Tag Archives: psychology

About suicide hotlines: My thoughts

About suicide hotlines: My thoughts

some hotlines: Crisis text line 741741, National Suicide hotline 1-800-273-8255, Trans Lifeline 877-565-8860, Trevor Project for LNGTQ 866-488-7386

After a 9 year old that came out as gay to his friend and then killed himself, there has been an increase in sending out the suicide hotline numbers. While I know that sending out and calling does help people, there are other that feel too hopeless and alone, maybe feeling ashamed, maybe feeling no one will understand, and therefore won’t reach out.

One thing that is often said in hindsight of a suicide is why? Why didn’t I see the signs? But knowing the signs are not enough. Often when confronted, people with suicidal thoughts or maybe even planning a suicide, will deny it. It is a sensitive issue. A private issue. I know when my best friend told me at the age of 11 to seek help, my response was “I am not crazy”. With stigma, it is hard to approach someone who is suicidal. Often, there is the thought, no way this person is thinking of suicide, not my child, friend, co-worker, etc. They may deny it and say they don’t because it is against their religion or maybe the person who asks, frightens their friend or family member for fear of being stopped or if they do say yes, the person who asks responds with “don’t do something stupid” or “I will kill you if you do this”, which further alienates the suffering person. I’ve had this experience from two different people. I’ve never understood this logic. I still don’t.

My point of all this is people who are depressed ad suicidal need to feel safe in order to talk openly about their feelings. Often calling a hotline takes a lot of effort to even pick up the phone or dial the number. It is so scary because they are afraid they will be turned away and that holds people back. Or maybe they have phone anxiety like me. The Crisis Text Line is super for those people. But it is still scary to admit they are having suicidal feelings. They don’t know what will happen when they call or text.

In this case of this little boy who apparently was bullied, I don’t know if he would have had access to a phone to reach out and seek help. We often think those under the age of 10 cannot think about suicide but the numbers are growing. I know when I was eight I started having suicidal thoughts and made my first attempt at age 10. I didn’t tell anyone about this besides my best friend. He was probably sick of me talking about it so told me to reach out and then I shut down. I stopped talking about it but the thoughts were still there. When I was 12 I did reach out to Samaritans. I talked to a nice British speaking lady. I was very scared to call. I never had another good experience calling a hotline again. I was often rushed off the phone once I mentioned that I was suicidal.

suicidal turmoil

Suicidal turmoil

***note this is just talk. No action. Just expression of feelings of suicide. If this bothers you, do not read***

My mood has been all over the place today. Last night I was feeling really suicidal. I was exhausted after a chat and wanted to sleep but my thoughts wouldn’t let me rest peacefully. I wanted to email my psychiatrist but I couldn’t come up with the words as my exhaustion out ranked my thought process. Eventually, I did find sleep.

I woke up in the middle of the night because of pain. I took my pain meds, made note of the time, and then went back to sleep. I woke up before my med alarm as I had to use the bathroom. I decided to stay up because I knew that if I went back to sleep, I’d feel like shit.

I got hungry and so made breakfast. I then had time to catch the bus, even though it was an hour earlier than I wanted to go to the square. Oh well. I took my time getting dressed. It was cool out so I had to switch things to my jeans from my shorts. I decided to wear a long sleeve T shirt rather than a sweatshirt. I figure it would be light and if I got hot, I could take it off. It was a beautiful day out. My pain was there but it was manageable. I got to Starbucks and had my espresso. Then I got my journal out and started writing as I wanted to keep it updated with what happened with my appt with the pain doc.

As I was writing, my mind kept going to suicidal thoughts. I wanted to write some more about suicide but I didn’t know what to write. It kept forming in my head. I looked in my bag for a notebook or notepad and there wasn’t one. GAH! Seriously??? I had bought a million notebooks and notepads and this bag was “empty”??? Guess I was off to Bob Slate in Harvard Square to get my favorite kind. I wrote down some more things in my journal and then went to get my med scripts before going to Harvard.

I got to Harvard and the place had change. I don’t remember the last time I was there. The newspaper stand had closed and it kind of changed the whole place. There was a new CVS next to the bank, which was also new. It was a jewelry place before. Starbucks was besides it. There was still construction going on in front of the Au Bon Pain. I still have no clue what they are doing. The construction has been going on for a couple years now. I went to Bob’s and got two notebooks. I only needed one but the other one was a composition type and was for quick notes. I thought it was cool so I bought it. I stayed away from the pen aisle but talked with the guy at the pen desk about refills. There are a couple of pens where I want black ink as they have blue ink right now. The lady became insistent that I bring in the pen to make sure I buy the right one. I am not a naïve pen person but thought it a good idea to do so. I asked what the price range for them were and she said $5 and up. I said I would be back. I’ll probably go Friday before my psychiatrist’s appointment.

I started walking down Mass Ave, not sure if I wanted to catch the bus down to my therapist’s office or just walk there. I got to the corner where there were some benches and sat down for a bit to drink some water. My bladder was telling me it had to go so I waited a little more, just taking in the surroundings and nice weather. I miss being in that part of town so much. It was like going down memory lane. I just started walking toward my therapist’s office. It was farther than I thought it was. I kind of figured that as the numbers were higher at Harvard than the other train station I usually get off. That part of Mass Ave had changed a lot. There was an Indian buffet restaurant, a Domino’s, a Dunkin Donuts. It was amazing to see all these new businesses.

By the time I reached my therapist’s office, I had walked off my suicidal writing energy. I went up to the floor and used the bathroom, then sat in the waiting room for an hour. I played on my phone for a bit and then I took out my journal to write some more. I tried to remember what I wanted to write about but nothing was coming to me. The bug had worn off. I wish I could walk off those feeling whenever ever they occurred. It would be a huge help to me but I know that might not always work due to pain.

I told my therapist right away about my suicidality and how my week went. A lot of stuff was stirred up. I forgot how much my PTSD was flared because of what happened in PT and then with the pain that activated the Cauda Equina Syndrome memories and surgeries, relearning to walk, etc. We talked about it and he listened to my suicidal ramblings. He didn’t ask if I was safe, didn’t get me off topic with plans or crisis stuff. He just listened and inputted his thoughts when I had finished. He does want me to see him twice a week just to have someone to talk to. He thinks I am too isolated. I explored it a little bit and I told him that was scary to me. I don’t know why. He playfully said that he shaves down the horns. LOL I told him I would think about it and let him know next week. I told him I would be on the new pain medicine and hope that would calm down flares and help me regain some things that I have lost.

When I got home and was thinking over the session, I wanted to cry. I never had a therapist that listened to my suicidal thoughts, plans, and other stuff before, in detail. I felt good about it and it made me feel better knowing I had someone to talk to about this stuff, the hardest stuff I can possibly talk about. He told me he wouldn’t be able to stop me unless I was telling him right then and there I was going to end my life after I left his office. It is Massachusetts law to protect someone from themselves or others. He didn’t give me an ultimatum, a do this or else scenario. I was appreciative because I never had that before. I never talked about how much I was feeling about suicide because safety was always first and foremost. Then add in a therapist’s anxiety and the whole thoughts about why you are suicidal are lost, never to be spoken about. For 27 years, no one heard me out after I said the “S” word. It was like the why are you suicidal didn’t matter and containment was more important. By then, the session was over and you were more frustrated because you were in this bind where you promised if you were going to act on your feelings, this and that had to happen and if it didn’t, you were on your way to the hospital to be admitted for a few days or more.

This is where suicide prevention gets mucky. You have a suicidal person and instead of listening to what they are going through that is making them think about ending their lives, they need to “prove” they are safe when they walk out that door until the next session with the therapist or psychiatrist. The client/patient may get angry they are being put in a bind and not heard. This has happened my entire suicidal career. Now I have someone that cares about me, wants to listen to me, and knows that if I really want to end my life, there is nothing he can do to really stop me. He is the perfect therapist for me and it is scaring me because I am expecting metaphorical handcuffs on my thoughts but they aren’t coming. I am free to talk about suicide as long as I don’t act on these feelings. It is freeing. It is validating. It is helpful. And I am grateful that I have someone like this.

I don’t know if I can see him twice a week because financially, that will be double the copay a month. Not to say that I will be able to make every session because I can’t always do that. We talked about that too. He understands that I have a chronic health condition that makes going out impossible some days. But he still wants to help me. He isn’t going to slam the door or give me an ultimatum saying I need to see him every week or else, which was what I was fearful about. He is a laid back therapist and I like this. I have to admit that my suicidologist instincts about him not using CAMS or some other EBP was freaking me out. How could I talk to him if he wasn’t going to measure the level of suicidality on a piece of paper? But I realized today, you don’t need that stuff to make suicide prevention/intervention happen. You just *need to talk*.

Therapist’s choice or fear?

Therapist’s choice or fear?

My therapist of sixteen years had decided sometime while on our three week break that she couldn’t work with me anymore for what reasons are still not quite clear. We had been arguing over various things the last several months, including my suicidality and it was becoming apparent that she refused to seek the given evidence based practices I was telling her about to deal with my suicidality. I was becoming more and more frustrated and wrote a blog about it that “opened her eyes”. Our engagement ended in February of this year. I was gutted. I had no choice but to end things with her if she had no idea how to work with me any more. So the hunt for a new therapist began, once I could manage it.

It is very difficult to find someone willing to work with a high risk suicidal patient, such as myself. When my therapist moved to her office thirty miles away and I had no means of getting there, I called ten therapists in a five mile radius of my house. I kept getting the run around. I couldn’t be seen by them because I was high risk and so they referred me to someone else. That someone else then referred me to someone else. I became distraught and just stayed with my therapist event though it meant more phone sessions and text messages.

Now I had the same problem, except I had no back up. There was no one. I had asked some therapist friends on Twitter in my area if they knew anyone seeking new clients. One responded and gave me a name. That therapist never returned my calls. After three weeks (one call a week), I gave up and moved to therapist number two. Same deal. It took me until April to find someone that a) took my insurance and b) wasn’t afraid of suicide. I’ve been seeing this guy for about three months now and it is getting obvious to me that we just aren’t clicking. You need a certain chemistry to work with someone is this guy is lacking. I thought I could work with him but he is my back up right now. I am looking for someone else.

The day that I had my first meeting with him back in April, two therapists returned my phone calls. One had taken three weeks to call me back so I was not in a rush to call her back even though her qualifications seemed like it would match what I was looking for. The other organization I didn’t know too much about but knew they offered CBT, a therapy modality known to work with some people but didn’t for me. I kindly told them I was not looking at this time but if that changed (I hadn’t met the guy yet so it could be possible not to work out), I’d be in touch.

So when I was hospitalized a few weeks ago and my current therapist told the social worker that I was there because of “family conflict” instead of a psychotic episode that happened that weekend, I got pissed off and realized I wasn’t going to waste 16 years with this guy to know it was wrong. I called the other therapist and she never called me back. Then I got in touch with the organization. I had a phone interview with them last week. He first went over my insurance as he didn’t take one of them. OK, but he took the other so I was okay with that. Then we talked about clinical stuff. He asked when was the last time I was hospitalized and I truthfully told him a few weeks ago. He ended the conversation saying his group would be unable to help me as I needed “intensive outpatient” treatment after a hospitalization. He basically said I was “too sick” to work with one of his therapists.

I was floored this happens in 2017. I have been studying suicidology since 2007, reading countless articles about how clinicians, particularly psychiatrists, are more prone to have a suicide during their career than any other profession. Psychologists are second to that. Yet despite the advancements in evidence based practices (EBP), there is still the fear of losing someone to suicide. I can’t make that go away and if I ever become a therapist, I too will have that fear. But there are measures you can take to decrease that risk in the high risk client, if there is a willingness to work with one. That opportunity is lost if you slam the door like countless therapists have done to me. Suicide is inherent in any psychotherapy, regardless of risk factors. It can “appear out of the blue” or not noticed until an attempt is made or a death occurs. The suicide rate keeps climbing. And one of these days, I will become part of that yearly statistic.

I look for help and get denied because of my risk factors, which are history of previous attempts, history of abuse, history of hospitalizations, and history of self harm. These factors I deem “high risk” can also be viewed as severe mental illness or “being too sick”. It was the director of the organization’s choice not to take me on as a client. Pissed me off but his choice regardless. But was it also his fear that I would take on a certain liability because I was chronically suicidal and mentally ill? I will never know but my gut says fear altered his choice. I understand that therapist want to have the kind of practice where things go smoothly and stuff like suicide is dusted under the rug. Suicide is a dirty word. I get that. I have lived it since I was eight, when I first thought of ending my life. No one wants to touch it with a ten foot pole. But excluding these people from these practices, what the hell did you enter the field for?? I have to wonder.

The therapist I work with now doesn’t follow a lick of EBP. I still don’t know what kind of therapist he is. Frankly, he just lets me ramble for 45 mins then it’s see you next week. He has explained what he does but he has yet to actually do it, which is why I want to see someone else, if I can find that person. I live in the hub of academia where there are thousands of therapists. The biggest problem I come across, other than their fear of suicide, is not taking new clients. OK. I get it but can you refer me to someone who IS taking them? No answer or try Susie Q who isn’t within my area of accessibility.

Anyways, these are my thoughts on the matter. Getting screwed by those that are supposed to help mental health patients but don’t want to deal with mental health patients that fit a certain criteria. I think that sums it up nicely.

busy Monday morning

Busy Monday morning

I had a shitty sleep. I fell asleep sometime after 0200 only to wake up around 6 because my foot was in severe pain. I took my pain meds and slept until my alarm went off. I didn’t want to get up but I had to be at the dentist office by 0800. I dragged myself out of bed, got dressed, brushed my teeth, and headed out. I had to wait until the dentist was available to see me. He said that I had severe inflammation of the gums but wasn’t too sure what was causing it. He wanted it to go down and for me to finish my antibiotics before taking x-rays.

I left in time to catch the bus to the Square. While I was waiting, I called my PCP’s office to see if my prescription was ready to be picked up. It was. I had breakfast at Starbucks. I ordered a snickers latte rather than espresso. I felt like treating myself to something good. I had 6 espresso shots. It was stronger than I thought it would be but still good. I went to my PCP’s office after I finished and then went to the pharmacy. My foot was in severe pain by the time I came home. I hadn’t taken any pain meds with me and the last time I had taken them was around 6 this morning. I was overdue. My foot was also on fire so when I came home, I took my pain meds and Neurontin. I also rinse my mouth out with the antibacterial rinse. It doesn’t go well with powerade but I can’t take the Neurontin with water because it is gross. Guess it was the lesser evil.

I wanted to get my meat sauce for supper but my mother is making lazy man lasagna. I will save it for another day. It’s not going anywhere. I have been wanting to have it with penne pasta for a while now. I haven’t had lunch yet. I will finish off the White Castle burgers. That should tie me over until supper time.

I am going to try and stay up but I have a feeling I am going to take a nap. I am really tired from all that I did this morning. I was out for 4 hours. I am glad I don’t have therapy this afternoon. It would suck. My mood sucks right now. I am just exhausted from hurting and not sleeping. I am so tired of waking up in severe pain. It’s really mentally exhausting. The hard part is that I have absolutely no control over it. It flares up whenever it wants to whether I am sleeping, trying to sleep, or just plain resting.

My fricken bowels are going nuts. Whenever I have Starbucks milk, it seems I am intolerant to it. I don’t fricken care because I have been backed up the last few days but the cramps are horrible. I just hope I don’t have an accident because that will kill me. I also hate having to go up and down the stairs a lot because of it. I so wish there was a half bath where the bedrooms are.

I’m trying to make plans with a friend that I met while in the hospital. Every time I ask when to meet up, she is vague or doesn’t answer. I really don’t want to go out tomorrow, except to Walgreens because idiot me forgot my strong pain pill script to get filled today. I had it on the edge of my bed so I wouldn’t forget it but I did. I also need to mail a birthday card for a friend of mine. Maybe I will get some pizza when I drop off the card to the mailbox, though I have been thinking of getting a pastrami sub lately. I love pastrami.

One of my blog readers suggested I get input for the blog about therapists who shaft clients for the suicidality or hospitalization history. If you would like to contribute, please email me at Collerone at Yahoo dot com or use my contact page to send me a message. I’m still mulling over ideas for it so you have time to also contribute if you would like. Please get it in by this week though. I’d like to write it up by the weekend. I think it’s important to get the word out that there are therapists and organizations out there that just don’t want to deal with severe mental illnesses.

CBT for Preventing Suicide Attempts: A Review

CBT for Preventing Suicide Attempts: A Review

I have been reading CBT for Preventing Suicide Attempts edited by Craig Bryan, PhD and these are my thoughts about the book by chapter. I also describe what each chapter is about.

Chapter 1: Deals with the problem of suicide and how it’s on the rise. It also describes the difficulty of knowing what works and what doesn’t. The authors goes on to what the book is about and how CBT has been shown to be useful in some clients with suicide ideation.

Chapter 2: Describes the dreaded nomenclature of suicide attempts, ideas, suicidality, etc. The authors describe how the term SDV (self-directed violence) is a more accurate term and also other terms to decide pathways on treatment protocols. They term the entire suicidality as SDVCS-Self-Directed Violence Classification System. It is used by three large federal organizations- the CDC (Center for Disease Control and Prevention), the VA (Veterans Administration), and the DOD (Department of Defense).

This chapter gives good examples of how different researchers, clinicians, and other professionals can use this classification system. I didn’t review the system pathways and yes/no guidelines because terms don’t mean that much to a suicide attempt survivor writing about my lived experience. I’m either suicidal or I’m not. I don’t need to classify and put myself into a category. But if you are a clinician/researcher or other academic interested in suicide prevention, the nomenclature is pretty good and better than what Silverman et. al. proposed in 2007 a and b (see this blog post on my thoughts about their terms).

Chapter 3 deals with what works and what doesn’t in suicide risk. It talks about studies pertaining to talking therapies and psychopharmalogical treatment of suicidal behaviors. I found this to be more of a review of what I know as of right now in terms of evidence based practices (EBP) and what is not. Some studies were really small and others were large. Most centered around Borderline Personality Disorder (BPD) as that is a high risk group. What I found upsetting is that those with bipolar disorder or those that were psychotic were excluded from most of the studies. As I suffer from psychosis and bipolar disorder, my participation would not be included and I find that disappointing, especially since bipolar disorder and other psychotic disorders such as schizophrenia have a higher incidence of suicide than major depression alone.

Chapter 4 was an eye opening chapter that I really liked. It talked about all of the suicidologists that I have been following for the past eleven years. It discusses different theories and models of suicide and risk assessment. It also discusses protective factors of suicide such as reasons for living/dying. I found this chapter to be really good and a lead off to how all of the things talked about lead to the next chapter, which is a case example.

Chapter 5: In this chapter, a case is described step by step of a suicidal older gentleman and the cognitive steps, consent, etc. are used by a play by play dialogue. Things like safety planning, coping cards, and hope kit are discussed in detail and how to implement them in therapy using cognitive therapy.

Chapter 6 talks about a brief cognitive behavior treatment (BCBT) for inpatient units called PACT (Post Admission Cognitive Therapy). It discusses the criteria for engaging patient, pros/cons of treatment and how not everyone may be suitable for this type of treatment, e.g., those with active psychosis/mania.
It would be good if this could be implemented but as the treatment is 5-6 days and on average most admissions are 3 days, I don’t see how this is to be helpful. Discussion of staff resistance and burnout are also discussed.

Chapter 7: This was very interesting as I’ve never really read about military psychotherapy before. The chapter gives specifics on how to approach a veteran or active military personnel in crisis or dealing with suicidal thoughts. It talks in detail about Brief Cognitive Behavioral Therapy (BCBT) and the steps per session. Not all persons will respond within the 12 sessions. It is individualized for each person. The chapter also talks about hot to discuss lethal means safety and means restriction (see chapt 9 for more information; e.g., gun safety in particular). When the sessions are down to the last two and command of previous exercises are demonstrated to be efficient, end of therapy is initiated. Booster sessions are discussed in case of future crises should happen. I found this therapy to be specific not only for military but can be used for any type of suicidal behavior. It’s a collaboration between therapist and client.

Chapter 8: Emergency departments are the top places suicidal people end up, either with an attempt, ideation, or crisis. Sadly, if the right precautions are not set (e.g., inpatient care or some type of follow up care), individuals are more than likely to die by suicide.
This chapter talks about the challenges and brief interventions that can be initiated so that death by suicide does not occur after a visit. The authors describe specific suicide safety planning that is individualized for that person to help them cope with stress that makes suicide appealing. It also gives crisis numbers, either a trusted person they can talk to in time of need and/or the National Suicide Hotline (1-800-273-8255, text 741741 (US only)). Once a little role play is done and the individual can demonstrate they will use this plan, patients are discharged to follow up outpatient care.
Only trouble I have with this approach is that not all EDs are equipped with mental health professionals and don’t have the 30-45 minutes or so it would take to implement the safety plan, even though it is crucial this should happen.

Chapter 9: As more and more evidence is building that suicidal individuals are seeing a primary care provider prior to death by suicide, it’s become imperative that PCPs have the training to ask patients for means restriction. The author suggests several ways to initiate the conversation and lists steps to do this. If patients are resistant, the use of motivational interviewing techniques are employed. The end result is a means restriction receipt where PCP and patient have agreed to restrict their lethal means. If possible, a supportive person is asked to help secure the means.

Chapter 10: This chapter talks about the use of psychotropic medication and the use of CBT or BCBT in suicidal patients. To date, there has not been studies where therapy and medication has been shown to be effective in reducing suicide risk. It is suggested that despite the thoughts and black box warnings of the FDA, suicide ideation is still likely to occur of not treated or dealt with at the beginning of pharmacological treatment. The author also discusses the risk of substance use and dependence disorders that can increase the risk of a suicide attempt. PTSD has also been discussed as hyperarousal states can increase suicide risk.

Concluding thoughts: Overall, I found this book to be extremely helpful, concise, and important in the prevention of suicide attempts. With the right intervention at the right time, Brief CBT can help decrease the suicide risk and possibly the overall suicide rate.