It crosses all lines: gender, age, socio-economic and cultural. No one is immune to thoughts of suicide.
Did you know that an average of 5,000 people show up each year, in mental health crisis, at the Psychiatric Assessment Unit at the Waterford Hospital or the other emergency departments in St. John’s hospitals? They come from all walks of life, are all ages and their issues are as individual as they are. It’s estimated that at least 20 per cent of them express thoughts or intentions of committing suicide as their chief complaint.
The number is actually higher than that: during their psychiatric assessment, even those who have not expressed thoughts of suicide, are often revealed to be at risk for it. And those are just the people who appear on our doorstep.
In 2013, there were approximately 12,000 calls to Eastern Health’s Mental Health Crisis Line.
Enter ASIST – Applied Suicide Intervention Skills Training, a two-day, interactive workshop that teaches suicide first aid interventions. An internationally-recognized workshop, it’s offered by – and to – a variety of groups in the province. At Eastern Health, it’s required training for all clinical staff in the Mental Health and Addictions Program.
Beverly Chard is a master trainer and workshop coordinator. A clinical educator with Eastern Health, she describes the workshop as ‘first aid for mental health.’
“Just as health professionals act quickly to perform CPR when someone suffers cardiac arrest, once we recognize the signs that someone is at risk for suicide, we must intervene quickly to help lead a person to safety,” Beverly says.
“When a person expresses thoughts of suicide, we often use the analogy that they are in a ‘river of suicide,’ heading for a waterfall. Though some manage to make it to shore by themselves, some people will need to be given help to get out of this dangerous current before they reach the falls,” she explains.
Some people give signals when they’re contemplating suicide. They take a variety of forms, but may include such things as isolating themselves, giving away their possessions or saying things like, ‘people would be better off without me’ or ‘there doesn’t seem to be any point in going on.’
These actions are actually an invitation to people to step in and help, according to Beverly. It is important to realize that anything can be an invitation and those trained to help need to be able to identify it as such.
“It shows they’re ambivalent or undecided about taking their lives,” she says. “They have come up with reasons why they want to die – but at the same time are looking for reasons to live. Our goal as mental health professionals is to hear their story about suicide and to support a person to turn to safety for now.”
Participants learn the necessary tools to create a ‘safe plan’ and ultimately prevent the immediate risk of suicide. The goal is that by the end of the workshop the participants are more ready, willing and able to do life assisting, suicide first aid interventions.
In Newfoundland and Labrador, for the year 2012, there were a total of 45 suicides, as reported by the province’s medical examiner. Thirty-six were male, nine were female and of the 45, four were youth under the age of 19.
According to the Canadian Mental Health Association, suicide is the second leading cause of death among youth aged 10-24 years of age.
“We have identified quality and safety as a strategic priority safety for Eastern Health,” says Beverley Clarke, Vice President with responsibility for Mental Health and Addictions. “As such, we have an obligation to ensure that our staff can recognize when a person is suicidal and then able to intervene quickly and effectively to lead them back to safety.”
Since the workshop was introduced in October 2011, more than 500 nurses, social workers and psychologists have taken part, with another 100 or so scheduled in the months ahead. Part of the training involves facilitated discussion, structured exercises and hands-on participation to teach our health care professionals the appropriate interventions, which can then be applied wherever a need is identified.
“There have been occasions, even in a social setting, when I have been asked to step in and provide assistance to someone at risk for suicide,” notes Beverly. “Not everyone will seek professional help, and this training allows Eastern Health employees to assist wherever and whenever a need comes to their attention, very much in keeping with our vision of healthy people and healthy communities.”
Despite the progress that’s been made in de-stigmatizing mental health issues, people are often still very reluctant to voice suicidal thoughts or plans, according to Linda Conway, a nurse at the Psychiatric Assessment/Short Stay Unit at the Waterford Hospital, who has completed the ASIST training.
“Sadly, because of this stigma, some people remain reluctant to speak up when they are suicidal,” Linda added. “Often, they feel a sense of shame about their feelings and may never reach out for help – which is tragic. So how can you recognize a suicidal person without knowing what to look for and asking the right questions to find that out? ASIST focuses on interviewing clients at risk for suicide and offers the tools to help them open up and receive the help they need.”
As vital as this intervention is to keep people safe from self-harm, do those who do the intervening themselves run the risk of being so ‘steeped in suicide’ that their work environment becomes a negative one?
Not at all, according to Beverly.
“Suicide intervention is actually a very hopeful environment, in that we offer help and hope to those who desperately need it,” she says. “We are offering a lifeline and helping to guide people back to mental health and wellness – and that is a very positive thing.
“Ultimately, I believe that hope is contagious!” ■
Do you know someone who needs help? Have you asked yourself some of the questions raised in this article? Call Eastern Health’s Mental Health Crisis Line at (709) 737-4668 or toll-free at 1-888-737-4668. It is available province-wide, 24 hours a day, seven days per week.
This story was written by Deborah Collins, a communications manager with Eastern Health, based in St. John’s. Photos by: Phil Simms.