Video Transcript: Suicide

Welcome back to mental health integration, after talking about the stats on  mental health and then which mental health issues were which and going  through the myriad of mental health issues that there were, but we need to take  some time and talk about suicide. Suicide and mental health are there together  a lot. So this is going to be a much more personal and much harder portion than the previous two. This is not in any way sort of removed and far away. We're  going to go through some tangible things to do as an individual. This is not going to be corporate. This is not going to be a large scale. This is what you can do as  an individual. We're going to go through a couple of stories, and we're going to  go through some of the statistics around suicide. So this is going to be a harder  space. So because of that, I just want to throw this out. This is going to be  information, but there could be some things, if you have experienced being  around suicide, this could be a little bit triggering. I have had the unfortunate  privilege of walking through and around families who have gone through  suicides, and I'll tell those stories in a few minutes. But so if this is something  really personal to you, please know that take some time do whatever you need  to take yourself. Now we're going to start with the facts and figures, so that you  understand exactly what's going on with suicide. In 2020 in the United States,  there were 45,797 suicides. Of those, 36,551 were males. 9,428 were females.  Of those, 40,155 were Whites, and 5,824 were non whites. I want to take a few  minutes just to talk about these stats and talk about kind of what's going on in  the United States. Males have a suicide rate of almost four to one compared to  females. It's 3.9 it's so much higher, it's just mind boggling. But that doesn't  necessarily tell the story of what's going on with desperation or what's going on  with hopelessness. Likewise, there were 40,000 suicides among whites, 5,824  among non whites. These numbers are actually not as disparate as they look.  They are quite desperate disparate, but they're not this. This jarring, the reason  being that the suicide rate for non whites compared to whites is around half. But  there's huge segments of the population that are far more white than non white,  and because of that, you just get very, very different numbers, even if the rates  aren't quite as Different as the numbers make them look like. Reason that  hopelessness isn't quite the same number as we think of is because of this.  There were 1,149,475 attempts in 2020 that is 25 to one the ratio of attempts  per suicide. So for every 25 attempts, there's one person who dies by suicide.  Girls, females actually attempt suicide at a three to one ratio, compared to men,  but men commit suicide or die by suicide almost four times as often. So when  we talk about suicide, we have to talk a little bit about which populations are  actually dying by suicide and what's going on now suicidal ideation numbers,  we're going to start there and then work backwards, have been going up a lot  over the last 10 or 15 years, to the point where suicidal ideation among teens is  around 10% in 2019 with about 10% of teens having points in the last year  where they were suffering from suicidal ideation. But the suicide rate for teens is

significantly lower because their rate of dying by suicide compared to attempts is about 100 to one, or 200 to one. The stats aren't clear because it's not clear how many attempts there actually are. Kind of, I mean, this is, this is not fun space to try and figure out exactly how many attempts versus how many suicides there  

were in the United States. Then when you start getting a little bit older, suicide  rates start actually going up. The highest rates of suicide in the United States  are middle aged men, specifically middle aged white men. The second most  high suicide risk race are American Indians or Native Alaskans, with suicide  rates that are very close to actually what white men are. Below that significantly,  about half are Blacks and Latinos, and even lower than that are women. And  then rate by by race, women, you have whites, and then you have the same sort of step down. So what's going on that so many people are dying by suicide? The rates on suicide are actually down a little bit. Suicide is 9012 leading cause of  death in the United States. It used to be the 10th leading cause of death in the  United States. It is the third leading cause of death in people under age 25 just  three or four years ago, it was the second leading cause of death under age 25  but the number of suicides has not really significantly dropped. It's dropped a  little, but not a lot, only 1000 or 2000 what we're seeing more and more is that  there are issues like opioids, that have gone up. We're actually seeing, we  actually saw the numbers of murders go up, which is really, really surprising in  kids under 20. Age 25 it used to be that suicide was by far number two,  accidents being number one. Now, homicides is number two and suicides is  number three. But what we're also seeing is there are these small pockets of  higher suicide risk that we associate with what's going on. So as you can see,  groups with a higher suicide risk include American Indians and Alaskan Natives,  like we just talked about, whites, specifically veterans, who have a suicide rate  almost 10 times as high as the general population, people who live in rural  areas, whether that's because they have less access to mental health services,  or because they have more access to firearms or more privacy or whatever it is,  and LGBTQ young people, specifically, having a suicide rate That is about 10  times higher than the general population. Now, some of these things have really  specific answers, and some of them don't. In the cases of LGBTQ youth, there  have been a number of nonprofits launched to try and work with them and try  and make things better. Same with veterans, same with a lot of these smaller  populations, because the suicide rates are just so high in some of these cases,  we know what's going on. In the cases of things like veterans, there are things  like PTSD at play, there's access to firearms. There's also issues of team and  family. When you've got a group of people that become so tight knit in the armed services, when they leave those armed services and they're suddenly alone,  there's not just the trauma of war, but there's also the loss of brotherhood that  comes with that, and it can be really, really hard for them to move through that at times. So now I want to talk a little bit about means. And this is not a really sexy 

topic. This is something that we just have to talk about, and that is that means  matter. Firearms are used in more than 50% of suicides in the United States.  Suffocation makes up about 29% and poisoning about 13% one of the reasons  that men die so much more often from suicide is because of the means they  choose, unfortunately, suffocation and suffocation and firearms are both very,  very effective in some of these populations, and they're used by those  populations. In a minute, I want to give a lot of guidance around how to talk  about suicide in general, there's not a lot of talk around means. And the reason  is because, if you tell somebody that you're worried about them committing  suicide, the odds of you implanting the idea that they should kill themselves is  almost zero. But if someone wants to kill themselves and doesn't know how, and you ask, Do you have a gun at your house? The odds of them latching on to a  means is much higher. So there's not a lot of talk about means, but we have to  talk about it a little bit, because when a mean of suicide, in this case, is so  effective, it doesn't give you a chance to screw up. There are studies done that  there was a man who saved a number of people on in San Francisco who were  jumping off the Golden Gate Bridge trying to commit suicide. And of those that  were saved, they tracked them, and 25% of those who were saved ended up  dying by suicide, which is bad, but 75% of those who had tried to die by suicide  that day but were stopped by a man did not go on to die by suicide, and in fact,  regretted that they had actually tried. So in some cases, we can see that suicide can be these acute points where pain gets to be too much. There's something  going on in the case of many youth who die by suicide, it's directly related to a  fallout with a peer group or with parents or with a relationship. So there are  these specific points life gets really, really hard right here we lose hope and we  want it to go away. But people who survive a suicide attempt often say that  they're so glad they did because they couldn't see that life could get better after  that point, and it does. So I want to talk a little bit more about means. Malcolm  Gladwell in his book talking to strangers, talks about town gas and coupling.  Now, in England, they used to use town gas, and it was a poisonous gas, and it  was used in place of natural gas, especially in ovens and in the way he tells the  story, it accounted for a significant number of the suicides in and around Great  Britain, up to close to 50% then tongue gas was taken out of stoves. All at one  time, you get this dramatic, dramatic change, the change of all these stoves,  and suddenly there is almost no tongue gas being used. So it's lost as a method of suicide. And instead of suicide rates staying the same and people finding  different means, the suicide levels dropped. And it looked like having a method  that was really, really effective kept the suicide rate up. In a way, it wasn't just  that people wanted to die. They had a really, really effective, really easy solution  to their problem, so they took it. In the United States, we have a lot of guns, and  they're are really, really effective means of suicide. I am not going to say you  shouldn't have guns or anything like that. But I am going to say that if someone 

is an active suicide threat, if you feel like you have an active suit, if you're  suicidal, it might be a good thing to say, hey, you know, I'm not thinking of, you  know, killing myself right now, but maybe I should. Have my friend take these I  am I'm starting to have these feelings that I could potentially hurt myself at some point. So I'll just take the means off the table. And what the research is showing  is that if the means are not available as easily, it's much less likely we're actually going to follow through, which is great news. That's fantastic news. It means that we have more control than we thought. Now I want to talk specifically about how to talk about suicide. You can't control the outcome, but you can make a  difference. I have been in more suicide trainings than I ever want to count, and  over and over it comes up, you can make a pretty profound difference. But there are some tools that you need to use now. There are specific signs that people  who are considering suicide often do. If they don't do these signs, that does not  mean they are not considering suicide. It means that these are common signs.  You can look for people who are giving away their possessions, who just lost a  job or just got out of a very serious relationship, people who are really, really  struggling financially. And then you can see those most likely to commit suicide  who are white males, specifically those other races you can look for as well, but  specifically males are the most likely to actually die by suicide. So if you catch  any of those sorts of clues, it's a good idea to talk to the person about suicide.  Studies have shown that if someone is talked to about suicide, their rates of  actually doing it go down. We're often told that don't talk to them about suicide,  because you'll plant the idea in their head. But the research has shown over and over, you'll not plant the idea they have the idea, or they don't have the idea.  You're not going to be the reason they commit suicide. You're going to be the  reason they talk about suicide. And because of that, they might just get better.  So if you need to talk to someone about suicide, there's some really, really  concrete, concrete rules. The first thing is this, actually use the word death or  suicide. Do not skirt around it. Do not use other words. Do not say, Are you  considering hurting yourself? Because someone might say, No, I'm not  considering hurting myself when they are considering killing themselves. It's just  one of these interesting things. But you can ask questions like, Are you  considering death by suicide? Are you considering trying to kill yourself? Are you considering suicide and just say it as bluntly as you need to, it can be really  jarring to go through. So in most cases, I would ask you to pause right now and  practice with a spouse or anybody who's around you and say, Hey, are you  considering suicide? You can talk about this in the case of someone who's lost  their job, saying, Hey, I know you just lost your job. That can be really, really  hard. I want to make sure you're safe. Are you considering suicide? Someone  might take it badly, that's okay. I would rather have them take it badly and be  alive than not have the opportunity and not be alive. The second thing is, if  someone says no, that's great, you don't have to worry about it. If someone says

yes, because they'll be as surprised you ask the question as you are in some  cases, then it's important to ask about next steps. Their next step after they say  yes. Is, do you have a plan? The next question after that is, do you have means  to accomplish your plan? The third question after that is, do you have a time  frame for your plan? In this case, you might say, Do you have a plan? And they  say, Yes, I was going to do such and such. And you say, Okay, do you have the  means to do that? Do you have that thing that it takes? They might say yes or  no. And then the third question is, and what's your timetable? And they might  say, I don't have one. Or they might say Tuesday. Or they might say this.  Afternoon, whatever it is, if they say yes, they are actively considering suicide  and yes, they have a plan, it's time to get some extra help involved. Now in the  United States, we have things like the National Suicide Prevention Hotline.  There are other resources across the world, wherever you're at as well, that help with those sorts of questions in the United States is really pretty phenomenal.  We can call a phone number and get a hold of a professional who can actually  walk us through next steps, and even talk to the person who's considering  suicide and walk them through next steps on how to get help if they're actively  considering suicide, it could be a situation where you actually need to help them  get to a safe space in the United States, you can do 72 hour mental health  holds. They are not meant to help you get better. They are not meant to  diagnose and treat diagnose and treat mental illness and make sure that you're  doing great. They are meant to keep you safe long enough that you can survive  until this immediate threat goes down, and then after that, we can work on  getting treatment in place. If you need those resources, please look them up. I  will include the data for the national suicide prevention hotline in the notes for  this class. Now a final note, you have to have really good boundaries, and you  have to have an idea of forgiveness. Because this can be really, really hard stuff  to walk through. I have had to walk through trying to prevent from people from  committing suicide on a number of different occasions, and some of those were  because of my job, working with mental health. I had a couple of clients that we  had to walk through suicidal ideation with, and some of those were personal and had nothing to do with my work or myself as someone with bipolar disorder. Any  of that, it just was what we were walking through with, somebody I cared about. I want to tell you three of those stories, how they ended, and then some things  that you need to know about moving forward. The first story is someone I was  related to, and they had been just blown up by their family. They had had a  really hard time with their family, and they were, at the time, actively considering  suicide. I didn't know it. We met for lunch, and we talked for about the next two  hours. And during that time, he asked me about my story and about how I got  better. We broke the ice on all sorts of things around mental health and mental  illness, and by the time that two hours was over, he said he didn't feel alone. In  that case, I never questioned him about suicide. I didn't know anything about 

questioning about suicide. I didn't know any trainings about suicide prevention. I  just told my story and I listened to his I got a phone call from one of my other  family members weeks later that said, you know that person you met with, they  were actively considering suicide. They were going to die if it was up to them,  like that day or the next day. But because they talked to you, they didn't,  because they believed they could get a little bit better. If somebody could make  it, they could make it. A story number one, that's kind of a best case scenario. I  didn't know what I was doing. I had no idea it was going on. It helped. This is  great. In the second case, I was married to the person that was struggling. I got  a phone call from my wife's school psychologist. My wife had been a teacher at  the time, and her school psychologist said, Hey, I think Eugenia is having some  really big struggles, but she's struggling with suicidal ideation. Does she have  resources and help? And I did everything that I could to put those resources and help in her way. On the way home, we called her best friend, and I asked her  best friend and Eugenia to talk to each other and form a plan about what to do  next. She had threatened to jump out the car window, she had made plans. It  was not a great place, but we got the resources in place. We got a peer support  network put in place. And over the next few months, she started to do better and better and better. And finally, months later, there was an event that happened,  and it would have pushed her. It would have been one of those things that just  did not go well. Of all things, it was a spice falling out of a spice rack and  breaking on the floor. And I remember being so scared, and then Eugenia just  being fine. And at that point, it was like, Oh, we made it. The last one is, was a  good friend of mine, and I had asked him if he was considering suicide, and he  had, he had been checked into mental health institutions a number of times. He  had more tools than almost anyone I've ever met to deal with suicide. And he  had attempted numerous times, and then in 2018 he died by suicide, and all of  us that were around him knew the joy and the goodness that he brought to the  world, knew the intentionality and the wisdom, and also knew his personal  demons and how he fought them and how He lost and the reason that I want to  bring his story up to you is because you can do everything right. You can know  the right interventions. You can execute them perfectly. You can be a great  friend. You can help with resourcing, and it still might not be enough. In many  cases, you can be the person who pulls them off the bridge right, and then 75%  say, thank you so much. I have my life back. I get to live it. But in those 25% of  cases, someone says, No, I'm going to try again until I succeed. And sometimes  there's nothing that you can do, and in that place, we need to talk about  forgiveness, because sometimes we hold ourselves responsible for someone  else's suicide, and you're not responsible. You can do your best, but there's  nothing that you can do as a person to just dictate that someone else's decision  can't ever get made if they've made the decision to do that, as my friend had,  there is nothing that any of us could have done to stop him, because it was we 

would have, we would have done anything to try and make sure that didn't  happen, but it still did a couple key pieces. If someone you know has attempted  suicide, get them help. Call a therapist. There are lines that exist for that. There  are resources around therapy that exist around that get them to a therapist, get  them, more than that, a community. Because one of the most damning things  about suicide is the isolation. If someone's alone and they feel like there's no  hope, that's a really bad place to be, but know also that you can't save them.  You can do your best, and sometimes that might be the thing that makes that  makes everything happen, right? Like my family member, you might be the  person who talks them back into life, but it doesn't guarantee that you will the  second thing is, if someone you know has attempted, it is a great idea for you  yourself to see someone, because having someone that you know has  attempted or who has actually died by suicide, it really messes you up inside,  because There are questions of, is it going to happen again? Questions of, what now? Questions of, is that something that can happen to someone else, that can rise and percolate up inside of you, and unless you have the space to deal with  those, it can be incredibly difficult. So please see a therapist, please get the  professional help that you need, and please work through your own stuff. Then,  as you do, reach out to the people you care about and make sure that they have the opportunities that they need, to see a therapist, to find community, to get the  help that they need, because they might just discover that this life is still worth  living. The last note is the importance of boundaries, which is you will try and do  everything that you can, often for someone you care about who is struggling  with suicidal ideation, but as I mentioned before, you are not in control of their  life. You do not have the dignity of their choices. They are still their own person.  And because of that, you do have to form some boundaries personally and say, I will do my best, but I cannot be responsible for their actions. You also have to  set the boundaries to saying, I will take care of myself, because this is hard for  me to go through, and I will do my best to do that. So as you step forward in this  journey, I know this is kind of a different set, a different section. Please know  that suicide is very real. This is a dramatic issue. This happens a lot, and it  happens, especially with people with mental illness. 90% of people who died by  suicide last year in the United States reported suffering from depression of some kind or a mental illness, which in my mind, means that 10% are probably in  denial that they do, but that's okay please know that suicide is a real big deal,  and know that it plays with mental illness. But the real issue here is  hopelessness and pain, hopelessness that it never gets better, and acute pain  that this hurts right now. If you have any other questions, I will leave some  resources below, and thank you so much, and I will see you next time so we can continue talking about mental health integration.