Monday, December 16, 2013

Putting Dignity First for Mental Health

Written and Reposted with permission by Guest Blogger: EDUARDO VEGA

Putting Dignity First

Many variables affect people in their ability to recover from mental illness and manage mental health conditions.  There is not one program, service, support or medication that will work for all, or that will work for many for an extended period of time. Intuitively we know this to be true, although many are still driven by the dream of a ‘silver bullet’, a perfect medication or treatment, or even an ideal array of services that could perfectly match all our communities needs.

We do not know if science will progress to the level of a ‘cure’ or prevention for mental illness— if it is even possible to so radically alter the biogenetic vulnerability factors that predispose some to mental illness as to significantly reduce its prevalence in the world.

We do not know if we can ever be free of the impacts of trauma, stigma, abuse, discrimination, poverty, and violence and all that they contribute to the manifestation of psychiatric symptoms in our communities, and the barriers they represent to recovery.

We do know a few things. We know that some things almost always make a difference to people living with mental health challenges. We know that hope is the greatest fuel for recovery, that without it the best services and supports in the world are futile. We know that people can accomplish almost anything with enough hope, and can achieve almost nothing without it.

But we have not talked enough about dignity in mental health. About its role in connection to recovery and resilience, about its centrality in the nexus of relationships that links every one of us to each other. About dignity as a human right that should be foremost in all our interactions with all people. Or about the many myriad of ways in which systems, public media and individual attitudes work to diminish the dignity of people affected by mental illnesses every day.

Some people grow up with a sense of purpose, with agency and confidence—perhaps because it was inculcated in them by great parents or their culture or faith. Some seem to gain dignity by association with status, position, class or wealth, which perhaps is false in some ways.

Some of us had to learn about dignity from others. Seeing it in their eyes or their actions when faced with insult and adversity.

I learned about dignity from friends struggling to put a few months of sobriety together, from hundreds of people who were homeless, from more than a few newly released convicts, and from the many I’ve known who continue to face down the pain, shame and stigma of mental illness to retain regain whole and meaningful lives.

I also learned about how people seek out dignity, and how they avoid its opposite at a profound and almost reflexive level. How the indignity that went along with things I was ‘giving’ to people ‘in need’ could more detrimental than I anything I could positively ‘provide.’ I learned from people who were in more desperate circumstances than I could ever imagine that honoring their personal dignity was much more important than ‘providing’ them a service.

You don’t have to spend time in a inpatient psychiatric ward to have a sense of how often one’s dignity can be undermined in services. But a few snapshots can help—
  •            You called for help because you were desperate and felt like dying and couldn’t be safe. When help came they pointed guns at you, put you in handcuffs, took you away in the back of the police car while all your neighbors watched.
  •           Perhaps you came in voluntarily, feeling completely anguished or out of control, then a few days later you find your status had been ‘switched’ to involuntary and that the papers you signed meant you had given up your rights to refuse medications you didn’t like.
  •           You’re in your room where there in no privacy from your roommate—multiple times of day staff, nurses, sometimes even students come in unannounced, begin asking you questions, often the same questions you’d already answered several times. 
  •            You go to “art group” in which the art activity consists of large nubby crayons and children’s coloring books even though its is an adult/geriatric ward and the average age is over fifty.
  •            You ask for a pen or pencil so you can write in your journal and are told you can only use them while someone watches you at the nurse’s station— and that they are too busy to do so.
  •            You find that your privileges for phone calls or cigarette breaks were removed because you failed to attend enough ‘groups’
  •            You ask where the policy for restoring privileges is and are informed that this is a ‘staff decision made at rounds’.
  •           You tell your prescriber about the debilitating side effects of the medications your taking. In response she rolls her eyes, saying ‘you’ll get used it’ or ‘nobody has all of those’.


Stigma? -yes. Discrimination? yes— but to most people these things that happen every day are just plain insults to a dignity they may be already struggling to maintain.

If we put Dignity First all these things things that drive people into despair, that magnify the fear shame and self-doubt that so often accompany mental illness, all these can be wiped away.

So people won’t seek death by suicide or painful isolation as more dignified than supports for their recovery.

When we put Dignity First we approach people as deserving and seeking more from us than ‘care’ or services. We recognize people are challenging us to respect them first and then to bolster their opportunities to respect themselves. By listening and engaging with the intention to understand what that would require, we challenge our assumptions and the power relationships inherent in health care that work against people’s dignity. And that, as a result, drive many people away. Putting Dignity First we understand that recovery needs to include recovering from the indignities that they’ve suffered as a result of their symptoms, their situations and the messages they’ve received from others and their society about what it means to have a mental health condition.

In putting Dignity First we know that honesty, hope and sincerity are our best resources for engaging people who so often have lost their dignity. We help by offering resources, skills and services that people want to use, rather than ‘providing’ them with the services we have and rejecting them if those do not fit.

Putting Dignity First is not just a crucial step towards systems in which recovery is realized, it is the mind-set, the approach we must take in relating to individuals with mental health conditions, and in reforming our world into one in which all people live in communities that truly support recovery and mental health for all.

Healing From School Violence

Written and Reposted with permission by Guest Blogger: Jess Stohlmann Rainey

“In every community, there is work to be done. In every nation, there are wounds to heal. In every heart, there is the power to do it.” – Marianne Williamson

Today the staff at the Carson J Spencer Foundation grieves with the faculty, staff, families, and students affected by the tragic events at Arapahoe High School. With the rest of the country, our hearts and minds are turned toward Littleton. Tragedy can make communities and schools feel fractured, as if something has broken and can’t quite be made whole again. By pulling together, offering hope, and focusing on healing, we can begin to collectively mend the injuries tragic events like this cause.

When hope is hard to find, we rely on the strength of the community to hold onto hope for us. As compassionate citizens, we can lend strength to people when they falter, be a shoulder for tears, and look forward to see a light in the darkness. Hope and comfort are most important when they are most elusive. As we begin to heal, lean on each other. Open your arms and your hearts. If you are concerned for someone or concerned for yourself, seek help.

As we cope with this act of violence, there are a few things we can do right now to help us heal (adapted from the Suicide Prevention Lifeline):

  1. Talk about the tragedy. Even if you weren’t directly affected, you may feel anxiety, fear, anger, or deep sadness. If you don’t have someone to confide in, you can call 1-800-273-TALK(8255) any time.
  2. Don’t watch (too much) news. Being immersed in the media’s portrayal of the most difficult parts of this tragedy can be overwhelming.
  3. Take care of yourself. Using positive coping methods will help your body and your mind deal with stress.
  4. Help Others. Promote lifesaving services like the Suicide Prevention Lifeline (1-800-273-8255) and the Disaster Distress Hotline (1-800-985-5990). Participate in vigils or volunteer in your community.

“Hope” is the thing with feathers -

That perches in the soul -

And sings the tune without the words -

And never stops – at all -

-Emily Dickenson



Wednesday, December 4, 2013

Innovation Challenge 2013!

Innovation Challenge Brings Bold Ideas to Youth Mental Health
Students across Colorado Join Together in Support of Entrepreneurial Approaches to Suicide Prevention


Littleton, Colorado. December 4, 2013 Over 150 students, teachers, and community business leaders joined together to participate in the 4th Annual Innovation Challenge facilitated by the Carson J Spencer Foundation and hosted at Columbine High School. The Innovation Challenge is one of several events associated with the Carson J Spencer Foundation’s FIRE Within Program; a year-long program where students learn how to use entrepreneurial skills to benefit suicide prevention efforts in their communities.

The FIRE Within program has expanded this year from 20 schools to 50 schools across the state. The Innovation Challenge is first opportunity in the program to bring students from many of these schools together in one place.  The kick-off of the event involved  FIRE Within alumni, now in college, giving advice and useful tips on how they capitalized their own FIRE Within experience to help pursue opportunities in college.  The main focus of the event was to challenge students to think boldly about how they might create something that would make a significant upstream impact on youth suicide and distress; the rules were simple, there were no rules.  Students were encouraged to come up with the most unique, out-of-the-box idea geared toward ending suicide and promoting mental health.  They then were asked to create a brief presentation promoting their idea to be presented to a panel of judges, made up of business leaders coming anywhere from the mental health industry to banking and construction. 

“I was very impressed by the students.  Great creativity and thoughtful engagement all around,” said Dave Thorpe, Vice President Shaw Construction.

In total, 20 students walked away with gifts and prizes for their innovative thinking and thoughtful presentations.  All students participating in the Innovation Challenge will head back to their respective schools to start preparing their business plans for the Business Plan Competition in February.  Each FIRE Within class submits a full business plan and video to the Carson J Spencer Foundation to be judged for seed funding ranging from $100 - $500. 


For more information about the FIRE Within program, please contact Dr. Sally Spencer-Thomas at 720-244-6535 or Sally@CarsonJSpencer.org.

###
 
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. We sustain a passion for living 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

Tuesday, December 3, 2013

Men and Suicide Bereavement Survey to Inform New Grief Support Needs

Men and Suicide Bereavement Survey to Inform New Grief Support Needs

Denver, Colorado. October 14, 2013.  The Carson J Spencer Foundation and Unified Community Solutions are conducting an exploratory survey to get a better sense of the experience of men who are bereaved by suicide and the needs they may have in their grief.


Men who have been bereaved by suicide are invited to participate in a survey to share about their experiences subsequent to their loss. If you are a man 19 or older and have lost someone close to you to suicide (e.g., family member, close friend, co-worker, etc.), your participation in the study is needed. The purpose of this survey is to better understand the experiences men have after suicide loss and the types of support they have found helpful or would like to have available.  All responses will be anonymous and confidential. The study should take no more than 10 to 15 minutes to complete, and you can opt out of the survey at any time. There is no compensation available for the completion of the survey, but we appreciate men bereaved by suicide taking the time to tell us about their experiences.

In addition, if you are connected to other men who have been bereaved by suicide, we ask for your support in passing along this request to them.

For more information about this survey, please contact Dr. Sally Spencer-Thomas at 720-244-6535 or Sally@CarsonJSpencer.org. Thank you in advance for your time and consideration.



###
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. We sustain a passion for living 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 Unified Community Solutions
Unified Community Solutions (www.unifiedcommunities.com) is a private consultancy based in Massachusetts, specializing in training and advocacy for peer-based suicide grief support and in planning, development, and leadership of community-based suicide grief support programs. UCS owner Franklin Cook is also the creator of Personal Grief Coaching, a telephone support service he administers to help bereaved people.


Contact:          
Dr. Sally Spencer-Thomas                                                                  
CEO & Co-Founder
Carson J Spencer Foundation
720-244-6535

Franklin Cook
Owner
Unified Community Solutions
617-398-0243
Franklin@UnifiedCommunities.com

Monday, October 28, 2013

IASP’s Remembrance Ceremony in Oslo: A Glow around the World

IASP’s Remembrance Ceremony in Oslo: A Glow around the World
Sally Spencer-Thomas
Carson J Spencer Foundation (USA)

On Friday, September 27th at dusk, I joined 30 attendees from the International Association for Suicide Prevention’s World Congress to walk together through the streets of Oslo to attend a Remembrance Ceremony at Domkirken, Oslo’s main church.

This place was chosen because of its special connection to supporting communities in grief. After the July 22, 2011 massacre, friends and loved ones gathered at the Oslo cathedral to mourn the 93 victims killed in twin terror attacks from a bombing in downtown Oslo and a mass shooting on Utoya island. Because of the important role the church played after this tragedy, the church was forever changed and became a place of safety for community healing.

During the remembrance ceremony, participants from Australia, Norway, China, Belgium, Ireland, the US and many other countries encircled a light globe in the center of the sanctuary.  After a moment of reflective silence, an opera singer began a haunting aria that filled the cathedral and brought waves of emotion over me. 
Not only for the losses experienced by our group and the spread of tragedy the impact of those losses had around the planet, but for the collective grief of this place and the honoring of the lives that goes in hand with the mourning.

After a welcome from the church’s pastor and Henning Herristad from LEVE - The Norwegian Organization for the Suicide Bereaved,  Jill Fisher from Australia’s StandBy and I led the group in a four candle ritual:

FOUR CANDLES RITUAL
The first candle represents our grief. The pain of losing you is intense. It reminds us of the depth of our love for you.
This second candle represents our courage. To confront our sorrow, to comfort each other, to change our lives.
This third candle we light in your memory. For the times we laughed, the times we cried, the caring and joy you gave us.
This fourth candle we light for our love. We light this candle so that your light will always shine.
As we share this day of remembrance with our family and friends, we cherish the special place in our hearts that will always be reserved for you. We thank you for the gift your living brought to each of us.
We love you. We remember you.

After we had lit our four candles, we invited the others to join as they were so moved to light a candle in member of a loved one that passed, in honor of those that struggle with or who have overcome suicide crises in their lives, and in solidarity of the fight we are in together to end suicide. Some people said the names of their loved ones out loud, others paid their respect in silence or in tears. In the end, the glow of the candles around the globe was more than a ritual, it was a symbol of our how our international community can pull together out of this human devastation and bring light and warmth to a world filled with despair.

As we closed our remembrance ceremony, a cappella music again filled the space with reverence and awe. We exited with our hearts filled with emotion and made a commitment to bring this tradition to every IASP conference.


The light shines on.



Reprinted with permission by the American Association of Suicidology and the International Association for Suicide Prevention
International Associate for Suicide Prevention
American Association of Suicidology


Tuesday, September 10, 2013

YOUTH SUICIDE PREVENTION PROGRAM LISTED ON BEST PRACTICE REGISTRY


Contact:          
Dr. Sally Spencer-Thomas                                                                   FOR IMMEDIATE RELEASE
CEO & Co-Founder
Carson J Spencer Foundation
720-244-6535

YOUTH SUICIDE PREVENTION PROGRAM LISTED ON BEST PRACTICE REGISTRY
The FIRE Within Youth Social Entrepreneurship Program Recognized on World Suicide Prevention Day

Denver, Colorado. September 10, 2013.  Today, on World Suicide Prevention Day, the Carson J Spencer Foundation is pleased to announce today that its FIRE Within program has been listed in Section III of the SPRC/AFSP Best Practices Registry for Suicide Prevention (BPR). Practices listed in Section III of the BPR address specific objectives of the National Strategy for Suicide Prevention and their content has been reviewed by a panel of suicide prevention experts for accuracy, safety, likelihood of meeting goals and objectives, and adherence to prevention program guidelines.  The FIRE Within program, a program of the Carson J Spencer Foundation in partnership with Junior Achievement and the Second Wind Fund, is currently expanding to 50 high schools in Colorado. The program uses principles of impact entrepreneurship to help develop student leaders in suicide prevention. Over the course of an academic year, the FIRE Within students create businesses that generate revenue while also addressing root causes of student distress. Positive outcomes for the FIRE Within program are evident in the areas of youth development, mental health outreach, and business education. For more information: http://www.sprc.org/bpr/section-III/fire-within-youth-entrepreneurs-preventing-suicide

“We are thrilled to have this credential to support our innovative work in youth suicide prevention,” said Jess Stohlmann, Program Director for the FIRE Within. “We will continue to develop and refine practices that promote mental health, student leadership, and community resiliency.”
 
“One of the most exciting outcomes for us to see is how many of our youth connect others to mental health resources – about 65% of our students do this during the year they are in our program,” said Sally Spencer-Thomas, CEO & Co-Founder of the Carson J Spencer Foundation. “The ripple effects of this level of reaching out are tremendous.”

A fact sheet describing the FIRE Within program is posted in Section III of the Best Practices Registry, located on Suicide Prevention Resource Center’s website (www.sprc.org). For additional information about the FIRE Within, visit our website (www.CarsonJSpencer.org) or contact Sally Spencer-Thomas at 720-244-6535 or Sally@CarsonJSpencer.org.

###

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. We sustain a passion for living 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

Bullying and Suicide: The Complex Connection

Written by Guest Blogger: Nicole Cochran

On October 10, 2012 Amanda Todd, 15, a Canadian teenager, killed herself after posting a YouTube video talking about her experiences with bullying, assault, and depression. Amanda begins telling us her story about how when she was in 7th grade, she would go on a webcam with her friends and a stranger eventually talked her into flashing the camera (Grenoble, 2012). “One year later, a man contacted her on Facebook, threatening to send around the picture of her topless "if [she] don't put on a show." Terrifyingly, the stranger knew everything about her: her address, school, friends, relatives, and the names of her family members. Soon, her naked photo had been forwarded "to everyone"” (Grenoble 2012). Amanda ended up switching schools because of the bullying but the stranger did not let up. Once she was at a new school, the stranger created a Facebook page where he used her uncensored picture as the profile image. The kids at her new school found out and this led to further bullying, harassment, and she was eventually assaulted and was left on the ground. Amanda turned to cutting herself. “Amanda's bullying continued despite moving to a new city. Anti-depressants and counseling did little to combat the severe depression” (Grenoble, 2012).

All too often we read media headlines about kids who die by suicide, allegedly “because they were bullied”. Far too often when we look at the reasons why people would take their lives we find bullying in their life history. But the relations between bulling and these individuals often had many additional underlying risk factors that make the relationship far from straightforward. In looking at the research that explains the characteristics that connect those who are involved in bullying to suicidal ideation, we see that bullies and victims of bullying generally have “higher levels of insecurity, anxiety, depression, loneliness, unhappiness, physical and mental symptoms, and low self-esteem” (Nansel et al., 2001). In today’s society, people are finally looking at the correlation of bullying and the connection it has to suicide. Unfortunately, it took too many publicized stories of this problem to bring the conversation to public awareness. The connection between bullying and suicidal ideation is complex and deepened by the mitigating risk factors that are a part of the lives of the bullies and the victims.

In order to understand the connection, we need to first understand bullying and suicidal ideation. Bullying, by definition, is “a specific type of aggression in which (1) the behavior is intended to harm or disturb, (2) the behavior occurs repeatedly over time, and (3) there is an imbalance of power, with a more powerful person or group attacking a less powerful one” (Nansel et al., 2001). Suicidal ideation, or thoughts of suicide, is just that, thoughts about suicide, but not the actual commitment or plan to die by suicide.

In looking at the risk factors that connect bullying and suicidal ideation, outside of a mental health disorder or biological factors, self harm and a prior suicide attempt are the most potent risk factors that underlie the connection. In the research reported by the Suicide Prevention Resource Center [SPRC] “during the 2007-2008 school year, 32% of the nations students ages 12-18 reported being bullied, 21% said they were bullied once or twice a month, 10% reported being bullied once or twice a week, 7% indicated they were bullied daily, 9% reported being physically injured as a result of bullying, and 4% of students reported being cyberbullied” (2011). According to the same publication, in a normal 12-month time frame, “nearly 14% of American high school students seriously considered suicide; nearly 11% make plans about how they would end their lives; and 6.3% actually attempt suicide” (SPRC, 2011).  Possibly the most daunting statistic is that suicide is the third leading cause of death amongst youth ages 12-18 (SPRC, 2011).

The statistics, although shocking, don’t tell the whole story. A lot of the youth that are bullied don’t feel as if they are able to report being bullied because of fear of further stigmatization and the fear that nothing will be done about the problem. To add to that, “many teachers do not consider social exclusion a form of bullying, or [they] consider this form of bullying as less harmful” (van der Wal et al., 2003). The commonality that we see between bullying and suicidal ideation is that many of the perpetrators and the victims suffer from a mental health disorder like depression. Many of them have also have low self-esteem and engage in self harm. These risk factors, along with bullying, elevate the risk for suicide in adolescents.

People turn to suicide when they feel like they have nowhere else to turn. When their psychological pain becomes too much the thoughts of suicide develop as an escape valve.
To effectively harness the problem of bullying and suicide, we need “a concentrated and coordinated effort – a partnership if you will – among our families, schools, youth organizations, and communities” (Morino, 1997 as cited in Donegan, 2012). In order to do this, the Suicide Prevention Resource Center (2011) lays out action steps to best address both bullying and suicide in hopes of creating that unified front. SPRC (2011) states we need to start prevention early (by addressing bullying before suicidal signs are there, there may be some “significant benefits as children enter the developmental stage when suicide risk begins to rise”), we need to keep up with technology (“young people may use social media and new technologies to express suicidal thoughts that they are unwilling to share with their parents and other adults. Both bullying and suicide prevention programs need to learn how to navigate this new world”), and we need to use a comprehensive approach (we need to focus on the young people and the environment in which they live).

One of the very first prevention programs implemented is the Olweus Bullying Prevention Program. This program “develops methods of dealing with bullying on a variety of levels including school-level components, individual-level components, classroom-level components, and community-level components…this creates a cohesive plan in which each level reinforces the next” (Donegan, 2012). By using a multi-tiered approach, models like this are more likely to have a proactive and sustained prevention outcome.

Children are often too scared to talk about these two things because they fear it will either get worse, nothing will be done about it to help them out, or they will be stigmatized. Kids need to know the severity of each of these and they need to know what they can do to help. Our youth need to feel it is safe to report bullying, that it is ok to talk about how they are feeling mentally, and if they are having thoughts about suicide it’s imperative to get help.

Bullying and suicide are both very complicated and serious issues. Once these two issues are connected, they begin to become deeper and more complicatedly intertwined. In order to address this, parents, teachers, students, and professionals alike need to talk about these problems so together we can prevent further suicides from taking place; and hopefully, begin to erase the stigma that is associated with both bullying and suicide.

Let’s look back at Amanda Todd once more. In her YouTube video description she writes:
I'm struggling to stay in this world, because everything just touches me so deeply….I did things to myself to make pain go away…” (Grenoble, 2012).
Amanda lost her battle, but we can remember the complexity of her death in our work for solutions. Those who are struggling need to know that there are resources available for them if they are victims of bullying and if the suffer from any mental health disorders; such as The Bully Project, Stop Bullying Now, The Trevor Project, Love Is Louder, Minding Your Mind, Boo2Bullying, and Stand For The Silent. 1-800-273-8255 is the National Suicide Prevention Lifeline; please call if you ever have thoughts of suicide. Together we can help prevent another heartbreak like Amanda Todd.

About the Author

Nicole Cochran is currently studying to receive her Masters in Social Work from Colorado State University in Fort Collins, Colorado. She received her Bachelor of Arts in Sociology from Regis University in Denver, Colorado. While Nicole was in her undergraduate degree she became involved with a group called Active Minds. Active Minds is a nationally recognized mental health awareness and suicide prevention organization. In her time with Active Minds, Nicole found a love for suicide prevention and mental health. She is planning on concentrating in mental health and wants to get her LCSW and eventually become a high school counselor helping those who suffer from any mental health diagnosis while continuing to bring awareness to bullying and helping in the prevention of suicide.






References
Donegan, R. (2012). Bullying and cyberbullying: History, statistics, law, prevention and
analysis. The Elon Journal of Undergraduate Research in Communications, 3(1), 33-42.
Grenoble, R. (2012, Oct 11). Amanda todd: Bullied canadian teen commits suicide after
prolonged battle online and in school . Retrieved from http://www.huffingtonpost.com/2012/10/11/amanda-todd-suicide-bullying_n_1959909.html
Nansel, T. R., Overpeck, M., Pilla, R. S., Ruan, W. J., Simons-Morton, B., & Scheidt, P.
(2001). Bullying behaviors among us youth: Prevalence and association with psychosocial adjustment. JAMA, 285(16), 2094-2100.
Suicide Prevention Resource Center (SPRC). (2011, March). Suicide and bullying.
Retrieved from http://www.sprc.org/sites/sprc.org/files/library/Suicide_Bullying_Issue_Brief.pdf
Van der Wal, M. F., de Wit, C. A. M., & Hirasing, R. A. (2003). Psychosocial health
among young victims and offenders of direct and indirect bullying. Pediatrics, 111(6), 1312-1317. Retrieved from http://pediatrics.aappublications.org/content/111/6/1312.html


Tuesday, September 3, 2013

The Paradox of Traumatic Grief

Take the light, and darken everything around me
Call the clouds and listen closely, I'm lost without you
Call your name every day when I feel so helpless
I'm fallin' down but I'll rise above this, rise above this
~“Rise Above This,” Seether
The lead singer for the rock band Seether wrote those lyrics in the aftermath of his brother’s suicide. The video for the song depicts what many people feel upon hearing the news that their loved one has died.  A mother, a father, a sister – all going about their normal daily lives -- are suddenly blown completely off their feet by an unseen force. 
The course of a complicated bereavement, like the process that often follows suicide, usually does not follow the straightforward path outlined by Elizabeth Kubler-Ross so many decades ago, but rather twists and turns and circles back on itself through mazes of denial, sadness, anger, shame, blame, and multiple physical reactions.  Several authors have described an “oscillating process” in complicated bereavement – a moving back and forth between loss-orientation and restoration orientation[1], between growth and depreciation[2]. In this oscillating process survivors of suicide loss can move closer to some people and further away from others. They may simultaneously experience increased symptoms of distress and feelings of adaptation as these states appear to be independent dimensions.
As survivors of suicide loss learn to adjust to the empty chair and redefine life without the physical presence of their loved ones, they can feel like they have lost a part of themselves.  Not everyone is debilitated by this loss, however, and the bereaved often fall into one of three clusters:
  1. Quick recovery.  Those who recover quickly without assistance and can return to functioning as before.  Some of these people are not distressed because they had only superficial contact with the deceased, while others are often internalizing and suppressing pain, anger or guilt.  In the latter case, maladaptive strategies of coping may emerge such as substance abuse or other compulsive behaviors.
  2. Modest support needed.  Most people who were functioning well before the suicide need only a modest level of support for anywhere from a month to a couple of years.  This level of support might include outpatient therapy or support groups.
  3. Psychiatric disability. Some people may develop a mental disorder, such as post-traumatic stress disorder or depression, in reaction to the trauma and loss and may require extended or intensive treatment.
For the first couple of years after my brother Carson’s death, I moved in and out of these three states. Sometimes I would feel like I was functioning well, other days I would get through with a call to a friend or a visit to a support group, and some days I would be so consumed with the sadness of what had happened that I would benefit from periods of counseling.
In the aftermath of an unexpected death, especially suicide, traumatic grief is a common reaction.  When this occurs both trauma and grief reactions are experienced together, and elements of this combined level of psychological distress are often debilitating and complex. 
A number of circumstances about a suicide death may influence traumatic grief reactions[3]:
  • Suddenness or lack of anticipation.  The unexpected death offers no opportunity for goodbyes, unfinished business, resolution of conflict, or answers to questions.  Very often the bereaved are left with endless “whys” and “what ifs.”  When loved ones die from a prolonged illness, by contrast, we have time to prepare ourselves for their absence.
  • Violence, mutilation, and destruction.  Deaths that involve suffering or extreme pain may cause horrifying traumatic imagery and intrusive thoughts – whether or not the bereaved actually witnessed the death or the body. If the death occurred in a familiar or personal space of the bereaved, that space will most likely continue to trigger traumatic reactions.
  • Preventability or randomness of death. The randomness of such a loss can trigger a greater sense of vulnerability and anxiety. This is often the case when there were no apparent warning signs before the person died.
  • Multiple deaths (bereavement overload) or multiple losses. In addition to the primary loss of the person, secondary losses may include loss of an income, loss of a home, or loss of all things familiar.  The resulting disorganization can strain the family and social system.
  • Contact with first responders or the media. Sometimes the reactions of first responders – who need to rule out homicide in every suicide case – can increase confusion and distress among those bereaved. If the events surrounding the death were newsworthy, the bereaved may also be dealing with the intrusion of the media.
Trauma reactions and grief work are often at odds with each other. On one hand, the trauma experience leads to continual intrusion of the death event.  That is, survivors of suicide loss can’t stop thinking about the death scene (even when they are dreaming), and disturbing images may flash before the mind’s eye when they least expect it. The horror can be overwhelming and the natural impulse is to stay away from anything that reminds them of the trauma.  Sometimes survivors develop post-traumatic stress disorder (PTSD) in the aftermath of a violent or unexpected death. 
When I first started reading about trauma as a graduate student in the 1990s, I was moved by Ronnie Janoff-Bulman’s book Shattered Assumptions.[4] Her basic premise is that traumatic events shatter three world views that all people tend to hold:
·         Benevolence of the world – people are generally good
·         Meaningfulness of the world – good things happen to good people
·         Self-worth – I am good and can keep myself and those who love me safe and healthy.

All three of these assumptions are usually deeply challenged, if not shattered, after a suicide death. The traumatic responses of re-experiencing intrusive thoughts through flashbacks and ruminations are the mind’s way of rebuilding new world views about the self and the world. When Randy and I were in Hawaii just months after Carson’s death, we were hiking along the Napali Coast – one of the most beautiful places on Earth – and I could not stop ruminating about the horror of my brother’s suicide. I remember saying to Randy, “In the last hour, I have imagined Carson’s final moments at least 40 times and have only thought of our children once. What is wrong with me?”
On the other hand, the grief experience works in phases as survivors of suicide loss come to accept the reality of the loss, and the tendency is to move toward things that remind them of the deceased. The intense sadness can feel like it will never go away; and I like to reframe this grief reaction as honoring our loved one. Kahlil Gibran once said, “When you are sorrowful look again in your heart, and you shall see that in truth you are weeping for that which has been your delight.” 
The alternating cycle of horror and loving memories, of avoiding and embracing things related to the loved one, makes traumatic grief complicated.  Not everyone is incapacitated, however, and many find unexpected twists in the journey can lead them to “rise above it” and integrate their experience into a deeper understanding of themselves, their purpose, and their world.
For more information on getting support in the aftermath of a suicide death, please visit: http://www.suicidology.org/suicide-survivors/suicide-loss-survivors
About the Author
Sally Spencer-Thomas, Psy.D., is CEO and co-founder of the Carson J Spencer Foundation, a Colorado-based nonprofit established after the suicide of her brother. The foundation is known for “sustaining a passion for life” by developing innovative and effective approaches to suicide prevention among working aged people, coaching youth social entrepreneurs to be the next generation of suicide prevention advocates, and supporting people bereaved by suicide. www.CarsonJSpencer.org




[1] Stroebe, Margaret & Schut, Henk (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197-224.
[2] Baker, Jennifer, Kelly, Caroline, Calhoun, Lawrence, Cann, Arnie & Tedeschi, Richard (2008). An examination of posttraumatic growth and posttraumatic depreciation: Two exploratory studies. Journal of Loss and Trauma, 13, 450-465.
[3] Ambrose, J. T (n.d.) Traumatic grief: What we need to know as trauma responders. Retrieved October 30, 2005 from http://wwwctsn-rcst.ca/Traumaticgrief.html

[4] Jannoff-Bulman, R. (1992). Shattered Assumptions: Towards a New Psychology of Trauma. New York: Free Press.

Tuesday, August 13, 2013

Unsafe Messaging in Film Project

Republished with permission by guest blogger: Jess Stohlmann
Dear Colleagues,
I wanted to take a moment to give you all some information about a video that is traveling around on social media called ‘Love is All You Need?’. The people who worked on the project clearly had very good intentions, and I understand the LGBT community’s concerns with both bullying and suicide. Both bullying and suicide are difficult, complex issues that we face as a community. There is great work being done to improve the lives of young people and adults who are impacted by mental health issues and bullying. We know that there are safe and unsafe ways to address these issues in the media. ‘Love Is All You Need?’ takes an approach that, while emotionally powerful, is incredibly unsafe. Below I have outline the unsafe messaging in the film: 
  1. The film identifies  suicide as an understandable result of bullying. This could cause bullied youth to feel that suicide is normal and acceptable for individuals experiencing bullying and increase their vulnerability.
  2. The film includes a detailed portrayal of a lethal suicide method. It explicitly shows a graphic portrayal of a suicide death that vulnerable individuals could replicate.
  3. The film does not list warning signs for suicide. In fact, it portrays suicide as an impulsive act in response to a particular life event. Listing warning signs and protective factors encourages others to intervene when someone is at risk.
  4. The film does not address the fact that suicide can be prevented.
  5. The film does not emphasize help-seeking behavior or provide resources like the Suicide Prevention Lifeline (1-800-273-TALK)
  6. The film does not emphasize the effective treatment for the underlying mental health problems with which 90% of suicidal individuals struggle.
 As a community, we should really be talking about bullying and suicide in different, more productive ways. We know that helping students to stand up for each other and intervene when a person is struggling will help assuage both of these social issues. By providing students the tools to seek help when they need it for themselves (Safe2Tell and the Suicide Prevention Lifeline), intervene when they are concerned for someone else (bystander intervention and asking their peers about their mental health), and to involve adults when things seem out of their control, many lives can be saved and improved. Focusing on positive messaging around healthy behavior is the best way to achieve the social changes that we all want for our youth. If you want to post something about bullying or suicide, please include resources and use safe messaging practices. In order to keep this video from continuing to be in the spotlight, remove it from your social media, ask others to do the same, and avoid playing it on YouTube, liking it, sharing it, or commenting on it.
You can find safe messaging guidelines here. Please feel free to forward this message to any of your contacts.

Wednesday, July 24, 2013

Five Things Employers Need to Know about Workplace Mental Health and Suicide

Here is the bad news…
1.       Depression is a top driver of health care costs to employers.[1] [2] Depression represents employers' highest per capita medical spending (per-capita annual cost of depression is significantly more than that of hypertension or back problems, and comparable to that of diabetes or heart disease. People with depression also have more sick days than people suffering from other conditions)[3].
2.       If we take a snapshot of any workplace at any given point in time, at least one in five people will have a diagnosable mental health condition.[4] The most common among these are mood disorders like depression or substance abuse disorders like alcohol abuse.
3.       The majority of people who die by suicide are working aged people. While other groups’ suicide rates are holding steady or decreasing, the rates for men and women in the middle years has increased significantly over the last decade.
Here is the good news…
4.       Everyone on a workplace plays a role in mental health promotion and suicide prevention. By engaging in simple preventative steps (e.g., stress management, depression screenings, etc.) anyone can help maintain their own mental health and by learning practical tactics (e.g., becoming suicide prevention gatekeepers, referring coworkers to employee assistance services, etc.) employees help promote the mental health and safety of others.[5] [6]
5.       A comprehensive and evidence-based approach to suicide prevention and mental health promotion exists,[7] is cost-effective[8] and gives employers a clear guide on what to do. By being “visible, vocal and visionary” leaders, employers can set the expectation that a culture of health and safety is a priority and that mental health promotion and suicide prevention are a critical part of that priority.
For more information: www.WorkingMinds.org
About the author:
Sally Spencer-Thomas, Psy.D., is CEO and co-founder of the Carson J Spencer Foundation, a Colorado-based nonprofit established in 2005 after the suicide of her brother. The foundation is known for “sustaining a passion for living” through innovation in suicide prevention. Working Minds, a program of the Carson J Spencer Foundation, focuses on helping workplaces build capacity to promote mental health and prevent suicide. www.CarsonJSpencer.org.




[1] Mental Health America (n.d.) Depression in the Workplace. Retrieved from http://www.mentalhealthamerica.net/index.cfm?objectid=C7DF951E-1372-4D20-C88B7DC5A2AE586D
[2] Witters, D. (2013, July 24). Depression Costs U.S. Workplaces $23 Billion in Absenteeism. Retrieved from http://www.gallup.com/poll/163619/depression-costs-workplaces-billion-absenteeism.aspx.
[3] Managed Care Magazine (2006, Spring) Depression in the Workplace Cost Employers Billions Each Year: Employers Take Lead in Fighting Depression. Retrieved from http://www.managedcaremag.com/sites/default/files/supplements/0603_depression_in_workplace/DepressionInWorkplace_Spr2006.pdf.
[5] Paul, R. & Spencer-Thomas, S. (2012). Changing Workplace Culture to End the Suicide
Standstill. National Council Magazine. (2), 126-127.
[6] Spencer-Thomas, S. (2012). Developing a workplace suicide prevention program. Journal of
Employee Assistance, 42(1), 12-15.
[7] National Action Alliance for Suicide Prevention (2013) Comprehensive Blueprint for Workplace Suicide Prevention. Retrieved from http://actionallianceforsuicideprevention.org/task-force/workplace/cspp
[8] National Institute of Mental Health (2007, September) Workplace Depression Screening, Outreach and Enhanced Treatment Improves Productivity, Lowers Employer Costs. Retrieved from http://www.nimh.nih.gov/news/science-news/2007/workplace-depression-screening-outreach-and-enhanced-treatment-improves-productivity-lowers-employer-costs.shtml