Suicide Risk and Children with Disabilties

By: Sally Spencer-Thomas

Written Originally on March 22, 2013

This morning I was interviewed by the Mary and Melissa Show, a call-in advocacy radio talk show led by two mothers living in the Nation's Capital who share the hurdles of raising kids with disabilities.

Before I launch into this difficult topic, I want to emphasize that people with disabilities who are supported and celebrated for who they are will have a high likelihood of successful and happy lives and rarely, if ever have problems with suicidal behavior.  For many people with disabilities, the suicidal thoughts are less about the direct consequence of the disability and much more about the negative social expectations, exclusion, and bullying that can result from the misunderstanding rampant in our society.[1] So while I may be presenting some information today that is concerning for parents about the safety of their children, I want to reassure them that there is a lot we can do to build protective factors for kids and prevent the escalation of despair by knowing what to look for and what to do when warning signs emerge.

That said, here are some concerning statistics on the topic of disability and suicide:

·         Teens with a learning disability such as dyslexia are ten times as likely to die by suicide as someone without a learning difficulty.  One study from Canada examined the suicide notes left by 267 teens, and an alarming 89% of the notes had spelling and grammatical errors indicative of learning disabilities.[2]

·         Childhood ADHD can linger into adulthood and suicide may become a concern. In a recent study cited reported by CNN, 200 adults who had ADHD as children tracked for mental health challenges. A stunning 57% had some type of psychiatric disorder (alcohol abuse, anxiety, depression) and were 5 times more likely to die by suicide. The reporter concluded that people with ADHD don’t tend to grow out of it and a combination of depression and impulsivity for an ADHD adult can have deadly consequences.[3]

·         A recent report on Disability Scoop that shared that children with autism were 28^th times more likely than typically developing kids to contemplate or attempt suicide. Those who were bullied, male, black or Hispanic, age 10 or older and those with lower socioeconomic status appeared to be at highest risk.[4]

What can parents of children with disabilities do? As a mother of a teen with severe dyslexia and as someone who lost her brother to suicide after his struggle with bipolar disorder, I am very concerned about this connection. Fortunately, I feel confident that there are things we can do to be effective advocates for and supporters of our kids to help them flourish and thrive while managing the challenges they endure.

·         Challenge the social barriers. Our first step in this process is to overcome the social barriers to this difficult topic. Knowing that social barriers also exist for issues related to living with disabilities, we have a double-duty piece of work cut out for us. For the issue of suicide, there are many misperceptions we can work toward dismantling with effective dissemination of stories and science. When we share powerful stories of hope and resilience, we let others know that suicidal behavior and struggles with disability ebb and flow and that people who experience these life challenges have much more in common with others than they do have a difference. These stories help people create roadmaps for recovery and coping and are critical in shifting the misperceptions that can lead to marginalization. The second strategy is science. We need to present solid, credible data that helps shape the case for understanding that disability and mental illness concerns are not about moral failings, but about complex social, psychological and biological functioning that can be affected with treatment, accommodation, and coping.

·         Know the model of suicide risk and suicide warning signs. If I am going to recommend one book for people interested in learning more about suicide risk, I encourage them to read Thomas Joiner’s Why People Die By Suicide (2005, Harvard University Press). In this theory, Joiner says that those who kill themselves not only have a desire to die, they have learned to overcome the instinct for self-preservation. That is, wanting death, according to Joiner, is composed of two psychological experiences: a perception of being a burden to others (perceived burdensomeness) and social disconnection to something larger than oneself (thwarted belongingness). By themselves, however, neither of these states is enough to move a person to act on the desire for death, but together with an acquired capacity (or fearlessness) they result in a high-risk state for suicide. Acquired capacity can come in the form of innate temperament (risk-taking/impulsivity), learned conditioning from provocative and painful experiences, or access to and knowledge of lethal means. Understanding this model can help parents look for themes in communication and patterns of behavior with their children.

Additionally, parents should be aware of the expert consensus  guidelines for suicide warning signs (summed here with the mnemonic IS PATH WARM):

I               Ideation (suicidal thoughts)

S              Substance Abuse

P             Purposelessness

A             Anxiety

T              Trapped

H             Hopelessness

W           Withdrawal

A             Anger

R             Recklessness

M            Mood Change

For more on this mnemonic go here.

·         Screening and surveillance for suicidal behavior. Training and screening tools are important weapons in the fight against suicide. Parents, teachers, and others who come into contact with youth can quickly learn the warning signs of suicide and how best to link others to care by going through national best practice “suicide prevention gatekeeper trainings,” like QPR (stands for Question, Persuade, Refer). Within one to two hours, lay people can be given the basic skills on what to look for, how to ask the difficult “suicide question,” and how to refer people to qualified mental health and crisis services (see below). Screening tools like those supplied by Mental Health Screening can help parents, educators and primary care physicians quickly assess risk for any number of mental health conditions.

·         Link children to qualified mental health and crisis support when warning signs are identified. Identifying youth at risk is the first step in the chain of survival; linking them to care is the next. Those at risk for suicide and the people who support them need to have quick access to qualified services. Two of the best resources I am aware of are:

o   National Suicide Prevention Lifeline – a free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week

§  1-800-273-TALK (8255)

o   HelpPro -- HelpPRO, the oldest, most comprehensive Therapist Finder, to help people find qualified suicide intervention mental health professionals

So in conclusion, I have observed tremendous passion in both the disability advocate world and the suicide prevention world. Both fields are fraught with marginalization and misunderstanding, and in both, there is a lot of hope fueled by tireless family and friends and people living with these conditions and experiences. I say, let’s pull together and unite in our effort to be heard, be understood, and create change so that people can get back into a “passion for living.”

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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 living” 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.Visit www.CarsonJSpencer.org for more information.

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[1] Disability and Suicide: The Social Factors that Put People with Disabilities at Risk (2/28/2013 by Amanda Lunday) http://www.theindependencecenter.org/blogs/independence-times/2013/2/28/disability-and-suicide

[2] Dying To Read http://www.dyslexicsuicide.com/

[3] March 4, 2013: ADHD may continue in adulthood, lead to another psychiatric disorder – Elizabeth Cohen reports http://earlystart.blogs.cnn.com/2013/03/04/adhd-may-continue-in-adulthood-lead-to-another-psychiatric-disorder-elizabeth-cohen-reports/?iref=allsearch

[4] Michelle Diament (2013, March 12). Kids with autism face increased suicide risk. http://www.disabilityscoop.com/2013/03/12/kids-autism-suicide/17483/

Social Enterprise and Suicide Prevention

Re-published with permission from original author: Jess Stohlmann

Since I started my job, I have found myself spending a lot of time explaining what I do to other people. I can never decide whether to say I teach suicide prevention classes or that I teach social enterprise first.
If I start with suicide prevention, the response is generally something like this: “Oh my gosh, your job must be so hard!” Then I am left trying to decide how much explanation I feel like giving about my work. If I decide to be brief, I will say something like this:

“Actually, I love my job! It is really uplifting and inspiring. I am in the PREvention field. Most of the time when we talk about suicide, we talk about INTERvention or POSTvention. Postvention is providing support to the bereaved and survivors of suicide. The best example of intervention would be hotline types of services. They are the people who help protect someone who is suicidal while they are actually feeling suicidal, not really before. I do the WAY before work. My work is focused on empowering young people to be resilient and helping them sustain a passion for life.”

Yes – that is the short version. I think that the “job-must-be-so-hard” response is really indicative of a big problem with the way people view suicide in the States, and particularly in Colorado (sometime I will get into how rugged individualism works against communities out here, but not today). The problem is that we view suicide itself as a problem, and usually a problem that is sort of inexplicable and unstoppable. Usually, suicide is seen by a suicidal person as a solution to set of other problems that seem insoluble. It makes sense that we, as a community, want to feel this way. We almost never talk about suicide except in the wake of tragedy, and when a tragedy has occurred we want to do everything we can to make sure that the bereaved people do not feel responsible for the death of a loved one. But when it comes down to it, most of the time suicide is preventable, and we should be treating it like any other public health issue. In my ideal world, we would treat suicide the same way we treat something like breast cancer. It would be something that people wouldn’t be scared to talk about – they would even wear gear and go for runs to support research to help prevent and treat it. Families who had lost someone to suicide wouldn’t feel responsible for the death of a loved one, even if there were signs and symptoms that they could have recognized if they knew what they were. Mental health screenings would be as common and “normal” as breast exams. I believe suicide is not only a public health issue, but a social justice issue – all people should be able to access the help they need to survive; no one should be dying from a treatable, preventable problem.

If I start with social enterprise, people generally give me a blank stare and try to move on. Because I believe that social enterprise is going to save the world, I feel the need to subject everyone that doesn’t know about it to one of my “why-social-enterprise-is-so-great” rants. They go something like this:

Social enterprise is the place where for profit practices meet nonprofit principles. They find a way to make money while solving social problems. You have probably heard of the Women’s Bean Project (http://www.womensbeanproject.com/) – that is a great example. They break the cycle of poverty by teaching women employment skills. While they are teaching those skills, they are also making a product that they sell. So they are making money and making a difference. Our government doesn’t provide all the services that people need, that is why we have nonprofits. The issue is that nonprofits have a model where money comes in from donors and resources go out to clients; so the services to the clients depend on money being given by others. Social enterprises sort of mix that all up and engage the “clients” in the work of the business. Clients are participants in their own liberation. If you are interested in learning more, you should check out this book, Social Entrepreneurship: What Everyone Needs to Know, by David Bornstein (http://www.oup.com/us/catalog/general/subject/Sociology/SocialMovementSocialChange/?ci=9780195396331&view=usa). Anyway, what I do is teach young people how to start social enterprises that find a root cause of suicide in their communities, and create a product or service they can sell to work to solve that problem. They submit a business plan, we seed fund their businesses, then they make their product and start selling!

So that begins to explain what I do. Every day, I see young people changing themselves and changing the world. Every day, I see youth becoming more resilient, building a passion for life, and learning the skills they will need to run enterprises that I truly believe will save us. And they won’t just save us from suicide; they will save us from every other ailment, from hunger to gender violence, because they will know what it means to be a force for good. They will know that good businesses revolutionize business and change the world for the better, and they will lead us into a brighter future than we ever could have imagined. I am in the business of fostering hope, and they are in the business of making it happen.

The Gifts of Gratitude

THE GIFTS OF GRATITUDE – Daily Practices Boost Emotional Wellbeing

Gratitude unlocks the fullness of life.  It turns what we have into enough, and more.  It turns denial into acceptance, chaos into order, confusion into clarity.  It turns problems into gifts, failures into success, the unexpected into perfect timing, and mistakes into important events.  Gratitude makes sense of our past, brings peace for today and creates a vision for tomorrow.

-- Melodie Beattie

A daily dose of gratitude may be just what we all need to improve our mental health and buffer against the effect of stress. Being grateful helps us be mindful of what is around us and shifts our focus outward.  Thankful people have been found to are happier, have stronger relationships, are more optimistic, exercise more and have fewer visits to physicians. Here are four things you can do to benefit from gratitude:

1)     Gratitude Inventory and Reflection

Make a list of the 100 things you are grateful for and keep it nearby to remind yourself on tough days. Include in this list:

·       What do I take for granted?

·       What challenges have made me a better person?

·       Who are the people who have improved my well-being?

·       What are the opportunities in the future that I look forward to?

·       What gives me joy?

·       Where do I find unconditional love and support?

Some people find it helpful to gather physical reminders of the things they are most grateful for and put them into a “hope kit” – pictures, thank you letters they have received, and so on.

Start and end your day by reflecting on these gifts and sending intentions of gratitude for their presence in your life by saying, “today I am especially grateful for…” or “my life is better because…is in it.” Notice the sensations you feel when you make these mental intentions of thanks.

2)     Give Thanks Freely

Look for small acts of kindness in your day and offer unexpected thanks without expectation of anything in return. Quick notes or comments of gratitude go a long way for the giver and receiver.

3)     Do the Gratitude Dance

Citation:

Harvard Health Publications, November 2011 http://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2011/November/in-praise-of-gratitude

Cultivating Innovation

By Guest Blogger, Jess Stohlmann

Growing up, I remember hearing my mom tell me, “Perception is reality.” She said it so often, that it became a sort of script for me. When people talk about a problem or a situation and have a very narrow, focused view, that is always what runs through my mind. What my mom was talking about when she said, “Perception is reality,” is so much more complex than it might seem on the surface.

First, there is an assumption that perception is not the same for all people. This means that there are constraints on perception, and that these constraints are different for each individual. This study is a great example of what I mean: 

The Simon & Levins “Door Study” shows us that there are constraints on what people perceive. When people are busy doing one thing, something that seems obvious from the outside can change without them noticing. If you think about how the subject would talk about what happened and what was important, it would probably be very different from what we, the observers would identify as what happened and what was important.

Perceptual constraints aren’t just what we are focusing on and what we are ignoring. Stereotypes put constraints on our perceptions, our past successes and failures shape how we approach problems, etc. All of these constraints narrow our perceptions. They narrow our perceptions so uniquely, that the way each individual perceives the world is different. That is part of what my mom meant when she told me, “Perception is reality.”

The other part of what she meant is that most people do not spend any time trying to remove perceptual constraints, so to them what is ‘real’ and ‘possible’ must exist inside those constraints. Innovators are people who can overcome their perceptual constraints.

Being innovative isn’t just a natural skill that certain people have; all people are capable of being innovative. We can create conditions in which innovation is cultivated. We can open up spaces for innovation by practicing overcoming our perceptual constraints. Using new methods for problem solving is a practical way to start. Here is a process you can try:·       Assume that all problems have multiple solutions

• Generate a lot of ideas – do not allow yourself to stop after you have come up with a few easy solutions. Problems are hard (that’s why they are problems) and solutions should not always be easy.
•  Spend time assessing the ideas
• Assume that innovation is based on utility – the best solutions are useful, not just different
• Choose the best idea and use it!

Once you start opening up spaces for innovation while you are problem solving, innovative approaches to other aspects of work and play will become easier and more natural. Practicing innovation broadens the scope of our perception, and makes things that previously seemed impossible, possible.

Gratitude Overflows in the Glass of Social Entrepreneurship

By Guest Blogger, Jess Stohlmann

This month, the Carson J Spencer Foundation is celebrating our core value of gratitude. Gratitude is an emotion expressing appreciation for what one has. It is what gets poured into the glass to make it half full, and increases the wellbeing and happiness of those who cultivate it.  In addition, grateful thinking—and especially expression of it to others—increases energy, optimism, and empathy.

As social entrepreneurs, gratitude is central to our work. Friedrich Nietzsche once said, “The essence of all beautiful art, all great art, is gratitude.” If we replace ‘art’ in his quote with ‘social entrepreneurship,’ it rings equally true. Gratitude shifts the focus from what is lacking to the abundance that is already present.

Shifting focus from weakness to strengths is at the core of social enterprise. Social entrepreneurs celebrate the gifts of both for profit and for impact sectors by utilizing the strengths of each to solve the root causes of social issues. We look upstream to the root of problems, and then draw on the strengths of our community, entrepreneurship, and empathy to make the glass half full – or even all the way full.

I love the “full glass” metaphor; it allows us to really think about what we are bringing to the table and how to combine the efforts of others for the benefit of all. When I think about our glass right now, here is what I imagine it filled with: strong partnerships, passion for our cause, skilled leadership, innovative ideas, and practical solutions. That glass is pretty full to me. Having a full glass opens up opportunities that we never thought possible. That is what social enterprise is really about – using gratitude to recognize the value of all the things we have and bringing our glass full of possibilities to the table.

How Mentally Healthy is Your Workplace?

photo credit: Nelson Webb @Flickr

By Sally Spencer Thomas, Psy.D

It’s not an easy topic to discuss. Suicide, that is. There is a lot of fear based on misperceptions about it. While pamphlets can disseminate information, they are usually not effective enough to shift attitudes or prompt discussion or even help people.  The fact is, the majority of people who die by suicide are working-aged people, and yet most of the suicide prevention efforts target youth. By training workplaces to be better able to identify people at risk, early in the progression of a mental health disorder, more people will get help.

Employers and managers are leaders who can champion a mentally resilient and thriving workplace. They do this by understanding that mental health issues are like other health issues and advocate for promoting protective factors, minimizing risk factors and giving access to quality care. When people are in crisis, these leaders can offer guidance on how to navigate the balance of workplace functioning and individual well-being.

How do you get there?

A great place to start is to take the online assessment.  Part organizational review and part environmental scan, the questionnaire is designed to get workplaces thinking about the many ways they could promote mental health in the workplace. The assessment is helpful, but it is really just the foundation, and one page from the Suicide Prevention Toolkit, which is a Working Minds Program and part of the Carson J. Spencer Foundation.  But the results from the questionnaire will help set the stage for the workshop that follows.

Utilizing the Suicide Prevention Toolkit, employee assistant or human resources personnel, will be able to lead between 25-35 people through the program. The program is practical, user-friendly and seen as highly effective tool for suicide prevention education in the workplace. . One of the main teaching tools is the DVD, which creates a forum for dialogue and critical thinking about workplace mental health challenges. Designed to be implemented over the lunch hour or as a half-day session, the workshop opens the lines of communication and lets employees learn and practice new skills, including help-seeking and help-giving skills.   

Just the employer is encouraged to take the organizational assessment; there is research that supports the use of anonymous online screenings for employees. Through WorkplaceResponse, a program of Screening for Mental Health, employers have a unique opportunity to offer a customized online screening tool that will let employees determine if their symptoms are characteristic of various mood and anxiety disorders and alcohol problems. 

Both programs are about preventing crises through a proactive approach. Both programs are low cost, high impact approaches that empower workplaces to help their vulnerable employees move from distress to coping, communicating that the workplace cares about the well-being of their workers, not just their immediate performance. Both programs have the potential benefit beyond the workplace. In other words, the skills/information acquired in these programs can be applied to family members, neighbors and more. This positions the workplace as responsible corporate citizen and this holistic approach can increase morale.

Click here to take the employer assessment. 

Meeting Workplaces Where They Are: Crisis Response, Safety Planning and Cost-Savings

By Sally Spencer-Thomas

Parts of this blog republished in the International Association of Suicide Prevention’s Newsletter

While most of us in the field of Suicidology can see the great benefits of enlisting employers to implement comprehensive approaches to suicide, most employers are not quite ready. They are unfamiliar with the idea of their role in suicide prevention and often find it initially daunting and significantly out of their usual business endeavors. For these reasons, we need to listen well, move slowly and let them lead.

Many well-meaning suicide prevention advocates jump into the work of fixing something before they understand what the obstacles to change are.  The “Stages of Change” model^[1] developed by Prochaska and DiClemente, informs us that in order to be effective, we need to craft our strategy of change to the readiness of the people or systems needing change.^[2] If the problem is not in awareness, they will not be motivated to take action. If the problem is in their awareness but brings with it some big perceived obstacles to change, they will not be motivated to take action. It’s only when the perceived benefits of change outweigh the consequences of staying the same that change happens. You know you are moving too fast in championing change, when you get a lot of “yes, but” responses such as, “Yes, there may be mental health issues at work, but no one has time/money/expertise (fill in the blank) to deal with it.”

For these reasons, suicide prevention advocates need to take time to listen to workplaces and find out how they are being affected by suicidal behavior, before we prescribe a comprehensive blueprint for change. Those of us interested in of suicide prevention in the workplace have noticed three main areas where workplaces have concerns about suicidal behavior:

1)    After death or a serious attempt has already occurred:  Unfortunately, most workplaces dealing with this issue are doing so in a reactive mode – wondering what warning signs were missed and how best to support their grieving and traumatized staff. To help workplaces in these situations, one goal of the workplace suicide prevention advocates is to provide succinct guidelines on how best to handle the crisis and suggested best practices on how to support bereaved employees.

2)    As they relate to healthcare costs and lost productivity costs: Most for-profit organizations make decisions based on how the choice will impact their bottom line. For this reason, suicide prevention advocates will continue to gather data to make a strong business case for suicide prevention. In other words, we need to demonstrate that engaging in suicide prevention will save the company money.

3)    As they relate to workplace safety: with suicide-homicide cases capturing the attention of employers for decades, much concern exists on how dangerous suicidal people are to others. In order to alleviate this worry, suicide prevention advocates can help link workplaces to policy, protocol and training that allows them to implement “early warning” systems and a process for linking at-risk people quickly to qualified care.

Thus, our general approach is to meet workplaces where they are – crisis support, cost-savings, safety protocol, or whatever other need they have. In order to better serve their needs we need to listen well to their concerns about suicidal behavior as well as their perceived barriers to doing something different. By aligning employers’ goals with the goals of suicide prevention, we will have a much greater chance of successful larger-scale change, as one step can often lead to another.

Contact the Carson J Spencer Foundation for more information about up-coming training on suicide prevention in the workplace and our Working Minds Toolkit (www.WorkingMinds.org).

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[1] Prochaska, James, DiClimente, Carlo, Norcross, John (1993). In search of how people change: Applications to addictive behaviors. Journal of Addictions Nursing, 5(1) 2-16.

[2] Edwards, Ruth, Jumper-Thurman, Pamela, Plested, Barbara, Oetting, E. & Louis, Swanson (2000). Community readiness: Research to practice. Journal of Community Psychology, 28(3), 291-307.