By Joe Borders,
In Roseville and Sacramento
September 28, 2018
Suicide Prevention Awareness:
Interview With a Crisis Line Director
September is Suicide Prevention Awareness Month. In light of this, I decided to connect with a local resource for suicide prevention and ask them some questions about suicide that frequently come up in therapy. Suicide Prevention and Crisis Services of Yolo County (SPYC) is an organization that provides a number of suicide prevention resources to the community.
Located in Davis, SPYC offers several programs, including a once a month Friends and Families of Suicide Loss Support Group, SOS-Signs of Suicide® School Education Program, and four 24-hour crisis hotlines: Allied Services for Kids (ASK) Teen Crisis Lines, School Safety and Violence Reporting Tip Lines, Suicide Prevention Crisis Lines, and Crisis Text Support available Monday through Friday, 12PM-3:30PM.
Today I am talking with Ting Ting Lee about some common questions and concerns that I hear in therapy. Ting Ting is an Associate Marriage and Family Therapist and the Crisis Line Director for SPYC. She’s been involved with SPYC for over 12 years.
-As a therapist, when I refer people to SPYC, I often get asked if people need to be Yolo county residents to use your services. Does SPYC serve specific communities?
We get this question too when we go to agency fairs and outreach events. Our mission is to provide crisis intervention services to Yolo County residents, but with crisis lines, there’s no real barrier to entry as you might find with other mental health resources. When someone is in crisis, it is our policy to work with the caller to assess for safety, deescalate, and then collaboratively problem solve with them. That might involve looking for resources in their area (which could include a crisis line that is more local to them).
The short answer to that is, no, we will not end a call with someone just because they are not presently located in Yolo County. Furthermore, if someone outside of Yolo is calling regarding someone they are concerned about who is located in Yolo County, it is definitely a good idea to contact us.
-What are the warning signs of suicide, and when should a person take action to prevent a potential suicide?
You can find these warning signs on our website as well as a great state resource called Know the Signs. I can’t recommend too much the importance of familiarizing yourself with the warning signs of suicide if you’re working in the mental health field. Critical warning signs to look out for when you’re working with a client are definitely things like talking about wanting to die, a strong sense of hopelessness or feeling trapped, seeking means or methods to harm themselves, perceived burdensomeness, and lack of belongingness. For the last two factors, if you are a clinician, check out the Interpersonal-Psychological Theory of Suicidal Behavior by Thomas Joiner.
-Is any of this different when the person you’re concerned about is “passively suicidal”; where they’re not planning on attempting suicide, but are engaging in behaviors that put them in danger (i.e.,: intentionally not taking a needed medication, driving without a seatbelt, or other things that could result in death)?
Good question! It may be different in the manner in which you address this with the person, but it certainly should not be different in your concern for their potential risk to themselves. Though suicide prevention awareness efforts, coupled with the attention on several high profile suicide losses in the past years, have gone a long way in reducing the stigma of talking about mental illness, suicidal thoughts, and prior attempts, it can still be a really hard topic for people to talk about. Someone engaging in risky behaviors but outwardly saying that they’re not suicidal can still be at risk of ending their own life.
-What should a person do if they are worried someone is in imminent danger of suicide?
Tips for this can also be found at our website or the Know the Signs website I named before but primarily: don’t ignore it, ask directly about suicidal ideation (and if a person has considered a suicide plan, has the means to carry out the plan, as well as a potential timeline), and work hard to remain non-judgmental, calm, and caring. When someone is struggling with suicidal thoughts to the point where they are in imminent danger of suicide, they are dealing with an incredible amount of pain. Be kind. Be there for them. Be educated on what to do (if you don’t know, call a local crisis line!).
-Follow up: what are some things people should not do if they are worried someone is in danger of suicide?
At this point, many know that you should reach out, talk to the person, express concern and care, and try to work with the person to get some help. Less people know what not to say to someone who is suicidal and these are the things we hear from callers who call our lines.
Some common mistakes are: telling the person to stop thinking about suicide, asking about suicide in a way that makes it seem like you want them to say ‘no’ (“You’re not thinking of suicide, are you?!”), shaming the person about their suicidal thoughts (some people will call the suicidal person selfish), or not asking directly (you will not put the thought into their head if it is not already there).
For therapists, not properly and adequately (and sensitively) assessing a client’s suicide risk, shying away from the topic due to their own countertransference and discomfort with the topic, not sufficiently safety planning with the caller, not reassessing or asking about suicidal ideation in subsequent sessions, or saying things like, “I can’t let you out of this session unless you can promise you’re going to be safe,” are just a few examples of some mistakes clinicians make. Take some time to get some continuing education on the various facets of suicide prevention (assessment, safety planning, treatment, documentation) and do some research on no-harm contracts and their efficacy (they can be fine as a supplement to a strong safety plan, but alone, they’re really only making the therapist feel safer rather than actually reducing significant suicide risk).
Teenagers
-As a therapist, I work with a lot of teenagers. I often find myself in a position where parents are concerned about their kid and worried about the potential of suicide because their child is withdrawn and/or apathetic….but this is also a common symptom of being a teenager. What would you tell parents in this position? When should they worry?
First I’d say, I’m glad you’re paying attention to changes in your child’s behavior and wanting to help them. We talk to many teenagers who don’t feel like they can talk to anyone (especially their family) about the tough issues they’re dealing with. This is a difficult question because it gets into parenting and how people relate with their teenagers. I would say to educate yourself on suicide risk factors and warning signs for young people (you can find teen warning signs on the Know the Signs website). In this way, you can look out for other warning signs in conjunction with the ones you named.
A teen’s suicide risk can vary so much from person to person. If you’re concerned, talk to a therapist, call a crisis line, or talk to a good doctor or pediatrician. Then you can talk specifically about the warning signs you’re seeing in your teen.
-Many teens I see also engage in cutting and/or other self-harming behaviors. A good number of them do so without suicidal intent. Where should parents “draw the line” and intervene?
Non-suicidal self-injury is something that some people do to cope with intense or overwhelming emotions and can be done without suicidal intent. However, as a parent, if your child is self-harming (which is a warning sign), you should work with your child and a professional to develop less harmful coping techniques and support. Self-harm can come in various forms such as cutting with different sharp implements on arms, legs, torso, or other ways like burning or hitting oneself with or against something.
-After taking steps to intervene and keep their child safe, lots of parents worry that they might be overbearing. On one extreme, you get parents who won’t allow their child to be alone while on the other, you have parents who are afraid to talk to their kids about suicide at all. Is there such a thing as caring and protecting too much? When and how much should parents believe their teen when they say they’re feeling better and are no longer in danger?
This is another tough question that moves into parenting style and your own personal anxieties as a parent. Since this is a question that could easily turn into a full dissertation on its own, I will just say that if your child is struggling with mental illness and working with a professional (or professionals), seriously consider participating in the treatment. That means, not solely putting your child in therapy and/or on medication, but considering additional therapeutic modalities like family therapy, individual therapy for yourself, couples’ therapy for you and your partner. In just about all situations, the child who is struggling is not struggling in a vacuum. There is a family system in place that is not helping the child to thrive, which could be in part from avoidant or overbearing actions like you mentioned in your question.
-In closing, what would you say is the single most important thing a person can do to help someone who may be in danger of suicide?
Get educated. Know the signs. We encourage people struggling with suicidal thoughts to reach out and remind them that they’re not alone. But the truth is that people dealing with severe depression, anxiety, or suicidal thoughts may be doing the best they can just to try and “keep it together” for the people around them. They may feel a lot of shame or fear around being open and vulnerable about their feelings. It’s those of us that recognize the signs that have the ability to reach out, make a connection, and help someone realize that they do not have to go it alone. It’s a powerful thing to be able to save someone’s life just by getting educated and becoming a beacon to someone who is lost in the dark.
Ting Ting doing another interview with a local access channel in Davis
If you or someone you love has been affected by suicide, you might benefit from contacting SPYC and taking advantage of the resources they have available. If you would like to contribute to the cause of suicide prevention, you can help SPYC by donating or volunteering.
Other Suicide Prevention Resources
If you or someone you love is in danger of harming themselves please call 911 or go to your nearest emergency room. If you are not in danger and/or are looking for other suicide prevention related resources please check out the following local, state, and national resources. You can also use SacWellness to see therapists who specialize in working with suicide issues in the greater Sacramento area
-Mental Health Urgent Care Clinic (in Sacramento)
-Crisis Residential Program (in Sacramento)
-TLCS Mental Health Crisis Respite Center
–WellSpace Health Suicide Prevention Crisis Hotlines
-American Foundation For Suicide Prevention – Greater Sacramento Chapter
-AFSP Suicide Loss Support Groups
-Friends for Survival – Based in Sacramento, offers support to those who have lost someone to suicide
-Sacramento County Community Support Team
-National Suicide Prevention Lifeline
-The Trevor Project – Crisis intervention and suicide prevention for LGBTQ youth.
About the Author
Joe Borders is a marriage and family therapist located in Roseville and Sacramento. He is primarily a sex positive gender therapist, but also specializes in working with couples, teens, addiction, and the LGBTQ community. Joe is also the owner and founder of SacWellness. You can find out more about him by visiting his sacwellness listing or by visiting his website: therapy and counseling in Roseville and Sacramento
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