I live in Milwaukee. Um, and we have had over the years several suicides from a major bridge in our community. Uh, about a year and a half, almost two years ago now, uh, barriers were put up on this bridge to prevent um suicide, to prevent other things from happening from the bridge. Since that time, we have had no suicides from the bridge, and we have not seen an increase in suicide in other parts of the community. So there was a fear, okay, we're gonna see other places or other things tick up. We haven't, we haven't seen that. Means substitution typically does not happen. It doesn't mean it never happens, but it means if you sort of remove a person's access to their lethal mean, they're not just gonna go find something else. Um, typically, again, that gives that person time to reconsider, time for an intervention to happen in a way that is not going to lead to another attempt.

SPEAKER_03 32:49

I was so surprised when I learned that. Because I just, you know, but that's not how it happens. It's not how it happens. And that's not to say it never happens, but this typically is not how this happens. Right. Yeah. How do we follow up on that?

SPEAKER_02 33:03

So there's if the suicidal crisis can last as little as, or is that the right word, as little as a few minutes? What about after those minutes? So we've sat with some of them, we've removed or restricted their access to the means they were going to use. Maybe you're physically sitting with them and they're in a different space. They say they're not in crisis anymore. Bye?

SPEAKER_04 33:26

Yeah. I know that can be uh, yeah. And I think that's a great conversation. So there, I think there's a couple of options, a couple of things that we can do here. One of the things that I like to suggest is developing a safety plan. You don't have to be a clinician to do this. In fact, there are safety plan apps you can download on your phone. It's called one is the Stanley Brown Safety Planning App. It's basically a plan that helps people uh sort of think through and know what to do when they're in a crisis situation. And so listing uh what we might call reasons for living, listing people you can call, listing signs that you're in a crisis, um, having all of that information in one spot, whether that is on a sheet of paper that's hanging on your refrigerator or in a phone app, when a person is experiencing that tunnel, that distorted thinking, having a place to go with that information can be really helpful. So if you do a safety plan with someone, particularly when they're past a crisis or not in a crisis, they'll have this information accessible if they do get to the point of a crisis again. Um, I think another option is to offer to connect that person to a mental health professional. Maybe not somebody they're gonna see today, but maybe someone that they're gonna connect with to get further steps. Um, I think 988, again, the person doesn't have to be in crisis to call 988. I think that can be another option. Um, and then of course, you know, offering to check up on the person. Okay, this situation, this just happened to me last week. So this is very fresh in my mind. I was very concerned about a person. We talked, um, there was a conversation that happened, they were no longer in danger. We followed up the next morning and then we called him again the next day. And then we made sure that he was connected with a mental health professional and we checked in him on him after the weekend. And so um, that follow-up. Um, and if you say you're gonna follow up, actually doing it is really important.

SPEAKER_02 35:20

So that scenario you just gave, he was no longer in danger. You didn't know that.

SPEAKER_04 35:25

First of all, that we had to acknowledge in the conversation that we were talking about suicide. He was, you know, definitely tossing out some invitations, things that were making me concerned. And I asked the question, are we, I want to make sure I understand, are we talking about suicide right now? And he said yes. And so, you know, again, I said, um, that must have been really difficult. I appreciate you telling me. Um, we had a bit more of a conversation about what was going on. I asked him if he had firearms in his home. He said no. I asked him if he had access to any other, you know, kind of dangerous things in his home. He said no. And through a phone conversation, um, was able to sort of hear through the conversation we were having that the situation was de-escalated. And so, um, and I was kind of tag tag teaming this to the coworker. Um, so we were able to kind of both have a conversation with him. We agreed that, you know, based on the conversation we had, it seemed that the danger had decreased. And so again, that was when we implemented that plan to keep following up and made sure that he had access to resources right away if he needed them.

SPEAKER_02 36:36

So you talked about a safety plan and another one that I have filled out is the wrap plan, the wellness recovery action plan, I think is what it stands for. And a part that I think is important, or at least for me, is to share it. Yeah. Right. So it's like when I make that call, if I make that call to say, like, oh, I am in a really bad place, and hopefully it'd be my little sister I would call, would know what that means. Yeah. If she could pull that out and it's like, have you? You know, who do you call? What works? And people have such interesting things that they put on those plans, you know, a box full of pictures of when things were good. Yeah, a note in your own hand. I sound so old when I say that, but not, you know, computer um that says, Hey, you, yeah, you've been here before. I have a voicemail on my on my phone that says, didn't think we'd be here again, did you? But here we are. Yeah. You can do this. You've done it before. It passes deep breaths, you know, all the things I know that help. Yeah. And I'm not chronically suicidal. You know, I I hope I never have to listen to it until just this minute I forgot it was there. And it's probably one of 300 voicemails. I should probably name it or something. But um there are so many ways we can protect ourselves.

SPEAKER_04 37:46

Yeah. I have, um, and I'm glad you mentioned it. I have the keep app on my, I'm an Android user. So the keep app on my phone, I've got my therapist called them coping cards. And so um, just little statements like, you are not alone, you can do this. Um, I can't remember what the other ones are. And I haven't used them in years, but they're there. And so again, yeah, something like that, it doesn't have to be a grant intervention. It can be something meaningful that's as small as I love the voicemail or the coping cards or a handwritten note or pictures. Sometimes it's a song that can help kind of bring a person back. Okay, yes, I'm starting to feel the hope.

SPEAKER_02 38:28

The hard thing to find. Yeah. So how do and maybe we've just answered this in this discussion, how do we protect ourselves through a suicidal crisis when we don't know it's gonna pass? I can sit here with you and say many last only minutes, but when you're in it, you are not thinking almost done. Yeah. You know, it's not in seven minutes. Yeah.

SPEAKER_04 38:46

Yeah. So I think if you recognize that you're in a suicidal crisis and you don't have something like a safety plan or a wrap plan or coping cards or whatever it looks like. Or those aren't working. Or those aren't working for you. I think that's a it's a pretty important cue to try and get somebody else to support you uh in that moment. Um, because it is possible that you will not be able to see uh the end of the situation, that you won't be able to see your way out of it. But if you're recognizing that you're in it, you're recognizing that you're needed that you need help. For me, what I did is drove myself to the hospital as scary as it was. And I work for a medical college and hospital system. So I drove myself to a hospital that was not affiliated with our hospital system because I didn't want to encounter any of my coworkers. But sometimes that's what you need to do. Drive yourself to the doctor, call 988, call a friend. Um, if you are recognizing yourself that you're in a suicide crisis, you you can't expect it, you can't be expected to try and navigate that on your own. Um, that is a time when you um should give yourself permission to seek help from others.

SPEAKER_02 39:53

Let's talk about all the time before that. You know, because I I know with depression, it has become my, you know, one of my key takeaways from everything I've learned. You gotta know your early warning signs. Because if I'm starting to slip, I have a number of tools I can access that will help me. If I am in it, all bets are off.

SPEAKER_04 40:14

And I think that's where something like a safety plan can be so helpful because that you list literally list out those early warning signs. Um, and I think being honest with the people around you, um, you know, if if you see me start to do this, um, that's a that's a cue to you to maybe reach out. And of course, in an ideal perfect world, we're doing this before we're in the muck, before we're in a crisis, before we're getting to a crisis. That's not always how things happen. Um, and sometimes we have to take other steps. Um, but I think recognizing those warning signs as as hard as it can be sometimes and being willing to admit to yourself that you need to seek help is really important.

SPEAKER_02 40:57

All right. The 10th most asked question on the internet. What did someone expect if they go to the emergency room with suicidal thoughts? And you said that you've driven yourself there. So you're the perfect person to ask.

SPEAKER_04 41:08

Yeah. I drove up to the emergency department, I walked in the front doors, I went to the triage desk and I said, I am so anxious. I don't know what to do with myself. I'm really desperate. I need help. Um, they didn't make me sit in the waiting room, which was lovely. Um, thinking back on it, they brought me back into a room. Um, they got me connected with um sometimes what uh folks will do in the emergency department is they'll have an on-call psychiatrist that they'll call and have you talk to on the phone. That happened with me. They had an on-call psychiatrist. They handed me the phone. I talked to her for quite a long time. She kind of helped me assess, and I imagine my doctor kind of assess what um where I was at and what I needed in that moment. Um, in my case, it was medication. I was given medication in the emergency department. And then my husband came and picked me up and brought me home. That's not always how things transpire. Typically, what happens first is you will have a medical evaluation to make sure that there is nothing medically wrong with you. When you go to the emergency department, they're looking for the big things that are going to be of danger to you. So they're gonna want to rule out those big things. I was having chest pain because that's one of the ways my anxiety shows up. So I had a chest x-ray to make sure I wasn't having a heart attack or I didn't have pneumonia. They did an EKG to look at my heart to make sure I wasn't having a heart attack. So they will rule out those medical things and then they'll start to get into more of the mental health things. So that might look like an on-call psychiatrist. It might look like a social worker who's in the emergency department. Um, they will assess kind of what is going to be, in their judgment, kind of the best um thing for you next. In some emergency departments, they will have someone come to sit in the room with you while you're there. Um, sometimes that person is a peer supporter, sometimes it's just a pair of eyes. That doesn't always feel the best. Yeah. But uh they're trying to keep you safe in that space. And then the outcome really depends on, you know, what the the team, the medical providers, and then the mental health providers decide uh is going to be the safest next step for you.

SPEAKER_02 43:20

You expressed what you were why you were there. Yeah. You know, using words like anxiety. I a 988 operator told someone I interviewed to walk in and say, I'm having a psychiatric emergency. He said to her, they'll know exactly what you mean. And just like you, they'll take you back. You're not going to be sitting there for hours. There's so I it's it can go, it can go sideways. You know, I mean, a lot of people, whether they have heard stories about very traumatic experiences or have had their own, it's a fear. If I like, well, here's a question if I walk into the ER and say I'm suicidal, will they put me in handcuffs or restrain me?

SPEAKER_04 43:54

That is real. And it does happen. Um why and when? So I I do think that, and I'm gonna make a general broad statement, I do think that we are getting better in our healthcare spaces at understanding that nuance and suicide and understanding that sometimes coming with lights and sirens and putting people in handcuffs does more damage than it does good in many situations. So I would say, on the whole, that is not going to be immediately what happens to you. Um, even if a hospitalization is the outcome, typically that in and in in Wisconsin, at least that will involve somebody coming to do an assessment and having a conversation for you. It's not going to be immediately you're going to the hospital. We're calling police right now. There will be a conversation. But again, it does happen. I think when we see this happening is typically when someone has already maybe made an attempt or uh when there's um, you know, really, really clear and a clear danger that something is going to happen imminently. Again, that's not most cases. Most cases, uh, someone that's having a psychiatric emergency and needs help in that moment. And you're gonna, in most cases, in a vast majority of cases, get that um that help without the lights and sirens that a lot of us are worried about.

SPEAKER_02 45:16

So if getting locked up is a number one fear, here's a related question from the internet. Will I get locked up if I tell my therapist I'm thinking about or planning to kill myself?

SPEAKER_04 45:24

So again, I think that is not the goal of your therapist. The goal of your therapist is to provide you with the help and support that you need to empower you toward that recovery that you're, I think, ultimately seeking. A lot of us are ultimately seeking that recovery. I think that, you know, in the past, that was a concern that was that was real and well-founded. I think now we have gotten to the point through research and through the work that we've done in the field of suicidology that most therapists understand that if a person expresses that they're suicidal, whether it's in a clinical appointment, that that person needs to be heard and supported, not necessarily put in a police car and taken to the hospital. So I would encourage folks to not let that be the barrier between you and talking to your therapist about how you're feeling. Um, your therapist is going to want to have that conversation with you that's going to help avoid that hospitalization. In fact, so I work closely with folks who uh work in crisis spaces who make determinations about involuntary hospitalizations. That is the last thing that they want to do. In most cases, people are wanting to find another another solution that does not involve that hospitalization.

SPEAKER_02 46:40

And yet, if they're mandatory reporters, would someone be better off asking hypothetical questions about a person who might be thinking about or planning to is that a way around it?

SPEAKER_04 46:53

You could certainly do that. Um, and asking your therapists like what their stance is on, you know, if someone were to come to your office and say, I'm feeling suicidal, what hypothetically, what would you do in that situation? And therapy is like a relationship. If that response to that question does not fit with what you're comfortable with, then maybe continue asking questions of other therapists.

SPEAKER_02 47:15

And there's the other side of that equation. Maybe you need care and maybe they will facilitate you getting it. Absolutely.

SPEAKER_04 47:23

Yeah, absolutely. And so I think however you're comfortable with broaching that conversation with your therapist, it's really an important one to have.

SPEAKER_02 47:31

So those are the internet's questions. What do you know to ask that they don't or I don't? What should someone be asking about the broad topic of suicide as we wrap up?

SPEAKER_04 47:42

Um, I think one important question for us to all ask ourselves is what can I do to create a community that is more supportive of people with thoughts of suicide? Because we know it's it's going to take a community. It's going to take our us as a community. And it sounds kind of hokey, but it's true. We need to have communities where it's safe to have these thoughts and people are supported. So, what can we all do? We can normalize this conversation like we're doing today. If we have lived experience, we can talk about that lived experience. We can notice, we can really pay attention to people who are around us and uh be willing to sort of have these conversations when they need to be had. So I think um we all have a role to play in this space and should we should be asking ourselves, what can I do?

SPEAKER_02 48:31

It's a really good way to end this. And I back to that quote with a lot of us are keeping the same secret from each other. Yes. It's like if we're both sitting across the table from each other saying we have lived experience, and the people, a number of the people watching, you know, do or they wouldn't have been watching for two hours. So perfect. Thank you so much. Yeah.

SPEAKER_01 48:48

Thanks for sharing.

SPEAKER_02 48:50

Thank you for your research. Thank you for sharing your lived experience and thank you for all the work you do.

SPEAKER_04 48:54

Yeah, you're welcome. It's good to see you.

SPEAKER_02 48:56

Thank you for joining us and for listening to what may well have been an intense conversation to listen to. I want to remind you to take care of yourself. If you have a mental health care professional and you need to check in, do that. Otherwise, 988 is always available. And we'll be back next week doing a deep dive into another topic.