By Hope Algeo
The Hero in Each of Us: Finding Your Role in Suicide Prevention
Around two years ago, one of my best friends from high school committed suicide. After finding out, my emotions reeled from shock and bewilderment, to guilt that I hadn’t reached out more, to anger at her for not reaching out to me. Since then, I’ve had a few friends who have struggled with long-term crippling depression and who have become suicidal at times. I didn’t know what to say or do beyond driving 50 miles to them in the middle of the night, hoping that my presence would mean something to them. After many nights like this the strain was too much, and I distanced myself over time.
It wasn’t until I attended the 8th Annual Suicide Prevention Summit that I now feel prepared to help my friends when they need it.
On a bright Thursday morning in downtown Los Angeles at the California Endowment center, Ellyson Stout, Director of the Suicide Prevention Resource Center, opened her keynote not with alarming statistics about suicide rates, but with a story of hope and an unexpected hero. A story of a gun store owner in New Hampshire who convinced a woman not to buy the first gun she saw in his store. The store owner was not trained in suicide prevention, and yet his calm intercession that day accomplished exactly that, and saved a woman’s life.
The Summit's theme, “The Hero in Each of us: Finding Your Role in Suicide Prevention” hit home that everyone has a role to play in suicide prevention. The event’s goal: to teach the best methods to screen, assess, and provide longer-term care for those at risk of suicide. The conference brought together teachers, law enforcement, psychologists, non-profit workers, and many more service providers not typically associated with suicide prevention.
211 LA attended because in addition to receiving around 200 active suicide calls a year, we are also LA County's hub for connecting people to critical health and human services that can help prevent or address the types of personal and family crises that can contribute to suicidal ideation.
Throughout the Summit, attendees learned how to tell the signs, assess the risk step-by-step, and reach out and talk about it. How to make environments safer for those who are suicidal through means restriction. Educators and mental health clinicians learned how to support schools and communities to recover in the aftermath of a suicide. Communicators discovered better ways to change the national narrative to bring awareness and erase stigma, and not inspire more suicide despite good intentions.
The event sold out, and had a waitlist in the hundreds.
For those who couldn't be there in person, here are some of the lessons shared from the Summit's experts.
How to Find the Hero Inside
“Some people need you, as their caregiver, to sit in the darkness with them and to just listen.”
-Shawn Silverstein, Ph.D, Clinical Psychologist
In order for us to get rid of the stigma that pushes so many people into ashamed silence, we need to give our suffering friends the space and understanding to talk about their struggle. Knowing that someone is there for them helps them see just enough hope to override the pain - to know they’re not alone. According to Kramer, and Didi Hirsch’s lead psychologist, Shawn Silverstein, the best thing you can do for anyone struggling with suicide or depression is to sit with them in the darkness and just listen to them.
Their core advice: establish trust with those who have suicidal ideations by remaining calm and listening to give them a safe space to speak out about their negative thoughts and experiences.
Silverstein broke the assumption that one should only try to get the person to think positively. That doesn’t always work.
“Some people need you, as their caregiver, to sit in the darkness with them and to just listen. When you do that, people will often let you be there, and be in that place when they’re ready to turn on the light... You really can’t believe how empowering it is, and how much people hold in. When they’re able to have somebody listen in a non-judgmental way, they can experience that catharsis and the relief that comes with that,” said Silverstein.
Silverstein and Kramer also talked about creating a safety plan, which is a great way to let suicidal people see a pathway out of the dark tunnel. The fact that it can be tailored individually to them also helps them feel ownership and a sense of self-efficacy in that path. It asks what you can do internally for yourself and things you can do to distract yourself. It also lists the people you trust that you can talk to and professional resources you can utilize.
Knowing when to call 9-1-1
One of the first points Kramer and Silverstein made was the importance not freaking out when someone expresses suicidal thoughts or intentions. A strong emotional reaction can lead to distrust, prolong stigma, and drive someone to not reach out for the help they need.
When someone says they want to die, it doesn’t always mean calling 9-1-1 right away. But many people don’t feel knowledgeable enough to make that decision safely.
Enter the six-question Columbia Suicide Severity Rating Scale (C-SSRS), a clinically successful and universal form that allows for a flexible assessment of actual needs with simple yes-no questions.
Many people who struggle with suicidal thoughts are afraid to express themselves for fear of judgement or hospitalization. It’s important to ask the question, but it doesn’t have to be outright. You can just start the conversation with, “Have you ever thought that you just want to leave all of this?” This flexible and calmer approach gives someone space to speak out, and avoids involuntary hospitalization.
The questionnaire increases from yellow, an indication of suicidal ideation (thoughts of suicide), to orange representing ideas of a plan, and then red, where the person has thought of or begun to enact a specific plan where immediate action is increasingly necessary.
While communication of suicidal ideations may only warrant a referral or connection to counseling, it’s usually in situations where someone is about to make the attempt that a professional is obligated to call the authorities so that person can get immediate help and hospitalization.
The Columbia Suicide Severity Rating Scale, developed by the Columbia Lighthouse Project, is based off of 20 years of research in suicide prevention.
It Takes a Village: Hope & Collaboration in Suicide Prevention
“What would it take for us to not see so many deaths? Well you’ve probably heard this before, it will take a village.” - Sandri Kramer, Suicide Prevention Center Program Director at Didi Hirsch Mental Health Center.
Suicide prevention can't be tackled by any one sector or organization - it requires an integrative approach across all sectors and organizations, to “bake” it into the overall system, as Stout described it. It’s important to see both your unique role and where it lies in relation to everyone else.
211 LA finds its primary role as the first lifeline for much of LA County’s most vulnerable populations. The advisors who answer live calls and online chats receive extensive training on handling and de-escalating crisis situation including suicide, but beyond that 211 LA also plays a role in both the prevention and recovery process for suicide attempts. “We refer to 211 LA all the time,” said Sandri Kramer, former Crisis Line Director for Didi Hirsch, and current Suicide Prevention Center Program Director.
For those who have gone through a suicide attempt, creating a consistent, positive, and secure environment for recovery requires solving many other issues that individual may have. But it’s very difficult for those already struggling to navigate that complex system of services and resources, which is where 211 LA comes in to match people to the right resources for their situation.
Kramer also brought up the importance of cross-trainings and educational workshops between organizations. Understanding each other’s roles allows their processes to work more efficiently. “What would it take for us to not see so many deaths? Well you’ve probably heard this before, it will take a village,” said Kramer.
Stout highlighted several recommendations to make suicide prevention efforts more effective:
Service providers can:
- Use data to inform care.
- Integrate multiple approaches to care, across multiple organizations.
- Include consideration of cultural factors.
Local businesses can:
- Tailor their store policies so that employees know to identify the warning signs.
- For high-risk businesses or organizations, like construction workers or law enforcement agencies: Join with mental health care professionals to make sure employees are getting the support they need to continue their jobs.
Legislators need to approve bills that provide funding to these critical partnerships and support integrated approaches to care.
When working with those who have experienced a mental health crisis, depression, suicide, or a loss due to suicide, it takes professionals and loved ones alike to provide the full care needed - it takes all of us.
Changing the media message
“We need to know how to tell the story safely and how to change the national narrative. Are we telling a story of despair, or of prevention and hope?” - Ellyson Stout, Director of the Suicide Prevention Resource Center (SPRC)
The deaths of Anthony Bourdain and Kate Spade have brought suicide near the top of the national conversation. There is risk in the way stories of suicide are presented in the media actually increasing suicide rates, due to what is known as the “the copycat effect”.
The breakout session, “Messaging Matters,” focused on the importance of presenting stories of hope and providing specific steps towards combating suicide, as opposed to simply providing alarming statistics on the issue.
Stout, along with Stan Collins, a media and communications consulting expert on suicide with the American Association of Suicidology, advised to not mention the means, location, or people associated with a suicide, as that can inspire ideas. No matter how tempting, it’s also best for communicators to not focus on dire suicide statistics.
She also stressed that communications may not be the best way to solve a problem. Communicators need to consider the “why” in their messaging. It needs to be systematically researched, have a clear audience, a clear call to action, and provide workable steps towards prevention.
Stout emphasized, “We need to know how to tell the story safely and how to change the national narrative. Are we telling a story of despair, or of prevention and hope?”
Stout’s opening message for the day exemplified that approach through his story - suicide can be prevented, and any and all of us can be that hero in someone’s story.
Christopher Brown, who oversees 211 LA’s performance coaches and attended the Summit, looks forward to bringing more awareness and training to 211 call center staff. The information he learned at the Risk & Assessment training was important to him, due to losing his cousin, who was a veteran, to suicide.
“At first, I didn’t want to talk about it. It made me feel vulnerable. But then I decided to talk about it, because that’s what this is all about. We all have a role in suicide prevention. If someone communicates that they might harm themselves, it is OK to ask very specific questions and seek help from others.”
Some members of the LA County Department of Mental Health donned green ribbons to identify themselves as trained support for any event attendees who felt triggered, needed to talk, or just needed a break.
Thank you to the wonderful presenters, as well as to event sponsors LA Department of Mental Health, Didi Hirsch, Teen Line, Each Mind Matters, the California Mental Health Services Authority, Know the Signs campaign, and the Center for Wellness and Wellbeing at Santa Monica College.
Connect to Didi Hirsch, Teen Talk, other specialty hotlines, and other suicide prevention and support services by calling 2-1-1 (24/7), or using our online search.
Photos from the event:
Members from the Department of Mental Health pose after the event. Members like Tracie Andrews (third from right), a crisis call coach, donned green ribbons to give counseling to attendees.
Didi Hirsch’s resource table at the event.
(left to right) Sandri Kramer and Shawn Silverstein, after presenting their breakout session on Suicide Risk Assessment and Safety Planning, along with 211’s community relations assistant, Hope Algeo.
Wendy Cabil, a service client of DMH and peer advocate, with friend Dorothy Banks, wellness outreach worker and volunteer coordinator at DMH.
Presenters Ellyson Stout and Stan Collins after the successful event.
Ellyson Stout and Stan Collins pose with 211 LA’s community relations assistant, Hope Algeo.