Wednesday, September 14, 2016

“Words Make Worlds”: Language and the Culture of Mental Health in Workplace Wellness

by Donna Hardaker and Sally Spencer-Thomas

Part III: Words about Mental Health

In Part I: “Words Make Worlds”: Language and the Culture of Mental Health in the Workplace”, we explored the rationale for being mindful and intentional about language as we address stigma and social prejudice due to archaic and unconscious speech. In Part II, we addressed specific language about suicide. Here in Part III, we look at specific language about mental health.
“Power is the ability to define reality and to have other people respond to your definition as if it were their own.” – Wade Nobles
“Words are powerful. Old and inaccurate descriptors and the inappropriate use of these descriptors perpetuate negative stereotypes and reinforce an incredibly powerful attitudinal barrier.” – Kathie Snow
Workplaces are microcosms of society as a whole and have a significant contribution in generating social inclusion or exclusion. Workplaces can be powerful change agents when they create caring cultures through mindful attention to how suicide and mental health are discussed.

Photo by Benjamin Child
It is difficult for us to write this article in a simple “Say This” and “Don’t Say This” way. The topic is far more complex than swapping out words. This discussion is inside of a social movement (generally referred to as the recovery movement) that seeks to draw attention to unconscious bias held by the powerful dominant group who own and operate the communication methods that describe people who are not in the dominant group.

Generally, clinicians are the dominant group who name this experience. Clinicians use diagnosis-based thinking. Thoughtful language about mental health and suicide does not rest on diagnostic categories, but rather tries to communicate more clearly, accurately, individually and holistically about the experience. We constantly look to find language that is dignified, empowering, and inclusive as well as being as descriptive as possible.

This is not about political correctness. It is about altering how we all speak, and therefore how we all think, in order to permanently end social injustice in this area. Just as with other social justice movements, polite society no longer accepts these terms: “mental retardation”, “handicapped”, “colored”.

It is not easy to find “the best” language; we are forced to use common terminology developed by the dominant group that does not emanate from the empowered voice of the people being talked about:

1. The terms are often clinically based and clinically biased. Many people in the recovery movement push back against the term “mental illness” because it puts the descriptor of a person in medical language. This forces a medical presence inside the naming of a group who do not always wish to be identified based on a medical perspective. The medical model, when socialized in the media and in boardrooms, contributes to rampant oversimplification that looks like this: “All that has to be done is to get these ill people to seek treatment, they take a pill and they are fixed!” It is important to keep in mind that diagnosis serves the medical practitioner in treatment planning. It does not provide good information or understanding about the whole person and encourages us to see a person only in terms of a medical condition. And diagnosis is often incorrect, so should not be the focus of how we educate.

Clinical bias mostly does not include a trauma-informed approach. It is very common for people who have received a label regarding mental health or substance use to have a significant history of trauma. 

This correlation is ignored in the language, and often in treatment too. The trauma experience is not addressed, only the set of “symptoms” currently seen.

2. The choice of words is not mindful. In heavy usage is the word “suffering” as in “people who suffer from depression”. This paints a pathetic picture of nothing but suffering inside this experience, which is a fallacy while suggesting a passive state of inaction.

Another common term is “the stigma of mental health”. This word usage infers that there is stigma inherent inside of mental health. Instead, words should more accurately describe that stigma is an attitude of prejudice towards a group of people by a group of people who are dominant. See below for suggested alternatives.

3. Terms promote “other than” thinking. The words “disorder” and “disability” inform us that those who fall into these categories are other than “ordered” or “able”. “Order” and “able” are the givens, the desirable things, the “normal” things.  “Dis” infers “other than” and forces the thought that a person described this way has a value relative to the desirable given, and of course falls short. 

Consider this: the term “non-white” is not used to name a person who is other than Caucasian because it would be deemed to be disrespectful. Unfortunately, we do not have a wording solution to this dilemma.

4. Better terms require more words. Because we are forced to use terms that represent dominant culture mindsets, we can refer to them as labels, not as the “truth”. For example, a better way of saying “a person who has a mental illness” could be to say: “a person who has the experience of having been assigned a medical label in the category called ‘mental illness’ “. But this makes writing and speaking very cumbersome.

5. We do not have consensus around best language. Inside the recovery movement, we do not have consensus on best language, and that is okay. Let’s all keep thinking about this, talking to each other and pushing us collectively toward better communication.

The chart below provides some principles of progressive language. The suggestions that appear in the right-hand column are far from perfect, and we hope that they will continue to adapt and improve. To fulfill our desire to support self-determination, please note that if a person with the lived experience of a mental health challenge wishes to identify themselves using language from the left-hand side of the chart below, we support their choice.

(This is not an exhaustive list, and for reasons of space does not hold all the terms and usage that we wish would change.)


Moving language away from…
Moving language toward…

Phrases that perpetuate incorrect thinking

·         “stigma of mental health”
·         “mental health stigma”

Infers that there is something inherently stigmatizing about mental health.

More appropriately descriptive phrases

·         “stigma, discrimination and social prejudice towards people who are deemed to be in the group labeled as having a mental illness”

We recognize that this is too long, but let’s continue in this vein! Especially important is the insertion of “social prejudice” to call out the group who are engaged in the attitudinal damage.


Words that promote only one aspect of the experience

·         “people suffer from a mental health challenge”
·         “people who struggle with a mental health challenge”

It is inaccurate to indicate that the entire experience is one of suffering and struggle.




·         “have a mental health challenge”
·         “lives with a mental health condition”
·         “living through suicidal thoughts.”
Language here begins to communicate resilience.

It could be appropriate to speak about functional impact with use of the word “struggle”
·         “overcomes struggles with concentration”
·         “finds ways to cope with the struggle of fatigue”

Confusing lay usage of clinical terms

·         “he is acting so bipolar”
·         “the weather is schizophrenic”


Test your language by swapping out a term for an experience that is generally accepted, for example, you wouldn’t say “he is acting so diabetic” or “the weather is cancerous”

Hate speech

·         “psycho”
·         “cray-cray”
·         “nutjob”
·         “whacko”
·         “lunatic”


Respectful language that promotes dignity. Ask: would you enjoy the word being used to name someone you care about?

·         ”a person in distress”
·         ”a person in emotional distress”
·         ”a person with a history of psychological distress”
·         ”a person experiencing a mental health challenge”
·         “a person living through overwhelming life challenges”

Language that cuts a broad swath and defines people by their conditions.

·         “the mentally ill”
·         “the homeless”
·         “the disabled”







Wording that recognizes individual experiences and differences.
·         “people who have mental health challenges”
·         “people who live with mental health issues”
·         “people whose experiences are labeled as a mental illness”
·         ”people who experience homelessness”
Language that uses clinical or legal identifiers

·         “a patient”
·         ”a case”
·         ”a client”



·         ”a person who is engaged in treatment”
·         ”a person who is receiving services”

Language that emphasizes a diagnosis, not the person

·         “he is a schizophrenic”
·         “she is bipolar”
·         “he is an addict”

People-first language

·         ”he is a person who has received a diagnosis of schizophrenia/bipolar disorder”
·         ”she is a person who experiences addiction”
·         ”he is a person who identifies as an addict”

Shorter, but problematic due to diagnosis as a descriptor:
·         “he has schizophrenia”
·         “she lives with an anxiety disorder”
·         “she is in treatment for depression”
·         “she is coping with the effects of trauma.”




Portions of this chart have been adapted with permission from Each Mind Matters, California’s Mental Health Movement, funded by counties through the Mental Health Services Act (Prop 63).

In conclusion, words matter, especially where there is such a long history of marginalization, misinformation, and mystery around daunting topics. When it comes to language related to mental health, we may not have all the right answers, but many of us are in the struggle to do better.

******

ABOUT THE AUTHORS

SALLY SPENCER-THOMAS: As a clinical psychologist, mental health advocate, faculty member, and survivor of her brother's suicide, Dr. Sally Spencer-Thomas sees the issues of suicide prevention from many perspectives. Currently, she is the CEO and Co-Founder of the Carson J Spencer Foundation, a Denver-based organization leading innovation in suicide prevention. One of the main programs of the Carson J Spencer Foundation is “Working Minds: Suicide Prevention in the Workplace” – the nation’s first comprehensive and sustained program designed to help employers with the successful prevention, intervention and crisis management of suicide (www.WorkingMinds.org). Additionally, she is the Co-Lead of the Workplace Task Forces for the National Action Alliance for Suicide Prevention, and the Co-Chair of the Workplace Special Interest Group of the International Association for Suicide Prevention.

DONNA HARDAKER:
Donna is an internationally recognized industry expert in the emerging field of workplace mental health. She is an award-winning curriculum developer, advocate, public speaker, writer, and advisor, who has leveraged her personal experience of mental health challenges and their impact on her employment history into a significant body of work. She is the Director of Wellness Works, a workplace mental health training program of Mental Health America of California that has been evaluated as highly effective in stigma reduction with lasting behavior and culture change. She is also a member of the Workplace Task Force for the National Action Alliance for Suicide Prevention. Donna is from Toronto, Canada, but now lives in Sacramento, where she greatly enjoys the California sunshine.
Learn more about the National Action Alliance for Suicide Prevention: http://actionallianceforsuicideprevention.org/



Wednesday, August 24, 2016

Male First Responders, Mental Health & Suicide Prevention: September 1st Twitter Chat to Kick off Suicide Prevention Month

We depend on our first responders to keep us safe and save our lives. Now we need to make sure those who are willing to risk their lives to protect us get the support they need when they hit hard times. To kick off Suicide Prevention Month, the Man Therapy partners ask you to join them on September 1st at 6:00 p.m. MT (5:00 p.m. PST, 7:00 p.m. CT and 8:00 p.m. EST) for a live Twitter chat hosted by the Carson J Spencer Foundation. The Twitter chat will engage first responders and mental health providers in a conversation on how to best reach and support first responders. To participate, simply follow #ManTherapy for the duration of the chat and be sure to use the same hashtag in your questions and responses.

During this hour conversation, first responder panelists (see below) will be engaging participants in a dialogue on the following questions:
  •        What factors increase risk for suicide among first responders? What are the differences among groups of first responders?
  •          What are some barriers to reaching out for mental health services and other forms of support?
  •          What are some promising practices, resources, and tactics for mental health promotion and suicide prevention among first responder communities?
  •          What do you think of the new first responder resources from Man Therapy?


Panelists
Derrick Delgado: Derrick Delgado is a Captain for the Denver Fire Department and the President of the Firefighters Incorporated for Racial Equality (F.I.R.E.). After the death of Captain Steve Magana, Delgado helped lead a new suicide prevention initiative at DFD that has become a model for other departments in Colorado and nationally. More here:
·         Delgado shares why suicide prevention in important for fire service: https://youtu.be/xSnVGwAc0mI
·         YouTube video from Denver Fire Department on Total Wellness: https://youtu.be/SskSfiMLxl8   
@DerrickJDelgad3 
Brian Humphrey:  A lifelong California resident, Firefighter Brian Humphrey is celebrating his 31st year as a member of the Los Angeles Fire Department. In 1993, Brian was appointed to a Command Staff position as Public Information Officer prior to that year's monumental wildfires and the Northridge Earthquake in the year that followed.
@BrianHumphrey
@LAFDTalk
Shawn Mobley: Shawn Mobley is the Otero County Sheriff in Colorado. He is a U.S. Army veteran, an accomplished police instructor, veteran criminal investigator, and a community-oriented problem solver. Mobley has received numerous awards throughout his career and is the highest decorated officer for the La Junta Police Department, earning the Distinguished Service Cross for heroism and bravery, two Lifesaving awards, commendations for homicide investigations, accident reconstructions, and community service.
@OteroSheriff
Greg Pixley: For over 30 years as a Firefighter, Greg Pixley has witnessed the tragedy of suicide faced by our Brother and Sister firefighters and their families. This has driven him to assist those in need. As the Director and member of the Denver Fire Department Peer Support Team, he knows how important it is to always be there when called upon.
@GregPixleyDFD
Tom Wood: Tom Wood is the Field Director and 18 year veteran of the Alpine Rescue Team in Evergreen, Colorado. He’s a U.S. Delegate for Terrestrial Rescue to the International Commission for Alpine Rescue. Tom is an author, and his memoir Trading Steel for Stone: Tales of a Rustbelt Refugee Turned Rocky Mountain Rescuer, tackles the difficult topic of backcountry suicides and their effect on first responders.   
@TWood715
Give Us Feedback on the Man Therapy website here: https://www.surveymonkey.com/r/ManTherapy

###
About the Man Therapy Partners
The Man Therapy campaign is the result of a unique partnership between Cactus, a Denver-based advertising agency, the Office of Suicide Prevention at the Colorado Department of Public Health and Environment and the Carson J Spencer Foundation, a Colorado-based nonprofit organization with a focus on innovation in suicide prevention.

Cactus

Cactus is a full-service brand communications agency providing business solutions for companies and causes through brand strategy, advertising, design, interactive and media services. Cactus has been nationally recognized for its breakthrough creative executions by The One Show, Communication Arts, The Webby Awards, South by Southwest, Favourite Website Awards, Advertising Age, Creativity and Print’s Regional Design Annual. To learn more about Cactus, visit cactusdenver.com.







Carson J Spencer Foundation - Sustaining a Passion for Living

The Carson J Spencer Foundation (www.CarsonJSpencer.org) is a Colorado nonprofit, established in 2005.  We envision a world where leaders and communities are committed to sustaining a passion for living. We elevate the conversation to make suicide prevention a health and safety priority by:
  • Delivering innovative and effective suicide prevention programs for working-aged people
  • Coaching young leaders to develop social enterprises for mental health promotion and suicide prevention
  • Supporting people bereaved by suicide and people with lived experience with suicide.




Colorado’s Office of Suicide Prevention –– Colorado Department of Public Health and Environment

The Office of Suicide Prevention, a legislatively mandated entity of the Colorado Department of Public Health and Environment, serves as the lead entity for statewide suicide prevention and intervention efforts, collaborating with Colorado communities to reduce the number of suicide deaths and attempts in the state. To learn more about the Office, visit www.coosp.org.



Wednesday, July 27, 2016

Inherited Conditions and Mental health

Guest blog by Tyrone Beverly
Photo by Mark Greenwood

Why is talking about race, inequalities, mental health, and suicide so challenging? Because it has the tendency to invoke uncontrollable emotions, subjectivity, and is a reminder about the open wounds that have yet to heal. We all see the world through our own lens, and we must do a better job listening to the voice on the other side of our personal narrative. It's okay to disagree but listen with clarity, emotional intelligence and work toward necessary changes.

We can strengthen and develop our emotional intelligence through our daily routines, the way we respond to conflict, and by seeing things for what they truly are. We have been conditioned to respond to discord in an unfavorable way. The moment a person or a situation can manipulate our temperament, we are easily controlled by it. Emotional intelligence is simply self-mastery, and self-mastery begins with self-acceptance, exploration, and discovery. I've come to realize that the majority of our problems are social, and it plays an instrumental role in the psychological warfare going on in the minds of many. In conversation, be slow to anger even when you disagree, decrease negative thinking, breathe peacefully, and be aware of those who strive to control you by your emotions.

When we truly seek to understand, we must realize that the innocence of a child is interrupted by the climate of their generation. At times, they are victimized by their inherited culture. What was your upbringing like? How did people in your community feel about other races and how has that influenced you? How many people from different cultures have you genuinely invited in your home on a regular basis, or vice versa? Our home is our most sacred space and celebrating our differences by opening the door says a lot about how a person views the world and the people in the world.

Fortunately and unfortunately, the era a person is born into and to what a person is exposed has the propensity to shape their reality. In 1851, Samuel A Cartwright diagnosed runaway slaves with a mental illness called drapetomania, which was considered to cause many enslaved to flee from captivity. What can possibly make a slave flee.... Today, drapetomania is considered pseudoscience and a contributor to the structure of scientific racism. Before drapetomania was debunked, people in that era believed and wholeheartedly accepted this condition to be true. Sadly, that could be said about many studies today, missing the underlying root causes ofwhat's classified as aberrant behavior.

In 2016, here in Colorado and across the country, the narrative is black lives matter, make America great again, tougher gun laws, the homeless crisis, an urgent need for mental health services, and so much more. One thing I would like to hear more of is labeling theory, as it relates to the transmission of functional and dysfunctional social relationships, behavior, and stressors from multiple generations to be next. Labeling theory is ingrained in the communal construction of a designed reality and continues to show up in everything previously mentioned (BLM, MAGA, the homeless crisis, etc). Whether or not drapetomania was real, the ideology that created the belief system is. Once a person is labeled, (NOTE there is a difference between label and identity) one of the easiest things to do is build stereotypes, separation, and pit people against each other. There is not one white person that represents all white people, there is not one black person that represents all black people, there is not one Hispanic that represents all Hispanics, nor is there one police officer that represents all police. When people get to a place where they can judge a person by the content of their character and not by the label they were giving, we will have a better chance at humanity, but people's values tend to be influenced by systematic thinking.

We all have inherited the history of this country, but have we addressed it? After slavery, Jim Crow laws, ills of segregation, drugs being brought into the communities and many other historical wounds, there were no mental health services addressing trauma for those being oppressed. There is growing research that suggests many classified as African American and other minorities still suffer from a psychological trauma that has been linked to post-traumatic slave and poverty syndrome.

When you see a Black Lives Matter protest after a police shooting, what comes to mind?

Everybody has an opinion, but everybody does not seek understanding. Police officers were once called slave patrol and many people are unaware of the historical trauma and mental health implications that still has on people today. I would love to see better relationships with law enforcement in minority communities. It's time to take a more holistic approach and deal with the psychology. Everyone is under what I call inherited conditions, and until we work towards understanding those conditions, the cycle will continue.

The complexity is vast, and there is no one answer.

Graphic by The Associated Press-NORC Center for Public Affairs Research
The truth is, no matter a person's label, everyone needs mental support and better living circumstances. We all occupy the same planet and we need to deeply evaluate our thinking. Minorities don't seek mental health services for several reasons. Some are:

  • Motivated to help themselves
  • Shame or pride
  • Don't believe the provider is qualified to deal with the needs of minorities
  • No relationship
  • Have been hurt by a broken system that doesn't seem to care about minorities
  • Don't want to be mentally molested by poverty pimps
  • Lack of resources
  • Financial hardships
  • Don't know how
  • Don't think they need help

Ultimately, everybody wants the best for themselves, their family, and community.So we must learn about the unique needs a person has on an individual level because one size does not fit all.

The Centers for Disease Control and Prevention recently reported that the rate of suicide in the US is increasing. Could it be the lack of social acceptance, people growing hopeless, the unknown, or a growing mental illness pandemic? I'm going with them all, but highlight the lack of social acceptance. In the 12th century in Japan, Seppuku (a samurai ritual for suicide) was performed from a lack of shame and to give or restore honor. When a person has private pictures released on the internet, like the samurai, suicide seems to be the only way to escape the shame and restore honor. Outside of the mentally ill, the thought of failing at life and not living up to the expectations people have for you or themselves, seems to be the common denominator. We live in a country that does not accept failure, and I believe we must look at the social pressures and truly acknowledge them to be major contributing factors surrounding the growing misconceptions about mental health.

When doing this work, we must continue to strengthen and develop our emotional intelligence. We need more kind-hearted and compassionate people. Compassionate about life and compassionate about endless possibilities. More people supporting those in need and just spending time together. Sometimes the only prescription that's needed is knowing that someone cares.

Let's fall in love with life and improve the quality of our relationships. To everyone reading this, smile because you're beautiful and you are what the world has been waiting for. When you wake up, wake up seeing how you can make a difference and never lose site of the beauty within.

*****

Tyrone L. Beverly, founder and Executive Director of Im'Unique, has been leading this type of community programming for several years and recently formed the organization in 2012 based on its popularity and demand.  His extreme passion for equality, humans rights, diversity, unity, physical and social health has lead him to become one of Denver’s leading advocates in health and wellness. He is both nationally and internationally known for his work in the yoga sector and his influence in the community.

Tyrone seeks to increasingly reach the global community as was successfully accomplished through his health initiative at the Ragamuffin summer camp in Settlement Jamaica and Wudang China.  Mr. Beverly’s enthusiasm and energy has continued to supersede stereotypes and create avenues to permeate social and cultural barriers. The culmination of Beverly’s life work serves as a foundation that represents his vision of a future, with more problem solvers and solution based thinkers that deal with the challenges we all face as a society. Which he believes will create a  better life experience for all people.

Wednesday, July 13, 2016

Mental Health From the Inside Out: Harnessing the Lived Experience of the Trans Community.

Guest Blog By Greta Gustava Martela and Nina Chaubal

No discussion about mental health and the Transgender community can be complete without addressing and understanding the community’s distrust of health care providers. The Trans community generally struggles with healthcare providers who have very little, if any, formal training in working with Trans patients. However, the widespread distrust of healthcare providers goes back further than that. For many years, the standards of care put forth by the WPATH included the practice of gatekeeping - where mental health providers became the arbiters of who was “trans enough.” These practices forced Trans people seeking transition-related health care to be put through a year of living as their gender before being allowed to access hormone therapy. Whether or not one could access transition-related healthcare such hormones, surgeries relied heavily on how well they would conform to society’s norms. The mostly heterosexual male mental health field perpetuated society’s homophobia and misogyny. Trans women who were queer or did not meet the stringent beauty norms our society places on women were often denied the care. Trans people who did manage to get the health care they needed were forced by their mental health providers to go “stealth”-live a life where they never disclose their Trans status to anyone.

In some ways, this has changed, in other ways it has not. The WPATH no longer restricts healthcare to queer Trans people, it no longer requires Trans people to go through a year of transitioning without access to hormones and it no longer requires letters from multiple mental health providers to access transition-related surgery. However, many mental health providers haven’t gotten the memo. It’s very common for a trans person seeking mental health care to find a provider who has never interacted with a trans patient before who will ask patients to wait a year before having access to hormones or bring up a Gender Identity Disorder diagnosis from an older version of the DSM - which in 2012 was updated to use Gender Dysphoria instead to avoid describing trans people as disordered. Even when a Trans person is able to find a mental health provider who is cognizant of the issues around Trans healthcare, insurance companies are more than happy to enforce antiquated requirements.

Transition is the most effective treatment for people dealing with Gender Dysphoria. Historically, this didn’t come from the medical profession. It came from the lived experiences of Trans people not being able to get the help of medical providers and self-administering hormones. The community designed a treatment that worked for its members because the medical profession at the time didn’t seem to particularly care. A community that’s been taking care of its own for generations, values lived experience. This extends beyond transition related care to mental health and psychiatric care. It is disappointing to see health care and mental health care providers consistently devalue their Trans patients’ experiences. The theories of healthcare providers are taken more seriously than the lived experiences of Trans people where these healthcare providers have no training around Trans lives and show a lack of understanding of Trans lives.

A classic example of this lack of understanding is what the Trans community calls the “trans broken arm syndrome.” It comes from the idea that a Trans person seeking care for a broken arm will have some health care provider blame it on their Trans status. The broken arm, of course, is a placeholder for any ordinary ailment. “Go off your hormones” becomes the default advice given to Trans people who are sick. The authors are well versed with this effect from their own experiences. Greta recently checked into the ER unable to breathe after a particularly bad asthma attack. As she was in the middle of the breathing treatment, a doctor noticed her hormones on her list of medications and started asking for her surgical history. How is whether or not a patient has had surgery on their genitalia relevant to their breathing? Nina is currently recovering from pancreatitis as a result of high triglyceride levels. In spite of her explaining her family’s history with high triglycerides, two different doctors tried to pin it on her hormones with one suggesting she go off hormones in the event of another bout of pancreatitis. Sadly, experiences of this nature are far from uncommon among Trans people.

Trans people on hormone replacement therapy repeatedly report increased levels of mental wellness. There are many anecdotal accounts of improving mental health coinciding with the onset of hormone replacement therapy.  We hear stories from a lot of Trans people saying they had to pick between transitioning and ending their own life. Asking a Trans person on hormones to go off hormones is one of the most misguided and irresponsible things a provider could recommend.

Trans people experience high levels of economic injustice and often have a difficult time finding jobs. Trans people who transition in the workplace, often lose their jobs as a result of their Trans status. Trans people experience losing their families and housing as a result of being Trans. It’s not that surprising that Trans people are angry about the systemic discrimination and scapegoating society throws at the Trans community. Frequently this righteous anger becomes the basis for stigmatizing mental health diagnoses such as Borderline Personality Disorder. Trans people with this diagnosis often report it to be inaccurate and as a result of their Trans status.

These are some of the experiences Trans people have with the accessing health care both historically and to the present date. The communal mistrust of healthcare providers is largely a reaction to the way healthcare providers have been treating Trans people. A community under stress can’t trust a profession that contributes to its stress.

The lived experiences of Trans people are also instructive in the realm of suicide prevention. Trans Lifeline is a crisis hotline for Trans people by Trans people and prides itself in being unapologetically informed by Trans people’s lived experiences. Our earliest decisions about care were drawn from Greta’s experiences trying to access suicide prevention care. She found herself, during a crisis, explaining what it means to be Trans to the crisis worker she was connected to. Greta found the workers reaction to her Trans status further isolating and alienating.

Photo from Trans Lifeline website
Later, Trans Lifeline conducted a survey of over 800 Trans people asking about issues surrounding access to suicide prevention care. Our biggest finding was around the attitudes of our community around emergency personnel. We found that on average the majority of our surveyed population was uncomfortable interacting with emergency personnel. We compared Nurses, Doctors, Paramedics, Firefighters and Police on a 1-5 scale, 1 being extremely uncomfortable and 5 being extremely comfortable. Nurses, who scored the highest, came in at an average of 2.88, just shy of the neither comfortable nor uncomfortable mark. We found that of all those who told us they had never called a crisis line, 51% reported not calling a crisis line in spite of having been in crisis. We asked this group to tell us about their experiences and while some of them talked about phone anxiety, the overwhelming majority talked of being afraid of being forced to interact with the police and of being admitted to psychiatric facilities without their consent. These experiences have informed Trans Lifeline’s policies and we only enact active rescue with the consent of the caller.

More recently, we have put together a survey that our new operators take before a training class. While it’s too early for the data to be meaningful, we’re seeing about 90% our operators reporting lived experiences of suicide. We are also seeing a lot of our operators report feelings of not fitting in anywhere (Joiner’s Thwarted Belongingness) and experiences with familial rejection. According to Injustice at Every Turn, one of the largest surveys of Trans people, 41% of their surveyed population reported attempting suicide. It’s not unsurprising that most Trans people have lived experience of suicide. It’s perhaps a little telling that it’s these folks with lived experience of suicide who are most keen to take a stand and help prevent suicide in the community.

We are continually confronted with a lack of quantitative data regarding suicide and the Trans community. The Census Bureau and the CDC don’t keep data on trans people. The above 41% number - a striking contrast to the 4.6% lifetime suicide attempt risk in the general population - mostly exists in isolation. We don’t have numbers on suicidal ideation in the Trans community. We don’t have numbers on loss survivors in the community. In an effort to address this, on June 27, 2016, The National LGBTQ Taskforce and Trans Lifeline announced a collaborative Trans Mental Health Survey. We hope to find the experiences trans people have that make them afraid of mental health providers and psychiatric facilities. We aim to gauge the general level of trans competency among healthcare providers and to figure out how often Trans people are taken off their hormones or given diagnoses for no reason other than their Trans status. We hope to uncover the degree to which mental illnesses interfere with the lives of Trans people and finally have some decent data about the extent of the mental health crisis in our community.


*****




Greta Gustava Martela is the co-founder and Executive Director of Trans Lifeline. Ms. Martela has drawn on her own experience with suicidality to create a resource that is able to respond to the needs of the Trans community. Prior to Trans Lifeline, Ms. Martela worked as a software engineer.









Nina Chaubal is a former Google software engineer who co-founded Trans Lifeline with her wife and transition buddy, Greta Martela. She currently serves as Trans Lifeline's Director of Operations as Chief Executive Officer of her tech startup Cupcake Systems.

Friday, July 8, 2016

Recovery as Liberation

By Jess Stohlmann-Rainey

As a suicide attempt survivor working in the suicide prevention field, my work is deeply rooted in social justice. During my tenure in suicide prevention, I have found it unsettling how little emphasis is placed on centering the voices of people with lived experience with suicidal intensity. The paternalistic approach to the field may be creating significant gaps in our ability to adequately support people with suicidal intensity and prevent suicide. People who have wanted to die understand in more depth than anyone else why and how the decision to live happens. The sublimation of those voices in favor of the voices of academic expertise has interfered with the field’s ability to create culturally relevant and effective strategies to prevent suicide. 


The underlying assumption of a social justice approach to suicide prevention is that liberation and efficacy come from a process that places equal value on the most current data available (science), strategies that have been proven effective (solutions), and the lived experience of those who have been oppressed or marginalized (stories).

The central goal of social justice work is liberation. In the context of suicide attempt survivorship, I have positioned recovery as liberation from a cycle of oppression that systematically mistreats people who live with suicidal intensity. Using Yariela’s Cycles of Oppression model, people living with mental health conditions and suicidal intensity are in the target group. Through these interlocking cycles of oppression, the experiences of suicide attempt survivors and their reactions to those experiences are used as justification for further marginalization.



Yariela’s model provides a good framework for understanding why suicide ought to be approached as a social justice issue. Within this framework, people who experience suicidal intensity become trapped in a cycle of oppression that self-validates, causing isolation, trauma, and internalization of stigma. This cycle works in direct opposition to recovery, and is reinforced by medical model of mental “illness.” This framework also shows how the dominant group participates in and benefits from the systematic mistreatment of people with suicidal intensity. The vast majority of the institutions that have been created for the purpose of supporting people with suicidal intensity actually alienate and isolate them, participating in their oppression and keeping them “sick.” Some of the best evidence for this is the astronomical suicide death rates of people leaving hospitalization. We have a system that tells people, “You are a danger to yourself,” then systematically increases their risk of death. This system is supported by legislation, law enforcement, mental health providers, schools, and many other institutions.

If this cycle is the means by which people are oppressed, recovery and liberation become synonymous. It is unusual for discussions about recovery to include activist language, but if these two are synonymous, perhaps people experiencing suicide ideation would benefit from understanding recovery in this way. The model below illustrates how recovery moves individuals experiencing suicide ideation out of a cycle of socialization that reinforces and perpetuates their suicidal thoughts.



The cycle of socialization starts at birth, is reinforced by families and institutions, and a primary contributing factor in our behavior. In the United States, we have been socialized to believe that people who experience suicide ideation are attention seeking, dangerous, and unpredictable. The cultural script we receive is that these people are weak, sick, and flawed. Rather than seeing suicidal intensity as symptomatic of deeply intense psychological pain, we treat suicide risk as a permanent and immutable characteristic. The message that is sent is that people having this experience are afflicted by suicidality, and it (and the individual) needs to be managed by any means necessary – forced treatment, incarceration, and even just allowing people to die.


To step outside of this socialization and into recovery is a radical act of liberation, and like all acts of liberation, can be dangerous and difficult. To push back against these cycles and say, “I deserve help and hope,” requires that we recognize how we have gotten to this place of helplessness and hopelessness. Entering into recovery disrupts and challenges the systems that have kept us shackled to our pain.  I can remember the moment I felt free, and it was powerful. Positioning recovery as liberation puts the people experiencing suicidal thoughts in the center of the discussion, asking them what it might mean to be free from their pain, and supporting them in their journey toward hope.


Thursday, July 7, 2016

CDC Report on Occupation and Suicide: Carson J Spencer Foundation’s Response

Making Suicide Prevention a Health and Safety Priority at Work

Photo by Patrick Lenz
Denver, Colorado. July 6, 2016. When the CDC released its report on occupation and suicide last week, many employers took notice. For the first time, researchers were able to rank industries by highest rank and largest numbers of deaths by suicide across 17 states. This milestone report immediately got the attention of industry leaders concerned about the health and safety of their employees. The Carson J Spencer Foundation, the nation’s leader in suicide prevention in the workplace, fielded scores of inquiries over the holiday weekend as companies requested information on how to build a zero suicide safety culture in their workplaces and associations. For more information www.WorkingMinds.org.

Two issues tend to make industries more at risk – the demographics of the workforce and the nature of the work itself. Workforces that are male dominated tend to have higher rates for suicide because men die by suicide at nearly four times the rate of women and represent 77.9% of all suicides (CDC, 2015). Additionally industries that have the following qualities also tend to have higher risk for suicide:
  • Access to lethal means (e.g., firearms, pills, high places)
  • Ethos of fearlessness, recklessness and/or stoicism
  • Exposed to trauma
  • Culture of substance abuse
  • Fragmented community or isolation
  • Humiliation or shame
  • Sense purposelessness
  • Entrapment (feeling trapped in a distressing work situation)
This report is a game changer,” said Dr. Sally Spencer-Thomas, CEO of the Carson J Spencer Foundation, a Denver-based organization known for leading innovation in suicide prevention and the umbrella program for the nation’s leading workplace suicide prevention program called Working Minds™. “For a decade, we’ve been helping workplaces build comprehensive and sustained suicide prevention strategies. This report now gives employers the data to help justify these efforts.”

Photo by Brandon Kish
The timing of the report release coincided with the conclusion of the Construction Financial Management Association annual conference in San Antonio where suicide prevention was a central focal point. Over the past nine months many new construction industry suicide prevention resources and publications emerged as the construction leaders started to acknowledge a growing concern. More information here: www.ConstructionWorkingMinds.org.

“Increasingly, we are hearing employers say, ‘Not another life to lose. What can I do to prevent this from happening with my employees?’” said Spencer-Thomas. “They want a road map to integrate psychological safety into their existing safety culture.”

Because most adults spend more waking hours at work than they do at home, workplaces are critical partners in a community approach to suicide prevention. Employers who value the well-being of their staff realize that it is not good enough to get people home safely from work, they also need to provide support in making sure employees get back to work safely from home. Like most cultural change, a multi-dimensional, long-term strategy is warranted integrating mental health services, training, communication strategies, leadership, and crisis response.


Occupational Rank for Highest Rates of Suicide Deaths[i]
RANK
Occupation
Rate per 100,000
1
Farming, fishing, and forestry
84.5
2
Construction and extraction
53.3
3
Installation, maintenance, and repair
47.9
4
Production
34.5
5
Architecture and engineering
32.2
6
Protective service
30.5
7
Arts, design, entertainment, sports, and media
24.3
8
Computer and mathematical
23.3
9
Transportation and material moving
22.3
10
Management
20.3


Occupational Rank for Highest Numbers of Suicide Deaths[ii]
RANK
Occupational Group
Numbers (%)
1
Construction and extraction
1,324 (10.8)
2
Management
1,049 (8.5)
3
Production
953 (7.7)
4
Installation, maintenance, and repair
780 (6.3)
5
Unknown
729 (5.9)
6
Student
665 (5.4)
7
Sales and related
651 (5.3)
8
Transportation and material moving
644 (5.2)
9
Homemaker, Housewife
534 (4.3)
10
Office and administrative support
481 (3.9)
















  
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About the Carson J Spencer Foundation - Sustaining a Passion for Living
The Carson J Spencer Foundation (www.CarsonJSpencer.org) is a Colorado nonprofit, established in 2005.  We envision a world where leaders and communities are committed to sustaining a passion for living. As leaders in innovation in suicide prevention, our mission is to elevate the conversation to make suicide prevention a health and safety priority. We do this by:
  • Delivering innovative and effective suicide prevention programs for working-aged people
  • Coaching young leaders to develop social enterprises for mental health promotion and suicide prevention
  • Supporting people bereaved by suicide
About the Working Minds™ Program

Working Minds™ (www.WorkingMinds.org) is the nation’s first suicide prevention program exclusively dedicated to the workplace. Our purpose is to give employers the confidence and competence to integrate suicide prevention into their overall health and safety culture. Since 2007, Working Minds™ has offered training and resources to industry leaders to help them build cost-efficient, effective, and culturally relevant suicide prevention strategies.




[i] Source: McIntosh WL, Spies E, Stone DM, Lokey CN, Trudeau AT, Bartholow B. Suicide Rates by Occupational Group — 17 States, 2012. MMWR Morb Mortal Wkly Rep 2016;65:641–645. DOI: http://dx.doi.org/10.15585/mmwr.mm6525a1.

[ii] Ibid