Reflections On Medicine, Shame And Stigma

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As I was entering medical school, I found out that my mother had made a postpartum suicide attempt. I did not find out from her; it was shared with me in hushed tones by another family member who thought I should know, “now that I was going to be a doctor.” I was quite surprised by this information. And it made me sad to think that this wasn’t a topic she felt she could openly discuss.

Suicide is a challenging issue for all of us. Secrecy surrounds the topic, with shame as a common co-traveler. That’s why it’s an honor for me to be a small part of NAMI’s movement to make seeking help and support more acceptable. I’ve met many resilient people in the NAMI community who have overcome suicidal thoughts or actions. Often because there was a person who stood by them during a crisis or a new treatment approach that made a difference in their life. Some found sobriety for a co-occurring substance use disorder. Others found clozapine or lithium, which have been shown to reduce suicidal thinking. Some learned coping skills through a psychotherapy like cognitive behavioral therapy or dialectical behavioral therapy. Many found relief in the community of NAMI. Regardless of how, their suicidal thoughts or actions were talked about and changed.

My field sorely needs similar conversation and change. Doctors also have high rates of suicide and it’s a major issue that some of the doctors we turn to for care are often not taking care of themselves. We need to teach help-seeking behaviors in the medical and psychiatric fields. Doctors need the same support and encouragement to get help as their patients.

I lost a patient to suicide early in my psychiatric residency. This was a person with many strengths, who was also in tremendous psychological pain. I worried about him during off-hours and felt powerless to help at times. After I learned of his tragic outcome, I was upset, slept poorly and struggled at work for months. I was worried I had said the wrong thing or had failed in some way as an inexperienced psychiatrist. I seriously considered leaving the field and entering another specialty. I was lucky to receive support and empathy from my colleagues and supervisors as they encouraged me to seek therapy. I did my best to carry on, but I never forgot about this patient and his suffering.

Last year, at an American Psychiatric Association (APA) event, I was impressed that even doctors are wondering if they worry, struggle and stress too much. APA president Anita Everett reviewed the stresses that commonly consume doctors and announced that psychiatric wellness would be a core feature of her leadership. Dr. Everett’s thoughtfulness and openness on the stresses doctors face and her emphasis on help-seeking was powerful; her efforts have started many overdue conversations across the entire field of medicine. Unfortunately, the same shame that led to the secrecy around my mother’s postpartum suicide attempt is alive and well in the medical field.

Doctors don’t have all the answers for stress, mental illness and suicide—our most challenging aspects of being human. Medical culture needs to continually evolve and learn from the remarkable and resilient people like those I have met at NAMI. Facing your mental health challenges head-on and working to get help with a supportive community behind you is a key piece of NAMI culture. It’s a culture we can all learn from.

 

Ken Duckworth is medical director at NAMI.

https://www.nami.org/Blogs/NAMI-Blog/September-2018-(1)/Reflections-on-Medicine-Shame-and-Stigma

5 Common Myths About Suicide Debunked

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Suicide affects all people. Within the past year, about 41,000 individuals died by suicide, 1.3 million adults have attempted suicide, 2.7 million adults have had a plan to attempt suicide and 9.3 million adults have had suicidal thoughts.

Unfortunately, our society often paints suicide the way they would a prison sentence—a permanent situation that brands an individual. However, suicidal ideation is not a brand or a label, it is a sign that an individual is suffering deeply and must seek treatment. And it is falsehoods like these that can prevent people from getting the help they need to get better.

Debunking the common myths associated with suicide can help society realize the importance of helping others seek treatment and show individuals the importance of addressing their mental health challenges.

Here are some of the most common myths and facts about suicide.

Myth: Suicide only affects individuals with a mental health condition.

Fact: Many individuals with mental illness are not affected by suicidal thoughts and not all people who attempt or die by suicide have mental illness. Relationship problems and other life stressors such as criminal/legal matters, persecution, eviction/loss of home, death of a loved one, a devastating or debilitating illness, trauma, sexual abuse, rejection, and recent or impending crises are also associated with suicidal thoughts and attempts.

Myth: Once an individual is suicidal, he or she will always remain suicidal.

Fact: Active suicidal ideation is often short-term and situation-specific. Studies have shown that approximately 54% of individuals who have died by suicide did not have a diagnosable mental health disorder. And for those with mental illness, the proper treatment can help to reduce symptoms.

The act of suicide is often an attempt to control deep, painful emotions and thoughts an individual is experiencing. Once these thoughts dissipate, so will the suicidal ideation. While suicidal thoughts can return, they are not permanent. An individual with suicidal thoughts and attempts can live a long, successful life.

Myth: Most suicides happen suddenly without warning.

Fact: Warning signs—verbally or behaviorally—precede most suicides. Therefore, it’s important to learn and understand the warnings signs associated with suicide. Many individuals who are suicidal may only show warning signs to those closest to them. These loved ones may not recognize what’s going on, which is how it may seem like the suicide was sudden or without warning.

Myth: People who die by suicide are selfish and take the easy way out.

Fact: Typically, people do not die by suicide because they do not want to live—people die by suicide because they want to end their suffering. These individuals are suffering so deeply that they feel helpless and hopeless. Individuals who experience suicidal ideations do not do so by choice. They are not simply, “thinking of themselves,” but rather they are going through a very serious mental health symptom due to either mental illness or a difficult life situation.

Myth: Talking about suicide will lead to and encourage suicide.

Fact: There is a widespread stigma associated with suicide and as a result, many people are afraid to speak about it. Talking about suicide not only reduces the stigma, but also allows individuals to seek help, rethink their opinions and share their story with others. We all need to talk more about suicide.

Debunking these common myths about suicide can hopefully allow individuals to look at suicide from a different angle—one of understanding and compassion for an individual who is internally struggling. Maybe they are struggling with a mental illness or maybe they are under extreme pressure and do not have healthy coping skills or a strong support system.

As a society, we should not be afraid to speak up about suicide, to speak up about mental illness or to seek out treatment for an individual who is in need. Eliminating the stigma starts by understanding why suicide occurs and advocating for mental health awareness within our communities. There are suicide hotlines, mental health support groups, online community resources and many mental health professionals who can help any individual who is struggling with unhealthy thoughts and emotions.

 

Kristen Fuller M.D. is a family medicine physician with a passion for mental health. She spends her days writing content for a well-known mental health and eating disorder treatment facility, treating patients in the Emergency Room and managing an outdoor women’s blog. To read more of Dr. Fuller’s work visit her Psychology Today blog and her outdoor blog, GoldenStateofMinds.

Traveling With A Mood Disorder

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I was diagnosed with bipolar II disorder when I was 14. It has taken me decades to come to grips with what that means, and to be in a place where I’m comfortable talking openly about it. Nowadays, I’m really open, because I work as a travel blogger, connecting with people and places for a living. I actually started my career at a nonprofit office job, thinking that was what I wanted. But the traditional professional life was something I couldn’t live up to, and I frequently used travel to re-center. I’m very lucky to have turned it into a career, because I’ve learned that travel can be one of the most incredible experiences for those of us struggling with our mental health.

For many of us, myself included, it can be hard to get out of bed some days. Depression comes crashing down, and just the thought of moving becomes overwhelming. Needless to say, the idea of journeying to the other side of the world can seem downright impossible.

But I’ve found that waking up in a new place can be very effective in breaking a downward spiral into an extended depression. My brain becomes too preoccupied with learning about a new place to focus on my mood. That said, traveling with a mood disorder also has its perils. So here are some tips and lessons (some of which I learned the hard way). May they help you, too!

Before You Go

Make Sure You Have Enough Medication. Most of us go month-to-month on our meds. That can be a challenge for an extended trip that overlaps with your refill period. I usually work with my doctor to get a two-month’s supply when I know I have a trip coming up to help with that issue. My pharmacy is also aware that I travel often and works with me to push up refill dates if needed.

Brief Travel Companions on Your Needs. Solo travel is easier for me in many ways because I don’t have to justify my emotional needs to anyone. However, when I travel with others, I try to discuss with them what I need (downtime, alone time, etc.) before we go. That way, we can work out systems that allow me to get what I need within the framework of our trip.

For example, I love taking road trips with my father, and it’s something we’ve been doing since I was a little kid. One of the systems we have in place is that when I feel like I need some alone time, we stay at a hotel with one-bedroom suites. He sleeps in the bedroom, and I sleep on the couch in the living room. Just that one wall and a few feet gives me the precious personal space I need.

Plan. For many of us with mood disorders, our anxiety worsens with the unknown—so having a plan can help with that. This doesn’t mean I have every day planned out, but I go into a trip with at least a rough itinerary. I also try to alternate busy days with lighter days to build in some downtime for myself.

While Traveling

Prioritize Self-Care. I refuse to neglect my self-care when traveling. For me, emotional balance begins with a good night’s sleep (at least eight hours, preferably more). I’ve accepted that this means I will rarely enjoy the nightlife in a new place, and I’m okay with that.If your self-care involves exercise, meditation or something else, structure that into your trip. Try to find hotels with fitness centers, room in your suitcase for your meditation materials, or anything else you may need.

Know Your Triggers. Our illnesses (unfortunately) don’t disappear because we’re on vacation. Our triggers are there as well, so we need to continuously pay attention to situations that can activate them. Knowing what our triggers are ahead of time can help us avoid things that might set them off, but sometimes it still happens. What do we do then?

When I was in Japan, I visited the Fushimi Inari Shrine in Kyoto. It was extremely crowded, and at one point, people were all around me, and I felt like I was trapped. I had a panic attack, and I decided that rather than push

through the rest of my day, I would take care of my needs and leave. I told my travel companion that I would meet him back at our hotel, and I left.

Practice Self-Compassion. This one is still hard for me. After a situation like the one in Kyoto, my natural inclination is to be upset with myself. What I (and my illness) needed that day prevented me from seeing a place I wanted to see. While shame, guilt or disappointment might be our natural first reaction, it’s important to then be compassionate with ourselves. Doing what is necessary to maintain balance is hard, and doing it at the expense of something we were looking forward to is even harder. We make tough choices like that every day, but prioritizing our emotional needs is never the wrong choice.

Keep Your Support Structure Engaged. For some people, this means doctors or therapists. For others, like me, it means certain friends and family members. My friend Ana is one of my first calls when I have panic attacks or depression spirals at home. So even when I was in Kyoto, she was my first call when I got back to the hotel. Hearing her voice, even while on the other side of the world, made me feel like I wasn’t helpless or isolated just because I was gone.I do my best to make sure my support structure is aware of what’s going on with me while I’m gone, and I have emergency procedures in place with my therapist and psychiatrist just in case.

After You Return

Update Your Doctor and Therapist. I find it helpful to do a “debrief” with both my psychiatrist and therapist when I return from a trip. What situations did I handle well? What do I wish I would’ve handled differently? How did my meds work in a completely different environment? I believe that we learn by doing, and keeping the professionals we trust informed of our discoveries along the way is important.

Congratulate Yourself. Regardless of whether or not you handled every situation in a way you consider “perfect,” you were able to travel with a mood disorder. That is an accomplishment that needs to be celebrated! Look through your photos, tell stories to your friends, and know that if you did this, you can do anything.

 

Jonathan Berg is a volunteer facilitator for the Depression and Bipolar Support Alliance and the founder and editor of the travel blog The Royal Tour (www.theroyaltourblog.com). He struggles to keep his bipolar disorder in check and shares his adventures and struggles with his readers.

https://www.nami.org/Blogs/NAMI-Blog/August-2018/Traveling-with-a-Mood-Disorder

College Students Of Color: Overcoming Mental Health Challenges

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July is Minority Mental Health Month which provides an ideal opportunity to talk about the mental health of young people of color. Our country is becoming more and more diverse—the proportion of children of color are projected to become the majority by 2020 and people of color are expected to make up the majority of the U.S. population by 2045. It’s crucial that we pay attention to the mental health of young people of color as they become the future of our nation.

Mental illness affects young people of color at similar rates as white young adults. However, they are less likely to be diagnosed or seek mental health services. This is largely due to stigma and a cultural mistrust of mental health professionals who lack cultural competence.

Not seeking needed mental health care is problematic for this (and any) population—but especially for college-aged people of color. Because 75% of all lifetime cases of mental illness begin by age 24, college is a time during which many mental illnesses first appear. Coping with an untreated mental illness can affect a student’s social experience and academic performance. And for students of color, there’s often more under the surface working against them.

How Discrimination Affects Mental Health

The social determinants of mental health include factors such as where people are born, live and work as well as their age. They also include things such as discrimination and exclusion, socioeconomic status and access to health care.

Some colleges and universities have recently become settings of discrimination, racial profiling and xenophobia. Universities that create these feelings of marginalization and isolation can be harmful to mental health, and for students of color who have a pre-existing mental illness, such acts of alienation can actually worsen their condition.

Many of us grew up hearing the adage: “Sticks and stones may break my bones, but words can never harm me.” Dr. Altha Stewart, who, in May 2018, became the first African-American President of the American Psychiatric Association, stated recently that “this old saying is incorrect and the truth is that  negative words, can be damaging to mental health, especially for young people.”

Racially hateful expressions broadcasted on social media or communicated face-to-face are harmful to the mental health and well-being of college students of color. This is especially true when cyber-based comments are anonymous. Not knowing if comments are coming from a classmate or someone living next door in the dorm can be frightening and anxiety-provoking.

Colleges and universities should create environments in which young people of color are valued. This can be done by recruiting and retaining a diverse staff and faculty; establishing zero-tolerance policies to racist actions; and developing and maintaining cultural supports, such as culturally-themed clubs, dorms and diverse student identity groups.

Positive actions like these are delineated in the Equity in Mental Health Framework developed by the Steve Fund in collaboration with the Jed Foundation. These resources can help young people of color thrive socially, academically and emotionally.

 

Annelle B. Primm, M.D., MPH is currently senior medical adviser to the Steve Fund, and senior psychiatrist adviser to Hope Health Systems and several other organizations. During her career, Dr. Primm has been Deputy Medical Director of the American Psychiatric Association; Director of the Johns Hopkins Hospital Community Psychiatry Program; an editor of the books, Disparities in Psychiatric Careand Women in Psychiatry: Personal Perspectives; and a lecturer and video producer on the mental health of diverse and underserved populations.

Getting Involved With Minority Mental Health

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Mental health conditions do not discriminate based on race, color, gender or identity. Anyone can experience the challenges of mental illness regardless of their background. However, culture, race, ethnicity and sexual orientation can make access to mental health treatment much more difficult.

America’s entire mental health system needs improvement, including when it comes to serving marginalized communities. When trying to access treatment, these communities have to contend with:

  • Language barriers
  • A culturally insensitive system
  • Racism, bias and discrimination in treatment settings
  • Lower quality care
  • Lower chance of health care coverage
  • Stigma from several angles (for being a minority and for having mental illness)

These are all in addition to the usual road blocks. Many cultures also view mental health treatment as a luxury, considering symptoms a “phase” that will eventually pass. These harmful perceptions of mental illness can further isolate individuals who desperately need help.

We can all help ignite change against these disparities and fight stigma this Minority Mental Health Awareness Month. It simply starts with learning more about mental health and informing your community.

Consider Giving A Presentation

Starting conversations about mental health in your community may feel intimidating—especially if your community views mental illness as a personal fault or weakness. But the more we talk about mental illness, the more normalized it will become. And NAMI is here to help!

Consider giving NAMI presentations to your community, like Sharing Hope for the African American community and Compartiendo Esperanza for the Hispanic and Latino communities. These presentations go over the signs and symptoms of mental health conditions as well as how and where to find help. If neither of these presentations fit your background, feel free to use them as models to create your own presentation tailored to your community’s needs.

Emphasize Treatment

Make sure to stress the importance of a culturally competent provider. These mental health professionals integrate your beliefs and values into treatment. To find a provider that does this, you may have to do a significant amount of research. In addition to searching online, you can also ask trusted friends and family for recommendations or ask for referrals from cultural organizations in your community (like your local AKA Chapter).

In your first session, make sure to ask any questions you may have about the professional’s cultural competence. For example:

  • Do you have any experience treating someone from my background?
  • Have you had any cultural competence training?
  • How would you include aspects of my identity into my care?

Be confident when disclosing relevant information about your beliefs, culture, sexual orientation and/or gender identity that could potentially affect your care. Your provider will play a vital role in your treatment, so make sure you feel comfortable and can communicate well with them before committing to them. Remember: If you feel like your provider doesn’t understand you, it’s okay to leave. Cultural competency is very beneficial to effective treatment. It might take a bit of effort to find the right fit, but recovery is worth it.

Share Your Story

When a person experiences symptoms of mental illness, one of the most helpful and comforting feelings is knowing that they’re not alone. It can be incredibly reassuring to know in this moment right now, someone else is going through similar struggles as you are—regardless of where they are, who they are, or how they identify.

If you’re ever feeling isolated or that your community doesn’t understand mental illness, explore story-sharing platforms like Ok2Talkand You Are Not Alone. On these platforms, everyday people write about their deepest struggles with mental illness and their hopes for recovery. If you feel comfortable, post your thoughts and feelings about or experiences with mental illness—it’s rewarding to know you are helping others feel less isolated.

Minority Mental Health Awareness Month is an opportunity to raise awareness and stop stigma in diverse communities. It’s time to improve the harsh realities minority communities face when it comes to mental illness treatment. In fact, it’s long overdue.

By Laura Greenstein

https://www.nami.org/Blogs/NAMI-Blog/July-2018/Getting-Involved-with-Minority-Mental-Health

How Fireworks Can Trigger PTSD

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You may see the signs popping up around your neighborhood this July 4—red, white and blue notices that indicate the home of a vet with the request to “Please be courteous with fireworks.”

The signs are the work of a Facebook-launched nonprofit, Military With PTSD, begun by Shawn Gourley, whose husband, Justin, served in the Navy for four years and returned with post traumatic stress disorder (PTSD). Sudden and loud noises can trigger episodes of PTSD, bringing veterans back to traumatic experiences they have lived through during their service. According to the U.S. Department of Veteran Affairs, up to 20% of military personnel who served in Iraq or Afghanistan experience PTSD each year.

The signs are posted on the lawns of veterans’ homes to alert people to be more considerate when setting off fireworks in the area. According to Gourley, who spoke to CNN, the group has mailed 2,500 signs, some of which were paid for by donations and others by the vets themselves, while 3,000 people remain on a waiting list.

The signs are not meant to quash any Fourth of July celebrations, but to raise awareness that the explosive sounds, flashes of light and smell of powder may trigger unwelcome memories for some. “If you are a veteran, on the one hand July 4th should be one of the most patriotic holidays that you feel a part of,” says Dr. John Markowitz, professor of psychiatry at Columbia University. “On the other hand, the rockets’ red glare and the bombs bursting in air are likely to evoke traumatic memories, and you might want to hide. It’s a tricky one.”

Having advanced knowledge of a fireworks display can help some people with PTSD to better prepare and cope with any symptoms they may experience. “A big component of the startle response and PTSD is the unexpected,” says Rachel Tester, program director of the Law Enforcement, Active Duty, Emergency Responder (LEADER) Program at Harvard Medical School’s McLean Hospital. “When people are able to anticipate, they are able to put into place mechanisms they have to cope ahead of time.”

That might include things such as relaxation techniques or being able to see the fireworks show and therefore know that they’re coming, as well as having headphones, music or other distractions at the ready.

Such strategies may not work for every PTSD patient, but being more aware that the explosive celebrations of the holiday might affect those with PTSD is an important step toward ensuring that everyone can enjoy the holiday without fear, anxiety or pain.

By ALICE PARK

http://time.com/3945001/fireworks-ptsd/

Opioids And Substance Abuse: What Can We Do?

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Opioids and other substances that alter how we feel, think and act have overtaken our culture, and have been declared a public health epidemic. We are losing our loved ones, friends, co-workers and neighbors to these substances. But we have yet to implement the solutions that will beat back this epidemic, as we have so many others, like HIV/AIDS, polio, smallpox and tobacco.

Substance use and abuse—of opioids, heroin, cannabis, stimulants, alcohol, etc.—is universal and the casualties of drug addiction affect all classes, races and regions of the U.S. These substances are too frequently used as an answer to pain, mental and physical, and have become a cure-all for people who’ve fallen on hard times. That’s why so many people use them and that’s why so many people become addicted.

Substance use disorders commonly co-occur with mental health conditions, especially serious mental illness like schizophrenia, bipolar disorder, depression, eating disorders, PTSD and other forms of trauma. People with mental illnesses often turn to drugs and alcohol to quiet their symptoms, and drugs and alcohol can adversely affect our nervous system and increase risk for mental illness.

The Solution

We are failing with this epidemic because of this country’s dogged attachment to policies and programs that have never worked for addiction. Vast sums of money continue to be wasted on campaigns of drug control and on public messages, especially for youth, that rely on scare tactics. We can and must do better. We can beat this epidemic with three public health approaches.

  1. Prevention. This includes school-based programs that provide youth with decision-making skills and methods of controlling their moods and impulses. One proven program is called the Life Skills Training. Prevention also extends to the family, such as “positive parenting,” or actively modeling and teaching children about positive behaviors. Big Brother/Big Sister programs—where an older youth of the same background takes on a younger, high-risk child—is also highly protective. These prevention programs work, and we have hardly started to apply them.
  1. Screening. Early identification of a problem means early intervention, before the substance use disorder becomes more firmly rooted. We have good screening instruments, (such as the Alcohol, Smoking and Substance Involvement Screening Test), and need to make them standard practice in schools, pediatric and family medicine offices.
  1. Treatment. Families and people affected by addiction should advocate for the strong, comprehensive treatment approach they need. Effective treatment means first detecting the presence of a co-occurring mental (or physical) condition and assuring it’s also treated. Treatment for a substance use disorder should then combine:
  • Cognitive therapy that focuses on reducing the triggers of relapse
  • 12-Step programs like Alcoholics Anonymous and Narcotics Anonymous
  • Family education and support
  • Medications

This public health epidemic that is seizing our country can be beaten. And by following these steps, we save lives, help families and restore communities.

 

Dr. Sederer is a psychiatrist, public health doctor and medical journalist. His new book is The Addiction Solution: Treating Our Dependence on Opioids and Other Drugs(Scribner, 2018). www.askdrlloyd.com.

https://www.nami.org/Blogs/NAMI-Blog/June-2018/Opioids-and-Substance-Abuse-What-Can-We-Do

You Can Be Prepared For Crises

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Each year, there are about 5 million visits to emergency departments due to mental illness. Five million people whose symptoms escalate to the point of crisis. Five million people who don’t understand what’s going on or what to do and rush to the ER.

However, this number doesn’t include the people who experience mental health crises without going to the ER—people who are scared and unsure if their situation is a “true emergency.” This number also doesn’t account for the caregivers and loved ones of those experiencing a mental health crisis, standing beside someone they care for, watching them struggle, unsure of how to help.

Mental illness is unpredictable by nature and crises can, do and will happen. Although these crises can’t always be prevented, it is possible to be prepared.

Learn As Much As You Can

The first step in being prepared is gathering any information, resources and support that is available. Start by fully understanding your loved one’s condition: What are the primary symptoms? How can you tell if symptoms are getting more severe? What can you do to support them? And the list goes on. It can be helpful to go with your loved one to see their mental health professional, so you can ask these questions and any others you may have.

Next, learn more about what a mental health crisis is and what to expect when one occurs. NAMI’s new guide: “Navigating a Mental Health Crisis: A NAMI Resource Guide for Those Experiencing a Mental Health Emergency” is a great resource. This free, downloadable guide offers practical strategies on how to deescalate a crisis, information about available resources, tips for advocating for a person in crisis and a sample crisis plan. Details like these are often critical in supporting your loved one during a crisis.

Make A Crisis Plan

Creating a crisis plan should be a collaboration between your loved one and you. The best time to develop this plan is when things are going well. Take the time to ask them questions that will help build a crisis plan, like: What would be most helpful for you? What would you like to do? Who would you like to call? Waiting to ask these important questions can make it difficult to make decisions during a crisis episode.

A crisis plan should include:

  • Your loved one’s general information (date of birth, social security number, insurance information, etc.)
  • Current medications and dosages
  • Current diagnoses
  • History of suicide attempts, drug use or psychosis
  • Addresses and contact information for nearby crisis centers or emergency rooms
  • Contact information for health care professionals
  • A determined behavior/symptom that would prompt going to the hospital or calling 911

Once you create a plane, share it with family members, mental health professionals or anyone else you think should have it. Make sure to update it whenever there is a change in diagnosis, medication, treatment or provider. A crisis plan can be a life-saving resource, so keep it up-to-date and in a safe place.

Notice Behavior Changes

A person with mental illness will typically experience changes in their behavior before a crisis occurs, such as sleeplessness, mood swings or paranoia. These changes are warning signs and shouldn’t be ignored. “Psychiatric illnesses, for the most part, evolve slowly, so there’s going to be a lot of warning,” says Dr. Daniel Lieberman to U.S. News and World Report.

If you notice warning signs, talk to your loved one and encourage them to visit their treating mental health care professional or doctor. “If somebody has a relationship with an outpatient psychiatrist, that’s the first place to go,” Lieberman says.In many cases, there might be enough time to get in contact with a provider before escalating symptoms become a crisis.

Mental health crises can be frightening for everyone involved. However, being prepared can take away some of the fear and uncertainty around what to do and how to help your loved one. Your preparation and support alone can help deescalate a crisis situation—just knowing you’re there, as a stable force, can be an enormous comfort.

By Laura Greenstein

https://www.nami.org/Blogs/NAMI-Blog/June-2018/You-Can-Be-Prepared-for-Crises

Why Suicide Reporting Guidelines Matter

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Many people have a difficult time understanding why the words we use are so important, especially on a topic like suicide. How can certain images or words influence a person’s willingness to take their own life? How can one suicide lead to another? How can conversations, articles, personal stories and media coverage about suicide carry so much influence?

The fact is: how we talk about, write about and report on suicide matters. For someone already considering suicide, it’s possible to change their thoughts into action by exposing them to detailed suicide-related content, including graphic depictions or explanations of the death or revealing the method used. The recent tragedies are an unfortunate example of this. Two days after the media irresponsibly reported on Kate Spade’s death by suicide, Anthony Bourdain used the same method to end his life.

Tragic events like this are why leading experts in suicide prevention, international suicide prevention and public health organizations, schools of journalism, media organizations, key journalists and Internet safety experts all came together to create research-based recommendations on how to safely report on suicide. The suicide prevention guidelines exist for a reason—to save lives.

Suicide Contagion Is Real

According to the Recommendations for Reporting on Suicide: “More than 50 research studies worldwide have found that certain types of news coverage can increase the likelihood of suicide in vulnerable individuals.” This phenomenon is referred to as suicide contagion and “the magnitude of the increase is related to the amount, duration and prominence of coverage.”

A key phrase here is “vulnerable individuals.” The people affected by suicide contagion are likely already thinking about suicide. They may be experiencing a mental illness or substance use disorder and be switching medications and be in a fight with their spouse or parent and be struggling to make ends’ meet and then they’re prompted to end their life because of what they saw on social media while scrolling through their news feed. In other words, suicide is usually the result of a multitude of factors—and the media’s irresponsible reporting can be one of them.

“The outpouring of collective grief, the tendency to present or discuss the person in almost beatific ways and physical memorials or ceremonies celebrating their lives are common practice,” says psychologist Paul Surgenor, suicide prevention expert. “And unfortunately, for someone who can only see pain, isolation and rejection, this level of adoration may seem preferable to their current state.”

Seeing sensationalized headlines and reporting about a celebrity who ended their life can make a person who’s already struggling believe that they can do it, too. That “it’s okay.” That “it’s easy.” And not only that but learning the method of how a person died by suicide shows how to do it—what “works.”

When Robin Williams’ died by suicide in 2014, suicides using the same method increased by 32% in the months following his death. That’s not a coincidence. It’s also not a coincidence that suicide contagion is also known as “copycat suicide.”

How To Talk About Suicide

The main message of any article, video or TV show about suicide should be to encourage people to get help when they need it and where to look for that help by including local and national hotline numbers or other crisis resources. Here are some other important recommendations to follow.

Inform, Don’t Sensationalize

  • Don’t include suicide in the headline. For example, “Kate Spade Dead at 55.”
  • Don’t use images of the location or method of death, grieving loved ones, memorials or funerals; instead use school, work or family photos.
  • If there was a note from the deceased, do not detail what the note contained or refer to it as a “suicide note.”

Choose Your Words Carefully

  • When describing research or studies on suicide, use words like “increase” or “rise” rather than “epidemic” or “skyrocketing.”
  • Do not refer to suicide as “successful,” “unsuccessful” or a “failed attempt.” Do not use the term “committed suicide.” Instead use “died by suicide,” “completed suicide,” “killed him/herself,” or “ended his/her life.”
  • Do not describe a suicide as “inexplicable” or “without warning.”

Report on Suicide as a Public Health Issue

  • Include the warning signs of suicide and a “what to do” sidebar, if possible.
  • Do not report on suicide the same way you would report a crime.
  • Seek advice from suicide prevention experts rather than quoting/interviewing police or first responders.

Suicide is not a subject that should be avoided, but rather, handled carefully and thoughtfully—the way the suicide guidelines have clearly outlined. For those who believe the recommendations were created to prevent offensive language or spare people’s feelings, please keep in mind that their purpose is so much more than that. This is not a matter of being “politically correct.” It’s a matter of saving lives.

 

If you are thinking about suicide, please call the National Suicide Prevention Lifeline at 800-273-TALK (8255).

 

Laura Greenstein is communications manager at NAMI.

https://www.nami.org/Blogs/NAMI-Blog/June-2018/Why-Suicide-Reporting-Guidelines-Matter

6 Homeless LGBTQ Youths Share Their Stories

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When photographer Letizia Mariotti began meeting homeless LGBTQ youth in New York City, she felt a duty to help spread their stories.

She began photographing the queer youth she encountered at LGBTQ gathering places and interviewing them about their experiences. All of the subjects of her photos live, or at one point have lived, at the Ali Forney Center, which serves LGBTQ youths in New York. The majority of them have faced rejection from their families because of their sexual orientation or gender identity.

“I want parents of LGBTQ kids to understand the tragic scope of this problem and the profound influence family acceptance plays in the lives of the LGBTQ youth,” Mariotti told HuffPost. “I want them to understand that an indecently high percentage of the LGBTQ youth suffer emotional abuse and violence first from their parents, relatives, and the communities they live in.”

With 40 percent of homeless youth identifying as LGBTQ, Mariotti hopes her project can help others see these individuals clearly and compassionately.

“People need to be less judgmental and more accepting,” she said. “People need to stop seeing the world in stereotypes, stop trying to define what ‘normal’ looks like.”

Check out photos and excerpts from interviews with the young people featured in Mariotti’s project below.

  • Alexander, 24 (Man With Trans Experience)
    “I started transitioning at 18. In Florida, at the time, trans-identified people were not really protected. I was diagn
    Letizia Mariotti

    “I started transitioning at 18. In Florida, at the time, trans-identified people were not really protected. I was diagnosed with schizoaffective disorder and also gender identity disorder. Nowadays they categorize it as gender identity dysphoria. It’s a big difference.

    “My mom was not accepting of me. But me liking someone of the same sex or gender was not the biggest issue. The problem was more me representing very masculine. She said to me once, ‘If you are going to like girls, then why don’t you look like one?’ She couldn’t understand. She was abusive both verbally and physically. After a while, it got to a point where it was too much. I couldn’t be myself. So I left.

    “My time as a homeless was hard. I didn’t know if I was going to make it. Many times I thought my mental health was not going to allow me to get out of this situation. What kept me going is the knowledge that I had goals. I really wanted to get out of the shelter system.

    “For a lot of people, what is missing is the hope. And hope is necessary to get out of these situations.”

  • Cyrus, 18 (Trans Male)
    “I didn't even know what being gay or being trans meant until I was about 15 years old because it was a bad thing to kn
    Letizia Mariotti

    “I didn’t even know what being gay or being trans meant until I was about 15 years old because it was a bad thing to know in my family. Even though I knew my whole life that I was attracted to women, I didn’t know there was a label and I didn’t know it was normal.

    “Before I came out as trans, I was identifying as a lesbian. And when my parents found out, it didn’t go well at all for me. They deleted all my social media accounts and they wouldn’t let me leave the house alone. I was not allowed to see my friends anymore. So, after a while, I got so angry that I got into a huge argument with my mom. We got a little bit physical and my dad decided to send me into a psychiatric hospital. In total, I went to five of them.

    “Because I wanted to further my transition, get surgery and start hormones, I knew I couldn’t stay at home. My dad doesn’t want me confusing my younger siblings or our family members. So I had to go.”

  • Frankie, 19 (Non-Binary Trans)
    “My parents tried to ignore what they called ‘my lifestyle’ and pretended that it would go away. Growi
    Letizia Mariotti

    “My parents tried to ignore what they called ‘my lifestyle’ and pretended that it would go away. Growing up, I started to be more unapologetic with who I am. I wasn’t hiding. So the tension at home just kept rising until one day my mom just exploded on me. She told me to leave and not come back.

    “Being homeless is very scary. You have no security and you can only keep what you can hold in a bag or a suitcase. Money is also a problem. I did sex work for a few months. It was dangerous. I had a lot of encounters that were very bad, but I made money from it and I was able to buy food.

    “Now I am lucky I don’t have to do it because I have a stable housing and a job.”

  • Eli, 17 (Gender Non-Conforming)
    &ldquo;I grew up in an Orthodox family. So when I was discovering my identity, I had to keep a lot of things secret. ...<br><
    Letizia Mariotti

    “I grew up in an Orthodox family. So when I was discovering my identity, I had to keep a lot of things secret. …

    “During my last year of high school, I came out to my parents. They weren’t supportive of it. They thought it was a phase that would go away or something that I should religiously keep under wraps and not act on it. Most of the times, they pulled the insanity card, saying things like I am not thinking clearly or people that I am around changed my point of view. …

    “This has been really hard for me mentally. I was sent to a religious school in Israel. But I got kicked out after just two days because of my gender identity. I told one of the social workers there, because I didn’t want to keep it secret anymore.

    “I booked a plane ticket and instead of going back home, I came here to New York City. I guess you could just say I ran away.”

  • Rose, 19 (Trans Woman)
    &ldquo;I realized from a very young age about my trans identity because I was surrounded by a lot of things in my childhood t
    Letizia Mariotti

    “I realized from a very young age about my trans identity because I was surrounded by a lot of things in my childhood that forced me to mature early. I think that is why I began transitioning so young at age 13. After my parents’ death, I socially came out.

    “When I started transitioning, I was mostly on my own because I didn’t have anyone to talk to. So it took me a while to figure things out. I knew about hormones and I wanted to go on them, but I couldn’t see a doctor. At 14, I managed to get black market hormones. But since I wasn’t able to get a steady supply, it didn’t last long.

    “Only at 17, I was able to really start and stay on hormones. For a while, my cousin took care of me, but she didn’t know how to help me and she didn’t have any understanding for me being trans. That made things tense and difficult between us. So last summer, I came to the Ali Forney Center to try to get myself together.

    “To get money, I was doing sex work. I did it on and off because I have a lot of social anxiety in general, so trying to find clients to have sex with for money was difficult for me. I would get a lot of money for it … but then I wouldn’t see anyone for weeks after that. And when I was really broke, I just went back on doing it. Sex work is very prevalent in the trans community.”

  • Je’jae, 24 (Non-Binary)
    &ldquo;At 18, I was sent to Israel on some heritage trip like a lot of young Jewish people do. The religious community where
    Letizia Mariotti

    “At 18, I was sent to Israel on some heritage trip like a lot of young Jewish people do. The religious community where I lived forced me into it. It was also a period where I was really struggling with my sexuality. And within an environment that was telling me that I should feel ashamed, I started feeling really suicidal.

    “I went through two years of shaming from our rabbi ‘therapist’ in Israel. It’s what they call ‘conversion therapy.’ In other words, it’s only physical and emotional abuse. I felt scared and trapped. It took me nearly two years to have the courage to leave that place and to tell my ‘therapist’ that I didn’t want to hide anymore. … This man, who was supposed to be my mentor, shamed me. He said that I would grow up being alone, that I was a sick and an unnatural person.

    “When I came back from Israel, as I was more open about my gender identity, my mom really started to have greater problems with me and she became even more emotionally abusive. And a year and a half ago, she locked the door on me.

    “That’s when I became homeless for three months.”

    #TheFutureIsQueer is HuffPost’s monthlong celebration of queerness, not just as an identity but as action in the world. Find all of our Pride Month coverage here.