So that really was the perfect note on which to end that first conversation and
the perfect segue to someone I'd love to have you hear from next I want you to
please welcome dr. Ursula Whiteside and Ursula is clinical faculty at the
University of Washington and CEO of now matters now.org and Ursula is going to
share her perspective as both a researcher and a clinician and she's
really going to deepen our dive into how we can use data to improve and
strengthen your clinical work so please welcome Ursula in 1999 I'm 20 and I'm
sitting at my rounded desk and my really blue office in Marshall enhance research
laboratory and I'm on the phone with a woman who's in her late 40s who runs her
own business in Seattle I'm going through the questions I'm asking her
when was the last time you had a suicide attempt and how many suicide attempts
have you had and her monotone responses really don't convey any emotion if she
is having any emotion when we get to the end of the call after me consistently
being on the edge of maybe too perky as many as thus are at that stage in our
career when we get to the end of the call I asked her her scheduling her
appointment there's anything else that she would like to tell me before we get
off the phone what she says after a long pause is if you could just take the
phone receiver and put it on your desk so I could hear you type I would feel
less alone and without hesitation I did that I was one of marsha linehan
students the the director of and developer of dialectical behavior
therapy and we were taught to be fearless
and at least fearlessly compassionate if nothing else but as I went through my
graduate training when I did my work outside of the research lab it was more
in a training that created more fear over time I lost some of that fearless
compassion and replaced it with worry about other things I don't know if
others of you have had similar experience of becoming more afraid over
time it's certainly true for me what do we do
with that fear because we know that it's getting in the way of our best work with
our patients that's what they tell us in anyway so I start with asking questions
and the question that I find useful in the situation that I've learned from
people who've been there is what is it like to be unseen like if you have ever
actually been in the situation where something was really important and
painful and it was not recognized or maybe even worse it was you were told
that it wasn't true and this really fits into the story of suicide when you think
about those who are at highest risk when you think about our trans youth who who
when people don't use their preferred name are a greater risk for suicide or
when you think about our native and black partners who have experienced such
injustice in the history of our nation that could never fully be recognized or
seen or what if it's the miner in northern Minnesota who's about to be
laid off from his job and is going through a divorce and feels like this
society is rejecting him being unseen contributes to suicide and as we become
more anxious in our sitting with suicidal patients we also become less
able to see them as they truly are ten years later I'm at the University of
Washington working with patients who have on clinical internship who recently
attempted suicide and I'm working desperately to get them into some kind
of mental health care much less dialectical behavior therapy and they're
like desperate for help and we are failing
our health system is failing and at that time I experienced suicidal thoughts
myself in part due to the experiences there it it isn't so much that we aren't
there it is that we don't necessarily know what to do and 20% of people who
die by suicide saw a mental health provider in the month before their death
and nearly 50 percent saw a primary care provider so we have a funnel we have we
have a way to find people and to work with them and in 2011 2012 a new
approach to suicide and health care arose and it's called the zero suicide
approach have you ever heard of zero suicide if you haven't I'm so excited to
tell you about it it is the first ever approach to suicide in health care that
was a line item in the president's budget so first in Obama's budget and
then now in the current president's budget this is recognized by our federal
government and there's funding and Samsa CDC NIH and the American Foundation for
Suicide Prevention all support this approach but what it is is helping
health systems prevent people from falling through the cracks it's a
systemic systems approach what this approach led to is something called the
recommended standard of care so never before in the field of suicide had there
been standard guidelines national expectations for what to do and can you
imagine if you've shown up in the emergency room and you were experiencing
cardiac symptoms or symptoms of a cardiac arrest
and if there weren't a standard process in place how insane would that be if
that were the case well the same that actually is true with suicide that there
was no standard of care clear expectations across health care settings
about what do you do when someone's at risk for suicide so in 2018 in April
national standards were released and essentially what they are is the minimum
standard of care for work with patients who are suicidal and they provide three
expectations evidence-based approaches that we all
should be using so if you haven't heard of recommended standard of care think of
this how great it is is it that you could have national recommendations that
you could rely on that if you followed you could say I'm following the National
recommended standard care guidelines and not only are these supported by the the
Commission around suicide prevention the National Coalition they're also
supported by organizations like the Joint Commission who do accreditation
for health care organizations so what are they again they're the minimum so
they are asking the question identifying who's at risk there are safety planning
including lethal means assessment and their follow-up caring contact there are
all things that we know can help prevent suicide when we're talking about
screening and assessment Jane mentioned earlier the patient Health Questionnaire
what we know about the last item on that question which asks about suicide is
that it is as good or better a predictor of suicide attempt as cholesterol scores
are of heart attack so you can use that imperfect non-proprietary tool to
identify who in your practice might be at greatest risk for suicide and those
would be people who are saying more than half the days or nearly every day I'm
having those thoughts with safety planning you're creating a plan for
people to follow the steps to take for what they should do when the when the
urge hits them and there's no reason why you couldn't put DBT skills in a safety
plan and then finally you're doing the follow-up with caring contacts at the
same time as the zero suicide approach was coming up Marsha Linehan came out in
the New York Times in 2011 about her suicidal experience and she talked
openly about this and I remember her saying she was terrified as she was
absolutely terrified although you would not be able to tell that from the
outside when she was speaking about it and her wish now when I visit her on
Saturday mornings is that people know how to go about doing this her memoir
comes out early next year and essentially this
- if I can do it you can do it and and here's how I did it
this is what she's most passionate about at this point in her career so stories
like marshes and especially Marceau's led the way for many people to come out
about their own suicidal experiences and the field of suicide has completely
transformed because of this and gotten a lot better I would add one of the things
it helped create was something called now matters now org this is a free
public resource that was funded by the National Institutes of Health or NIH and
the American Foundation for Suicide Prevention and it was created by and
with people with lived experience of having suicidal thoughts
they were consultants they were paid consultants in the same way you would
pay any other advisor or collaborator on a research study and what it is is that
stories of how people got through suicidal times using strategies from
dialectical behavior therapy it's a video based tool and as a leader creator
of this website what we recently published is a finding that people who
report suicidal thoughts while visiting this website including those who say
that they are completely overwhelming have reductions in those suicidal
thoughts in under 10 minutes so it's a free public resource intended for you to
provide to patients so they can get a little bit more information about how to
cope with suicidal thoughts using an evidence-based strategy in the work that
I do training providers in how to work effectively with suicidal patients
across the globe I do these 6-hour trainings but when I have my team or a
team now matters now the group of people who advise the development of that
resource when I have them review the content that I've developed what they
say is yeah Ursula great you can talk a lot six hours is a long time but if they
leave and they they don't know these three things then you really haven't
succeeded so what they say is what's most important to them when they're
going through a suicidal time are these three things and that is that you don't
panic your present and you offer some kind of
hope and one way that you can offer hope providing a caring contact card so
underneath your seat or on your seat was a card and that is a caring for you to
use as a caring contact and a caring contact card is a way that you can
communicate expressions of care support and hope hope being really key in
addition one of the things that we learned from people with lived
experiences that some people have an overwhelming urge to die that arises
very rapidly they didn't wake up with him and so we haven't really developed
interventions for what to do in that situation except for to call a crisis
line but what people are describing is that that state is so uncontrollable
that it's really difficult to think clearly and that reminds us of when
you're on fire physically it's very difficult to know what to do and if you
didn't you would run through the halls screaming if you were on fire physically
but what if we learned what to do when you were on fire emotionally from when
we were children what if that went right alongside that we had steps to take so
we we crowd-sourced a drop a stop drop and roll we ask clinicians we ask people
lived experience we asked crisis for sponsors responders these are the three
steps you can learn more about them and now matters now org that we came up with
one includes dunking your head in cold water
there's a great video on the now matters now website so there were two themes in
the last 20 years that I found working with suicidal patients training
clinicians and what those are is that we often feel powerless and afraid because
the problem feels so big and that patients find simple things helpful well
the four percent of Americans seriously consider suicide in in a given year we
need to get on our game what I'd like you to do now is just take a breath and
pull out that car that's under your chair or that was sitting on your chair
it may it may look like this it may just be a card
and if you don't have one look harder but no if you don't have one send a text
message to someone we know that carrying messages at least four people who are
really really suicidal our associations with reductions in suicide there
non-demanding expressions of support and usually they my guidance around these is
that they say something about I see how strong you are or I have hope for you or
I'm looking forward to seeing you again I'm looking forward to seeing you again
I have hope for you I see how strong you are putting something like that in the
context of a message for somebody who's suicidal is such a simple thing and and
there's research just to suggest that that could prevent suicide so I hope
you'll consider some of these simple things as you move forward today and
write a caring message either to a friend to yourself or to a future or
current patient thank you so much for your time today