Suicide first-aid – a useful life skill? HSE ASIST training …

Following my last post over on Facebook, I’ve just registered with the HSE to complete their ASIST (Applied Suicide Intervention Skills Training) course. Though not highly publicised, it’s a free, two-day interactive workshop in suicide first-aid which trains participants to reduce the immediate risk of suicide and increases the support for a person at risk.

ASIST

The issue of  our high suicide rates is always simmering away in the background, but it feels like recently, frustration with our mental health services, and increasingly, the difficulty in accessing treatment is starting to reach boiling point, as more and more people tell their story. There was the horrific death of Caoilte O’Broin, whose family had so desperately tried to get him the help he needed, only to meet frustration and closed doors at every turn, the tragic death of Stephen Byrne, and of course the dreadful loss a while back of Sharon Grace and her little girls, not to mention the loss of Una Butler‘s family. And of course Bressie’s impassioned appeal to the Oireachtas Joint Committee on Health and Children to address the “epidemic of our generation”. I could go on; these are just a handful of examples.

Dealing with service issues can be fraught, frustrating and there are many problems to be navigated, not least the question of the involvement of families in mental health treatment, and the terrifying barriers to treatment that exists when a person, such as Caoilte, has a dual diagnosis.

I therefore feel, that for as long as we live in a country where equity of access to well-resourced, timely, affordable, holistic, compassionate, recovery-led mental health treatments is at present, a distant aspiration, we need to start equipping ourselves to better deal with the reality around us. That reality is that approximately 500 people annually in this country lose their lives to suicide. While our government has an obligation to step up to the plate, I can’t – won’t – accept that there is nothing we ourselves can do as a society to try and change this.

Prevention strategies have their place when it comes to addressing suicide; however, we can all sit at any point on the mental health spectrum at any time, and sometimes, it’s emergency intervention that’s needed. While we have become very, very good at telling people in distress that they should “seek help” or “talk to someone”, if someone did exactly that and told you they were considering killing themselves, would you know what to do? Would you feel confident you could help?

I know I wouldn’t.

According to the HSE, the ASIST workshop encourages honest, open and direct talk about suicide as part of preparing people to provide suicide first aid, and helps participants understand what help and support people in crisis might need. But it aims to instil a confidence in dealing with crisis situations that may just save a life. ASIST workshop places are limited, they say, therefore preference must be given to participants who are likely to come into contact with someone who is at risk of suicide in their daily lives. Given our current suicide rates, that could be any of us.

See how I got on.

Further Information

  • Training dates: Regular trainings are scheduled around the country – you can find more information on these by contacting your Regional Resource Officer for Suicide Prevention at the following link. http://www.hse.ie/…/resour…/officers_suicide_prevention.html
  • Cost: ASIST training is free. You just need to register in advance.
  • Who can take part? Anyone can partake in ASIST training, but it is particularly suitable for all kinds of caregivers – health workers, teachers, community workers, Gardai, youth workers, volunteers, people responding to family, friends and co-workers. he course can be intense, and it’s not recommended for people who may have lost someone to suicide or have been recently bereaved.

Download the ASIST leaflet 

Other mental health training resourses from the HSE National Office for Suicide Prevention

Donal Walsh and Suicide: What’s missing from the debate, and where do we go from here?

Donal Walsh

There has been lots said and written on the subject of the late Donal Walsh over the past 48 hours. Rarely has the passing of a young man evoked so much emotion and passion among the public, but then, Donal was without a doubt an exceptional young man, who displayed remarkable courage, dignity and bravery as he faced his future knowing he was dying from cancer.

On Wednesday night, RTE 1 showed a documentary entitled “Donal Walsh: My Story”, which followed Donal and his family throughout his last few months as he came to terms with the fact that he was dying. Knowing that he had very little time left, Donal, his friends and family spoke eloquently and earnestly about his treatment, his feelings, his aspirations, and his frustration that he would never get to achieve many of his dreams and goals. The public was already familiar with Donal’s story, having witnessed his candid interview with Brendan O’Connor on the Saturday Night Show in May 2013, where he implored teenagers to think twice before they considered suicide.

RTÉ tends to excel in the genre of documentary making, and as a human interest story, this was an exceptional, evocative and heart-breaking piece of film-making. Donal’s courage, and that of his and his family – mother Elma, father Fionnbar and sister Jema –  and his loyal bunch of friends is one of the most inspiring stories of our generation, and a story worth telling. There are lessons to be taken from the way in which Donal faced his illness, and it’s hard to imagine that anyone watching it could fail to be moved.

A central focus of the documentary was Donal’s opinion on teen suicide, as broadcast on the O’Connor interview in May. Statistics had shown a consistent upward trend in recorded suicides in Kerry in previous years, many of those deaths occurring among young people.

“I just didn’t want them to see suicide as a solution to any of life’s problems. It hurts me to see them think about it… to see it among their friends. But it kills me because I’m here fighting for my life for the third time … I’ve no say in anything, and I’m still here waking up every day. And they think that they have a problem, and this might be a solution. That does make me angry, and I’m not going to lie about it. I’ve nothing against people with mental illness. But these people have to realise that there is help.”

His words triggered a nationwide conversation on suicide, and widespread media coverage. Young people claimed that his message had touched them, had changed their outlook, and had resonated in a way that the voices of adults – parents, teachers – had not.

During the documentary, his father, Fionnbar, read from a letter received from a student in Waterford.

“Your story was so powerful and moving. I’m 16 myself, and the thought of going through what you have gone through at the same age is just hard to believe. Many people would have been afraid to say what you’ve said about suicide. It wouldn’t have been politically correct, and all that bullshit. You tell it how it is, and I respect that”.

The words of another student:

“Young people shouldn’t be thinking of dying so soon. They should be just growing up, thinking about what they want to be, what jobs they want to have … that kind of stuff.”

Donal himself said:

“If I’m meant to be a symbol for people to appreciate life more in general, he said, then I’ll be happy to die, if that’s what I’m dying for.”

His father put it in starker terms.

“There is no comeback after death”.

The HSE’s National Office for Suicide Prevention (NOSP) adopted Donal’s message, rolling it out to schools, and embarking on a programme to educate young people on appreciating life before they considered dying by suicide.  It’s a good video. But as a strategy to tackle youth suicide, it is lacking. And it is here that the discussion becomes problematic.

There has been much debate raging online since the documentary was aired on the merit of Donal’s message. There is little doubt that it had resonance. It spoke to young people at their level, it moved people of generations older than himself and it made probably anyone who encountered it stop and think. It potentially saved lives. Was it worth saying? Yes, I think so. The phenomenon of suicide clusters and copycat suicides is well documented, and the theory that some suicides are decisions made, not after months of depression, but on the spur of the moment or as a knee-jerk reaction to a traumatic occurrence cannot be discounted. I can’t quote the prevalence of such happenings, nor am I sure what statistical evidence is there to back it up, given the difficulty of collecting such information on suicide. But I do think there was an audience for and a merit to Donal’s message. I’m not convinced we can argue that there was not.

But there are a number of things that are deeply alarming, both within the documentary, and in the way that Donal’s message has been perpetuated by adults almost as a universal truth. What is not acknowledged  is the fact that that this fails  – and fails utterly – to address the fact the suicidality is just not that simple, and that the factors contributing to any one person’s suicidal intent can differ greatly to the next. Suicidality is also strongly linked with depression. At no point in either the documentary or in the wider campaign has depression been acknowledged as an illness, has its nature been explored, nor has the fact that suicide is very rarely a decision made with a clear and rational mind.

No professionals working in the field of mental health were interviewed during the course of the documentary. No account has been taken, either within or outside of the documentary of the fact that a one-size-fits-all message is not an appropriate way in which to go about formulating a suicide prevention strategy – even a youth suicide prevention strategy.

There have been a number of pieces written in the past 48 hours on depression and suicidality from the point of view from those who have themselves been there , and I urge you to find them, read them, absorb them and think about them. The point has been made that we are now at a stage where people feel supported enough to be able to disclose their experiences, and this alone is evidence of the strides that have been made in this debate.

However, it is absolutely crucial to remember that there are two levels of understanding of suicidality. The understanding of those who have been there, and who have felt that despair, and those who have not. The latter, if they are serious about wanting to help to address this problem, need to take responsibility for learning about the state of mind in which a fellow human being  finds themselves to not want to exist anymore. From my own experience, it is born out of a desperation to escape a hellish existence in one’s own mind, where nothing exists but self-loathing, darkness and a sense of being trapped. When I felt suicidal, and contemplated dying, it wasn’t because I wanted to die. I just wanted to escape. I didn’t want to live like that any more, and the only way in which to achieve that was to stop living. To a healthy mind, that’s almost incomprehensible. There is no rationality involved in that particular state of mind. None. But I urge you, try to contemplate it.

Now picture someone telling you “Sure you’ve loads to be thankful for. There are people dying through no fault of their own and you want to kill yourself.” Consider how, in a mind full of despair, hearing those words would make you feel. Would you feel any better about yourself? Already, you can’t find anything to make you feel grateful for living (as illogical as it may be, but remember, there is no logic left). Now, the implication is that you’re selfish, too. Which, in turn, reinforces every negative thought you’ve already had about yourself, and increases that sense of self-loathing. How is that helpful? How?

Above, we had a student dismissing public discourse on suicide as “politically correct” and “bullshit”. This assertion remained unchallenged within the documentary. Suicidality is so complex. It IS delicate. We are still learning how to talk about it in a responsible way. Treating it with sensitivity is not politically correct bullshit. I have no issue with this young man saying it as he sees it, from the point of view of a teenager who has in all likelihood experienced suicide by peers. But I do have an issue with this viewpoint not being challenged by adults, or those who deemed the documentary an appropriate commentary on suicide. Again – it’s just not that simple.

So why, at no stage, has no-one in the public eye, the media, the health professions,  while this campaign has been running, and documentary been airing, strongly and explicitly acknowledged that this message, while extremely laudable in one sense, is absolutely not applicable to everyone out there who is contemplating suicide? Why has the negative impact that this message may have had on those in a depressed and suicidal frame of mind not been acknowledged?  Why are we consistently fed a strategy of soundbites that may resonate with some, but may alienate others? While NOSP claim that they had the input of a number of professionals in producing the Donal Walsh video on their website to ensure it was appropriate for young people, why did they not acknowledge the complexity of suicidality, the fact that each sufferer is dealing with their own individual struggle? They tell young people about the “value life” message, yet do not acknowledge the difficulties involved in doing so when struggling with a mental illness like depression.  This “scratching the surface”, one-size-fits-all approach doesn’t cut it anymore, and if anyone should be acknowledging that, it is one of the few – if not the only – public bodies currently tasked with suicide prevention.

The issues I raise in this post aren’t with brave, dignified Donal Walsh. They are not with his tremendously courageous and generous family and friends. I hope that is absolutely clear. They have lost a son, a brother, a close friend. They have given magnanimously of their time, their privacy and shared their grief with a nation, in order to spread the message of Donal’s courage and dignity. There is hardly a person watching RTÉ 1 on Wednesday night who didn’t want to put their arms around them and take their grief away, or could fail to be inspired by their appetite to inspire massive societal change, as evidenced in the setting up of Donal Walsh Live Life. Donal’s words – which his family explicitly acknowledge were said in anger, by a dying child who never claimed to be an expert on mental health – inspired a wave of emotion, and injected impetus into a conversation we are only starting to have at a national level. And for that, I am certainly grateful.

But they should not be perpetuated as an all-encompassing strategy, nor do they speak to everyone. It is now the responsibility of public policymakers, mental health bodies and organisations (starting with the Minister for Mental Health), medical professionals and indeed, ourselves as a mature, responsible society to continue that conversation, while striving to educate ourselves and others on the nature of suicidality, mental ill-health and depression in a meaningful way.

Soundbites aren’t enough. Platitudes aren’t enough. We’ve all heard messages at this stage like “talk to someone”, “get help”, “there’s always someone out there willing to listen”. They are just not sufficient anymore. We can’t just dump them out there and expect people in distress to find their own way.

Let’s look at this in real, practical terms.

If you were desperate, in the frame of mind where the only relief you could contemplate was not living any more, where would you turn? Who would you talk to? If you make the (difficult and brave) decision to “talk to someone” and seek help, where would you go first? Would you get the support you needed from your family? Friends?  Would your employer support you if you need to take time off? Would you even feel comfortable telling your employer? Would you receive the best advice on embarking on the path of medical support such as taking anti-depressants?  Would you be able to access the right therapy for you, with a therapist you felt comfortable with? Would your health insurer pay for you to get all the therapy you need? If you don’t have health insurance, how would you go about accessing that therapy? How long would you have to wait to access that therapy? Bear in mind here that you are desperate, and need help quickly. And not just any old help. The right help and treatment for you, as an individual, with individual needs.  If you dial 999 in the middle of the night, or contact an out-of-hours GP service, will you get the help you need?  We need these assurances.

What if someone came to you in desperation, telling you that they couldn’t cope with living any more, and didn’t know where to turn, would YOU know what to do? Would you know where to go to get help? Would you know what to say, what not to say, how to listen?

Make no mistake, this conversation is merely in its infancy. Donal Walsh and his family have played a huge part in building that conversation. This is not a battle for them to fight alone. What is the HSE doing to address the above questions? What is the Minister for Mental Health doing? What are you and I doing, as members of a mature society with a collective responsibility to each other other than repeating platitudes that make us feel better about ourselves? Are we educating ourselves on how to recognise the signs, how to react?

It’s time to stop paying lip service to suicide prevention, and start coming up with real solutions, fast.