Well, you know, suicide prevention
and suicide in general, it's just a topic a lot of people are not comfortable with.
And I have to admit, I was one of those people.
I feel really strongly that suicide prevention is everybody's responsibility.
And it's it's a reason there's a big movement towards,
I think, in the VA, educating everybody about suicidality.
And even a lot of the trainings that they provide on TMS
are focused around developing some degree of minimum competency,
and I think that's important and necessary.
Just think about how you might be the person that somebody
discloses that to. For whatever reason,
even a technician answering a phone call at a call center,
you might be the person that somebody makes it makes a vague statement to,
and you should know what to do, have a general sense
of at least what to do in those moments.
When I had my
first experience with suicidal patients,
I was all set to do diabetes.
And he kept mentioning
about a fall that he had and how bad his pain was,
and he couldn't handle it more.
The things he was saying to me
were not things he normally said about his pain.
You know, if I don't make it, you know, I don't care if I don't wake up tomorrow.
This pain is taking too much of my life.
That scared me.
I've had one particular veteran who was given some news
that they were facing criminal charges and and after hearing that,
they got all their affairs in order and began to make some preparatory
take some preparatory actions, including returning their vehicle,
organizing paperwork, organizing all their medications.
And they were given that information at 10 a.m.
and waited until our appointment at 430 in the afternoon to
basically it wasn't clear when we began.
But then through the
course of the appointment, it was clear that they had suicidal intent
and in that moment, I kept the veteran talking in the VC appointment.
They had a loaded firearm with them in the appointment.
And then I contacted the police and used teams
to activate a number of people to start helping defuze the situation.
And this particular veteran was in their early thirties
and was very fearful about spending the rest of their life
in jail or prison based upon some criminal charges.
But they waited six and a half hours after
they were told that information until our appointment.
And I mentioned to the veteran, I said, it's remarkable
that you waited all this time
after returning your vehicle, getting all your affairs in order,
putting all your medications in specific places.
And you waited.
And I have to believe that a part of you wanted me to stop you.
A part of you knew that I would stop you and would intervene on your behalf.
I'd like to hear more about that part of you
and did you stop them?
Yeah.
The veteran was stopped. Yes,
the veteran was stopped.
And the police came.
The veteran and the police would not go inside the veterans apartment.
They would not do it because there was a loaded firearm.
So the veteran had to leave their home and the police
made sure that they parked their cars like a block and a half away.
So there were not just this
string of all these emergency vehicles outside the veterans door.
They waited down the steps with the crisis
counselor there, and they introduced themselves to this veteran.
And the veteran, nobody knew who these people were because we talked about them.
And the veteran told me it was a very comfortable experience and it felt safe.
The process of intervening has to feel safe, too,
because that can feel really scary to have to be converged
upon by a multitude of different health care providers and police
could be a very frightening thing.
So a lot of it was just talking to the veteran through the process
of who's coming, who they are, where you're going to go,
what is the experience so where you're going to go going to be like.
But that moment of telling and saying to the veteran
that you waited six and a half hours
and I believe that a part of you wanted me to stop you.
A part of you wanted me to intervene.
I'd like to hear more about that part of you.
The veteran was in tears when I said that
and then started talking about the reasons they had for living.
And we were able to even then kind of talk about a safety plan
and go into some safety planning in that moment organically.
Actually,
in this particular situation, the appointment started off
like any other appointment and the veteran told me one.
I did notice that at the beginning of the appointment
the veteran was in their bed, in their pajamas, which was unusual.
It was a VC appointment from it was a BBQ appointment in their home
and the veteran was in their pajamas in bed, which was unusual to me.
And the veteran looked as though they had been crying.
I could see that those were the only things that were unusual
in the appointment started off,
and then the veteran proceeded to tell me as they asked how their day was going,
that they were served that morning by the chief of police in the area
they lived in about facing charges that would result in them going
to jail or prison. And
people who
face jail or prison, that's that is a puts
people in a high risk category for suicidal thoughts and behaviors.
And that's when I thought
something is certainly off here and I need to dove into this deeper.
And then I actually told the veteran, when people face charges
such as those that you were presented with this morning, and often
there's there's risk around having more suicidal thoughts.
And I said that just as a statement.
And then the veteran started to cry and then said that they were planning
on suicide in that afternoon, were not planning on telling me and
things kind of progressed from there.
I was still on the VC appointment with the veteran
when they left the home that I wanted to stay engaged.
I wanted to continue to look at each other the whole way through.
I never wanted to break eye contact essentially as best I could.
And so the veteran carried the phone with them outside
as they left their apartment to meet the police.
I actually heard them exchange hellos.
By the time the the call was disconnected.
I wish I could say I have no
personal experience of
the suicide,
but I've lost a lot of friends and people in my community to suicide,
and I wasn't able to be there for them.
But there was a turning point in my career and in my personal life
with one of my patients that I saw
is a Vietnam veteran, came in for diabetes management appointment.
I'd seen him for a couple of years, so
this was nothing out of the ordinary.
He came in that day and I could just tell something was off.
He was really quiet.
He was tearful, hopeless.
This really withdrawn.
And I noticed his diabetes control
had begun to decline over time,
and I could tell there was something deeper going on with him
and I really needed to figure out what that was because
I didn't think
addressing just medications at that moment would really make a difference.
I had never asked any of my patients before
if they had thoughts of suicide or thoughts of harming themselves.
It took a little courage for me to ask that for the first time.
And to be honest, when I asked him that,
I really just expected a no answer.
So when he answered yes to those questions that he was suicidal
and he had different things that he had been thinking about
of potential ways that he could end his life.
I was shocked.
I was I was unprepared.
And here, you know, here I am in the position
to be face to face with someone and potentially save a life.
And I didn't know what to do.
And one of the things I learned about during this encounter was a safety plan.
I had never seen a safety plan.
I had never heard of a safety plan.
But throughout this visit, we were able to sit down
and actually fill out a safety plan.
And if you don't know what that is, it's just a plan
that you can actually go over with a patient who may be in crisis,
where you identify protective factors for living,
support people to call if they are in a crisis and need help,
ways to take their mind off of the circumstance
that put them in the crisis.
And this veteran trusted me.
We were very close.
I saw him every month for, you know, several, several months.
And I felt like I needed to be the person
to sit down and go through these things with him.
Throughout completing the safety plan, I felt
at the end of the visit that we had mitigated that risk.
He was
no longer an immediate threat to himself.
We deemed he was safe to go home.
And I mean, I like to think we saved his life that day.
When I had my first experience
with suicidal patients,
I was all set to do diabetes.
And he kept mentioning
about a fall that he had and how bad his pain was.
And he couldn't handle it anymore.
The things he was saying
to me were not things he normally said about his pain.
You know, if I don't make it, you know, I don't care if I don't wake up tomorrow.
This pain is taking too much of my life.
That scared me as
I knew something was different
in his demeanor.
I knew this was not my normal patient.
The way that he acted.
I said, I hear what you're saying and I want to help.
He didn't want to be a bother.
And so I reassured
of how much I care for him.
I was able to do a warm handoff to the suicide veteran crisis hotline.
We both conference, then I made sure they knew
who the patient was, what their name was, where they were.
Any other information about what was going on?
A lady on the other line said, I have it from here, you're okay to hang up.
And I made sure that their provider knew
the mental health provider knew everyone knew what had just happened.
So that whole team, we together were helping this veteran
and then also alerted
his providers so that he got the care that he needed.
And I got him again for diabetes
and he was so appreciative of the help and was doing in a much better place.
And honestly, it hasn't come up again.
You would think that that little intervention would have that
kind of effect.
I was hoping I was hoping he would get the care he needed.
But to
to create that relationship with that patient
that he felt comfortable enough to tell me what was going on.
I think
meant a lot to me.
You don't think a diabetes call is going to go that way?
And when it does,
it can be life changing.
I once thought, you know, as a pharmacist,
I wasn't
properly trained to assess for suicide or suicidality.
And it's become more aware in my career
and in my personal life that it's everyone's role.
Everyone should know how to ask those questions
and be prepared to be there and to help that patient
pharmacist have a lot of touches with veterans,
and we could very well be the last person they speak to,
and we need to be prepared
to be there in the event
that that happens.
And it will at some point in your career, it will happen.
First and foremost, suicide prevention
and suicide risk reduction is everybody's responsibility.
It's everyone's responsibility.
And sometimes what it really takes is to listen
and to show somebody that you care and you'll continue to be there
to see them through the moment that they're in, the crisis that they're in,
too. If you notice something, ask about it.
If you notice something, talk about it.
Don't leave something unsaid.
If a friend makes a vague statement
about having suicidal thoughts, ask him about it.
Ask your friend about what's going on.
What did you mean when you said that to me?
To never shy away from even
the most vague statement about safety.
That's the starting point.
The veteran told me that staying calm and presenting
lots of education and explaining things was extremely useful.
And I think that that's very important too,
because there's a lot of doubt and uncertainty of what's going to happen.
I think part of it is just a fear of the unknown
and what what's going to happen, what's going to happen in my life,
what's going to happen to me going to jail?
How am I going to feel this way forever?
These are all the different thoughts that go through people's mind
when they're thinking about ending their life, at least some of them.
So when you're able to explain more about where they might go from here,
what their life could look like,
what treatment might look like, and how it could change,
what are the services and resources that are available?
What you've seen at work for other people and how their life might be different?
Five years from now, I think that affords people hope and a moment where hope is
the furthest thing from them.
And I always say, say to them
your future self,
your future self will thank you for making the choice to be here today
because you can't imagine what your life will look like five years from now.
But I imagine you'll have learned from this.
You have grown from this experience.
After it was all done
and the veteran was safe, I knew that they were in the hospital.
The police had called me and debrief with me.
I talked to the chief of psychiatry.
I sat in my office and just had a few tears to myself
just from the intensity of it all.
And also just to think that
I just was I was grateful for how things turned out.
And and then I felt prepared.
The veteran came back after being in the hospital for seven days
and with tears in their eyes, thanked me and said that you saved my life.
The VA saved my life.
And I'm really glad. I'm very hopeful.
I didn't know that I was going to get a lawyer, that
that was going to change my medications, that now I'm working with a therapist.
This is the first time I've really ever been this engaged in treatment,
and I've probably needed it for a very long time and I'm very grateful to the VA.
It was pretty amazing.