Things suicide intervention trainings miss

First - let me be clear that I'm okay. I'm going to talk about my own experiences with suicide and suicidality below, but please be reassured that I am in a good place. I am choosing to write about this now, having had it stuck in my brain for a while, because I'm okay. 

Second - I am going to talk very openly here about suicide and related thoughts. This is going to be hard to read, especially if you love me and want me to be okay. Or if you have your own history with suicidality. I want you, reader, to make sure you're okay to read this. Not just a quick 'yeah, yeah, I'm fine'. Do a body scan - are there signs of stress as you have started reading? Are your shoulders inching up? Do you feel that stress fluttering in your stomach? Or are you good. If nothing else, go drink some water before continuing. You probably need to move and hydrate. 

Now let's give some context. I have a long history with suicidality. Most of my active suicide attempts occurred at a young age, but I have experienced suicidal ideation for literal decades. It's not that interesting of a story, I promise, but I share so you know where I'm speaking from. Suicide prevention is not theoretical to me - it is a thing I have experienced many times as both the person needing intervention and as the person intervening. I have formal training (including Mental Health First Aid and Applied Suicide Intervention Skills Training), lived experience, and lots of practice. 

I had cause recently to reflect on some of the issues I see with suicide prevention information, especially when done in large groups. These thoughts can also apply to intensive, small-group trainings as well, depending on who is delivering them (and how closely they stick to the scripts). Those trainings are valuable and important, but there are things that I think they miss. I am sharing these ideas with you, mostly so they'll stop rattling around my brain.  But, who knows, you might even find this helpful if you have cause to support a person experiencing suicidality in future. 

Disclaimer: this is all just my ruminations. This should not be considered to replace existing trainings, or to in any way be professional advice. This is the ramblings of one weird person. 

Active Talk About Passive Thoughts

Asking about suicide is uncomfortable. You have probably been taught that it is better to ask "are you thinking of killing yourself" or "have you had thoughts of suicide" than to use coded language about 'harming yourself' or 'doing something stupid'. And that is very true. But that's only part of the story.

If you ask me directly if I have had thoughts of suicide recently, I can pretty much always say yes. Once again, I promise I'm fine. But I can still pretty much always say yes. This comes to that 'suicidal ideation' I mentioned above. I often add the word 'passive' for clarity when talking about this. See, I have passive thoughts about suicide regularly. These thoughts are often 'I could step in front of that bus right now', or 'I could turn this steering wheel and go off this overpass'. If you don't have these thoughts, this can sound intense. But I'm used to these thoughts popping up. I'll note I also have regular thoughts about licking dirty sidewalks, accidentally hurting my cat, and many other unpleasant things that I don't want to put in your brains. These are all intrusive thoughts related to my anxiety and depression. We all experience intrusive thoughts here and there, but I have frequent, stubborn, and highly repetitive ones. This includes ones about suicide. It is important to note that suicidal ideation is a risk factor for active suicidality, but not identical. Many folks who live with ideation never move into active risk. 

Why am I telling you this? Because asking me "have you had thoughts of suicide" isn't going to get you a clear answer. My usual answer is 'not active ones', but that isn't actually the right question for me. I might be having more frequent passive thoughts or they might have changed recently - and those are warning signs for me. If you know someone has passive thoughts (or their answer indicates they might), it might be worthwhile to explore a bit further:

• It sounds like you might have ideation or passive thoughts, is that the case? 
• Are your passive thoughts happening more frequently? 
• Have your passive thoughts changed or you had new ones? 
• Are you concerned at all about your passive thoughts? 

These questions can prompt some reflection and help identify if someone is living at their baseline of weird thoughts, or if they are having increased risk. 

Listen to the Youths

Do you know what 'unaliving' means? What about a grippy sock vacation? 

One of the other issues that I see with a lot of suicide intervention training is it focuses on the language that the professionals use. This makes sense - it is often professionals designing and/or delivering the training. And professional language is important - having the language for ideation and passive thoughts helps me understand my own experiences without feeling shame or guilt. But, we need to keep in mind that that language may not be what a suicidal person uses, especially a younger person. 

Social media censorship has led to a wild world of new language for generally censored topics as a way around filters. A young person who spends a lot of time online may not say that they are feeling suicidal, but they may say that they want to unalive themselves. Or that they they need a 'grippy sock vacation' (psychiatric hospitalization). And if you don't know these words, you might miss the reference.

Social media can be a scourge and a huge source of stress, but it is also important for those involved in suicide prevention to pay attention to how these discussions happen and how social media influences language. Those of us over (insert arbitrary young age here) may never be cool again, but we need to at least know how the cool kids are talking if we want to help them. 

Dark Humour

The final thing I think these trainings miss is that we need to become comfortable with dark humour. I'll be honest - I have absolutely laughed talking about my own ideation with people who get it. Just like any other shared experience, we have to laugh about the darkness sometimes to make it not feel so dark.

So here's a confession. I laugh when a video pointing out that advice to 'take the jump' is not actually meant for me crosses my social media feed. It makes me laugh every single* time. Seriously, every damn time. (There are other variations, but I'm lazy and google led me to ones with that one starting clip). More than making me laugh, it makes me feel not alone. And that's deeply healing.

One of the tools that I have found most powerful during interventions is being able to be human about it and dropping the formality. I make a big deal of being awkward getting out my ASIST card from my wallet. I gently make fun of myself (or my cat). I make myself clearly flawed and human, not some removed professional. Sometimes I can even get a small chuckle out of a suicidal person, and that brings the tension way down and creates space to move forward. I do need to note that how exactly I try to break that tension is very context- and person-dependent. This isn't the right approach with everyone, but when it works it works beautifully. 

Sometimes laughter is enough to chase the darkness away, even just for a moment of beautiful relief. And sometimes that's the only way we can get through this world together. 

So there are my ruminations on things we miss in suicide intervention trainings. I am sure that every person out there who has experienced suicidality would have their own thoughts and additions, so once again these are just my ramblings. 

As a final note, take care of yourselves. It's a hard world out there. All we have to get through it is each other - and if you are reading this because you know me, just know I am here for you with a map and a headlamp to help you fumble out of the darkness when you find yourself stuck there. 

*even if you don't watch the others, watch that one. It has Spiderman.  

Practice

It has been a rough few weeks in our household. I honestly don't know how to explain it all, nor do I think there is value in putting it out there in the world. The impacts - sadness, hopelessness, grief, anger, despair - alone are a lot to put on others. 

And that's not my goal today. My goal today is to talk about the idea of practice, and how it fits with having rough weeks. But first, I have to take you into the world of online video games. 

I play an online role-playing game, where I can play cooperatively with other players. I am in a guild (organized group), and I am in charge of leading members of that group through doing hard group content ('trials' or raids where 12 of us work together to get through a set of enemy encounters). 

If your eyes have glazed over, don't worry - I'm almost done with setting the context. Doing hard 'trials' means we often don't succeed our first time in. We 'prog' (progress through) the content, learning it together and getting (hopefully) a bit further each time. 

In this group, we often remind ourselves that 'practice makes progress'. I love this phrase. When we are in the same trial for the 5th week, this phrase reminds us to celebrate the things we have already conquered. I love that this version takes the focus from perfection, an often unattainable end goal, to growth and learning. It reminds me that end goals are guideposts, but often not what really matter. Trials are fun because I'm learning with my friends. Yes, of course, I cheer loudly when we finally clear something, but I do trials to be with this amazing group and improve our playing together. 

And this phrase applies so far beyond video games.  

Writing this blog again is practice. I missed a couple of weeks while my routine was up in the air, but that's okay. Because writing this blog isn't about being perfect - it's about practice and progress. And each time I write I feel like I'm finding my voice again and enjoying the process. 

Strengthening my body is practice. I ended up spending my training session last week crying and focusing on what my body needed to get through another stressful week instead of moving my body. And that's okay. Because this week I went in, said I needed to do something that made me feel strong, and had a glorious workout with weights and balance (and I could see so much progress from over the last few months!)

And maintaining my mental health and well-being is practice. It got knocked around this last couple weeks, and I'm under no illusion that I am fully in the clear. I am still having to be very cautious what I expose myself to in media (and social media), I am monitoring very carefully for signs of needing medical intervention, and I am taking steps to protect myself from overload. I am using the techniques I have learned from therapists and trainers and many amazing folks I have worked with. This is my lifelong practice, and when I focus on progress I can see how strong I now am, even in my weeks where I feel bruised and battered. 

The world is really rough right now. I am finding it hard to keep up hope. But, the idea of a little bit of progress is something I can believe in. So, this week my focus is on practice for the sake of progress. 

Surviving

It's been a rough couple weeks. Today things crested. My brain said no more. I ended the day feeling like the emotional and cognitive walking wounded, bleeding out from the soul. 

Those wounds aren't gone. But tonight has been focused on stopping the bleeding. Instead of bandages, I've applied a crackling fire and the weight of a blanket. Instead of applying pressure, I'm applying music and the sounds of Kyle puttering in the kitchen. There is no paramedic to staunch the flow, but a soft kitty on my lap does the trick. 

Stopping the bleeding doesn't mean the wounds are healed. There is healing to be done, and it will happen. But for tonight, it's enough to be stabilizing.