Suicide. Its an awkward topic blurred in a haze of misunderstanding and stigma. Many of us couldn't fathom the idea of coming right out and asking someone, "Are you thinking of suicide?" The thought alone causes stress. Some might even find it outright ridiculous. The fact of the matter is many of us, when presented with all kinds of signs that someone we know may be thinking of suicide, still don't ask the question staring us in the face.
This week I'm at CMHA Durham to take their ASIST course. ASIST standing for Applied Suicide Intervention Skills Training. Three quarters of the way through I'm still asking myself if the "S" for "Skills" is just there because ASIST sounds better than ASIT or if it's intentionally there because while "skills" can be trained no training can guarantee a positive outcome when it comes to suicide. Perhaps after today I'll be finishing the article with that question answered. There is one thing I've learned that really stood out for me so far.
We need to ask, directly, about suicide once we feel someone is at risk.
The past day and a half I've learned a relatively simple 3 step framework for assessing and intervening with a person in crisis. I say "with" that person because you really don't intervene on your own. It's far from scenes in the movies where the hero distracts a distraught man on the roof of a building and then tackles him to safety. Instead its more like a sales process. First looking for signs of a potential crisis (needs you can help solve) and confirming what you see. Specifically by asking questions and asking about suicide. Then gently guiding the process through questioning and active listening (qualifying). Identifying the hook that can be used to help that person choose safety (buying signals). Adjusting as needed to changes in the persons responses (objections) to remain in-sync. Finally helping them create their safe plan and gaining agreement on it (contract).
"We need to ask, directly, about suicide
once we feel someone is at risk."
Most would assume the hardest part would be confirming the potential for suicide. Coming right out and asking, "Are you planning on killing yourself?" Without asking this question you may never get to the opportunity to guide that person to safety. The reality is, once you come to grips with it, asking is actually the easiest part. It's not that difficult if you just acknowledge the signs that something is wrong.
You see/hear/feel the signs that something is wrong.
You confirm what you see by asking about it.
You ask straight up. "Are you thinking about suicide?"
What I've learned in this training is that so often those signs something is wrong are invitations for you to support someone. When you ask them point blank you can be surprised by the honesty of the response. When someone is able to acknowledge those feelings and ideas it can lift a weight off their chest and make the rest of the process achievable.
There is no guarantee you can stop someone from dying by suicide. You can however, learn "skills" to make sure you do what's in your power to help that person. That's what ASIST is all about. Looks like I did answer my question.
For more information on ASIST (Applied Suicide Intervention Skills Training) visit Living Works @ www.livingworks.net
To book ASIST Training or for information on upcoming sessions visit CMHA Durham @ http://cmhadurham.ca/education/applied-suicide-intervention-skills-training-asist/
As we got closer to today, Remembrance Day, we're encouraged to reflect on the brave acts of valor and sacrifice that secure our way of life. The pride we should feel in the way our armed forces have come to the defense of Nations mired in turmoil and marginalized citizens caught in the crossfire. We're encouraged to place a poppy on our lapel and remember the fallen soldiers, the brave men and women who gave their lives so that we could enjoy a semblance of peace and tranquility.
We all experience Remembrance Day in our own way. We think about Grandparents who may have participated in WWII. Maybe we have a family member serving now or who served in the recent past. Maybe a friend of ours has done tours in Iraq or Afghanistan. Maybe we don't know anyone but history is a constant reminder of the battles that have been fought up to this point. We all channel it in different ways.
Some of us even put ourselves in the shoes of a soldier as we reflect on what Remembrance Day means to us. We imagine soldiers ducking into dirty trenches in the cold fields of Europe or storming the shores of Normandy upstream against a hail of bullets. For a moment we might assume the stress of the battlefield. Never knowing when an enemy would fire or when chaos would erupt. Never being certain the next step could be the last with the grim prospect of an IAD or a roadside bomb. It raises our blood pressure as our adrenal glands pump out cortisol in response to this imaginary stress.
What could be worse than experiencing that kind of emotion? That fear? You can imagine the relief at the end of a long battle, or better yet, the end of a war. The joy of reuniting with family. Going home after your tour was complete. Resuming civilian life. Maybe the military is a career and the experience would benefit a career greatly. Improving rank and status within the field.
But what if that relief was only temporary? Sure you'd survived but at what cost?
What if your memories weren't moments of glory but of bloodshed? What if you found yourself consumed with guilt over a lost comrade or you saw the faces of the enemy combatants you'd put to death when you closed your eyes? What if you couldn't stop thinking about innocent civilians caught up in the conflict or that the war wouldn't end now that you were back at the base, on your side of the pond, or back at home with your family. That it would play out in your head. What if you just couldn't shut off that need to be constantly vigilante? You couldn't relax. You still felt your blood pumping. Even as it exhausted you, at night, you couldn't fall asleep. What if you had no one but yourself to endure this mental minefield? What if you did speak to a professional? Would your career be in jeopardy? If your service was complete, how would you cope? Where would you turn for help?
The questions keep mounting when you put yourself in those shoes. You really begin to feel the gravity of war. The long term impact it can have on individuals long after the last shot is fired. This is what I think about when I imagine life as a service man or woman. I don't imagine this is how it is for most, but I'm sure, for many.
On 4-Nov the Globe & Mail posted an article in a series entitled "The Unremembered". The article called "We Remember" brings to our attention that at least 70 of Canada's service men and women who served in Afghanistan mission died by suicide. It provides brief stories of 31 of those service men and women shedding a light on and "raising questions about the thoroughness of their post-deployment health screening and the psychological support offered."
This year when you get your poppy from that humble old veteran standing outside your local grocery store, as you pin it to your coat, remember that the sacrifices you are honouring come not just from the battlefield. Think of service men and women today and throughout history who's battle rages on.
PTSD Association of Canada
Founder of No Surrender Hockey Challenge.