AZPA Carefree Conference 2015 - Everything I Knew About Suicide Was Wrong
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David Covington slide deck from keynote on Zero Suicide principles at Arizona Psychological Association conference in October 2015.
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AZPA Carefree Conference 2015 - Everything I Knew About Suicide Was Wrong
- 1. BH Version 3.0: The New Operating System David w. Covington, lpc, mba Ceo & President, RI International, Inc. 0
- 2. Not a Healthcare Issue? Prominent suicidologists, argued successfully, albeit erroneously, that this is not a healthcare issue. They kept suicide out of the mental health Bible, the DSM, stating, “suicide is, by definition, not a disease, but a death that is caused by a self-inflicted intentional action or behavior.”
- 3. Is Suicide Really A Choice?A Vivid Memory
- 4. Pupils Dilate & Eyelids Widen
- 6. Is Suicide Really A Choice?
- 7. Depression is a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self — to the mediating intellect– as to verge close to being beyond description. It thus remains nearly incomprehensible to those who have not experienced it in its extreme mode. - William Styron
- 8. What I Didn’t Do…
- 9. I finally succumbed when all my strength was fully, completely gone…
- 10. Suicide Can Be Prevented. A. Never in Those Truly Intent on Suicide B. Sometimes, but Only in Advance of Acute Risk C. Always, but Only in Advance of Acute Risk D. Always, Even Up to the Last Moment
- 11. How Long Could You Endure the Ice Water…
- 16. Disease Transmission R Nought Measles Airborne 12 – 18 HIV/AIDS Sexual Contact 2 - 5 SARS Airborne Droplet 2 – 5 Influenza Airborne Droplet 2 – 3 Ebola Bodily Fluids 1.5 – 2.5
- 20. me too
- 23. Many, many more suicides can be prevented, but it will require… Healthcare systems must work together and within communities Utilize a systems approach to quality improvement Develop clinical pathways for direct care
- 24. Forbes Magazine 2010, “The Forgotten Patient” – Those at risk of suicide are pressed to the periphery of healthcare. © Koren Shadmi
- 25. Suicides are being averted every day around the world… but the effort is generally individual… not systematic. Kevin Briggs, Guardian of the Golden Gate Bridge
- 26. That’s also true in healthcare (many lives are saved)… but like the Golden Gate Bridge, far too many are lost. Greater suicide death risk relative to general population
- 27. The impact of patient suicide deaths upon the healthcare workforce is significant.
- 28. It is time… for healthcare leaders to aim for the bull’s eye on the challenge of suicide
- 29. This means targeting zero… which systems do every day around the world for other complex challenges.
- 30. None of our patients should die desperate and alone by suicide.
- 32. Adopt the mindset. Change the world. Zero is the only goal we can live with. Zero Suicide in Healthcare Atlanta Summit 2015
- 33. zerosuicide.comzerosuicide.org The Social Movement The HealthcareToolkit
Editor's Notes
- Despite the fact that the largest Ebola epidemic in human history was occurring and affecting multiple countries in West Africa. More than 25,000 individuals were diagnosed, primarily in Sierra Leone and Liberia. Fever and severe internal bleeding generally mean this disease is fatal, with more than 10,000 succumbing to the scourge including many healthcare workers. Not on our radar? All that changed on September 30th the same day the CDC announced that a 45 year old from Liberia, Thomas Eric Duncan, had been diagnosed… not thousands of miles away in west Africa, but while visiting family on US soil… in Dallas, Texas. He was treated at Texas Health Presbyterian Hospital in Dallas, and within two weeks, two nurses who had treated Duncan also contracted the infection. Our response? Well, we did what any self-respecting, intelligent, capable and thoughtful nation would do… we immediately…
- PANICK!!!! As a nation, we basically twirled around a few times and then went running and screaming, imagining a full-scale Zombie invasion and the total breakdown of society! The spread was uncanny fast- like nothing before seen- oh not the contagion, but the irrational fears. Yeah, those swept the nation! The Boston Globe reported that half of Americans (that’s us) were concerned that there would be a large outbreak of Ebola and more than one-third feared a family member would get sick. A teacher from Maine was placed on a 21-day leave demanded by parents because she had recently attended a conference in Dallas. And, no surprise, Time Magazine explained how a toxic mixture of fear and misinformation led to discrimination against African youth.
- However, Ebola did not hold exclusive claim to fear of contagion in 2014. After the death of beloved actor Robin Williams last August, there was a tremendous national dialogue and opportunity to get it right, to speak about the previously unspeakable. Instead, and oddly to me, the suicide prevention field received the most attention for its response to this tweet from the Academy of Motion Picture Arts & Sciences. We see Aladdin hugging the character voiced by Williams, saying, “Genie, you’re free.” This image was seen by over seventy million people. I don’t doubt this tweet comforted many people grieving the death of someone they felt they knew, but the tweet also prompted the Washington Post to express concerns about the dangers of infecting others through social media and the news. The New York Times reported that “suicide contagion is real,” and they suggested there was science to prove it. This idea argues that - repetitive or prominent coverage; - including the word suicide in news headlines; - talking about the means of suicide and/or - presenting death as an escape. The belief argues that vulnerable people exposed to this information will be impacted.
- Our response to Ebola was to run and scream… With suicide.. The consequences of a suicide-is-contagious approach…. is silence! Avoid the topic. Ignore. Last year we as a nation panicked when Ebola hit the ground in the US, going so far as to track a nurse on the news who had treated patients in Sierra Leone while she went on a bike ride. Debates about quarantining individuals who might pose risk to the greater population became the national dialogue. Suicide may be the last true stigma! It really doesn’t need help in this regard. Discrimination and stigma are associated with both. We want to quarantine, protect ourselves and our families and keep these diseases far away from the broader population.
- But, fear is not always based upon facts. What seemed to get lost in all this was the actual risk of contagion. Disease researchers use a basic metric to estimate how many people on average each sick person will infect. “[The basic reproductive rate (R nought)] is calculated by estimating the chances of exposure, number of susceptible persons, length of contagious period, how the disease spreads, and how much time passes between exposure and becoming contagious.” Using this scale, one of the most infectious diseases we know is measles, which is airborne and leads to infection on average of 12 to 18 people for every infected person. The December 2014 event at Disneyland is just now coming to a close, after it infected nearly 150 people in California and five other states. HIV/AIDS typically spreads to 2 to 5 other persons through sexual contact. The 2003 outbreak of SARS had a similar R nought impact. By contrast, Ebola, which is communicated only through bodily fluids and only while a person is showing symptoms, is much more difficult to spread, with an estimated reproduction of 1 to 2 persons on average. The goal of public health is to drive the rate of spread for any disease to below 1, which is the difference between it dying out or it becoming more widespread. These are simply the facts that we Americans missed- Ebola is not less serious than SARS, measles or influenza – it just doesn’t spread as easily as they do. In fact, it’s the least communicable of all well-known infectious diseases. Despite all the hysteria, only four individuals actually contracted Ebola on American soil.
- Suicide simply does not have an R nought. Suicide is NOT communicable in any way comparable to infectious diseases. Columbia researcher Maddy Gould has disproven the myth that the idea of suicide will infect someone who doesn’t have it. Think youth sex education. If we talk about birth control, we will give young people an idea they didn’t already have. Hmm. That’s not the way it works. And yet, researchers struggle with how best to describe the increase in deaths that can occur after a high-profile (and widely reported) death by suicide, or the apparent clusters of suicides that sometimes happen in small communities (think Malcolm Gladwell’s Tipping Point story of suicides in Micronesia). In this map, we see a cluster of four young girls who died by suicide within a very close time frame in small communities just outside Dublin, Ireland. The three large dots represent three girls who were just 13 and 14 and died within three weeks. A 17-year-old girl had died before Christmas. The girls all knew each other and had friends in common. So how does this occur?
- The three young girls who followed with their own suicides were just like us… they had encoded in their DNA a strong security system that has been evolved over millions of years that powers our fight or flight mechanism. Like us, they had two legs… given to us primarily to run away from danger. Two fists, to fight that we cannot evade. And, an amygdala in the brain that fires exceedingly strong fear messages to our mind and body to protect us from danger. Without these developments we would have joined the extinct long ago. It’s been a decade since Thomas Joiner’s “Why People Die by Suicide” gave the field a model to unify all others, explaining the key role of suicidal capability. Nine million Americans each year seriously contemplate suicide but most people simply lack the combination of courage and competency necessary to face down something as fearful and daunting as executing one’s own death. As Joiner says, the flight or fight to survive is in our cells and in our souls. Three girls all in unbearable (frankly unimaginable pain for those of us who haven’t been there)… Ashley Judd called it her own hell… that desperation does not carry with it the ability to end one’s life. Our life is bounded by a wall, and that wall has strong security systems, designed to protect us from whatever might threaten us, including ourselves. Yet, the question persists: If suicide is not contagious, then why does someone take their life only days after a fellow student, close friend, or revered media figure has?
- Perhaps the answer lies in my experience with The Spartan Race, a mudrunner event I participated in a few years ago. For the uninitiated, this race is like boot camp, Survivor, and a 10K, all rolled into one. Before this, I had never contemplated quitting a road race, but as I stood looking up at the unscalable wooden wall in front of me, I assumed this would be my first. I was only two miles into the eight mile event and I was totally spent, exhausted, having already dragged two 70 pound sandbags through an extended obstacle course and fought my way through deep trenches filled with thick, muddy water up to my neck. My arms felt as swollen as Popeye’s; my body limp. My first attempt at clearing the wall failed miserably; Ashley Judd’s wonderful doggie from yesterday might have had equal success to my own. Despair consumed me. Head down, I began looking for the exit when, out of my peripheral vision, I spied a middle-aged woman racing past me toward the wall. Undaunted, she threw her foot into the wall, catapulting her high enough for her fingers to grip the top. In the next instant, she flung a leg up and caught the edge with her toe, pulled herself up, and flopped over the wall. Gone. I’m a foot taller and have a runner’s build, yet she cleared the wall. Did I observe her technique? Yes. In fact, I replicated it exactly. But the most powerful motivator was not tactical; it was the sudden belief that I could now do something that only seconds earlier was unattainable. Prior to that moment, I desperately wanted to clear the wall, but knew I could not. Watching her do it, though, was like flipping a switch. My mindset changed and I cleared it easily on my very next attempt. People want to die when their deep anguish and belief that their life has no value intersects with an abiding loneliness that aches in the soul. The desire to die by suicide isn’t catching; it’s a response to intolerable emotional pain. The overwhelming majority of these individuals already stand in front of the wall, head down, wanting desperately to get over the wall, but assuming it is impossible. If someone had told me how to scale the wall, I’m not sure I could have. But watching it gave me courage. I knew I could do it. And, this is a very dangerous thing for those who are experiencing unbearable pain. Surely, skills are observable and techniques can be learned quickly, but what is truly contagious is courage. Believing it can be done because you witnessed it. “If they made it over, perhaps I can, too.” This is what frightens those in the suicide prevention field and what leads us to advocate for more thoughtful and careful media coverage when someone dies. When people die by suicide, others around them, also struggling with unbelievable pain, are suddenly at greater risk.
- “Me too” – Brene Brown has suggested that these are some of the most powerful words known to humanity. But, because of the silence… the courage that has most often been shared in our world around suicide has had to do with ending one’s life. But what about if? WHAT IF the stories people heard were about those who lived… about those who found a way to hold on a little longer… until the pain subsided… The Suicide Prevention field has invested a significant amount of time and effort attempting to eliminate negative messages and control media stories after someone dies. Maybe the strongest answer is to instead focus more on those who live. What if those examples were the ones more readily accessible to those in desperate pain? Ten years ago, those stories did not seem to exist at all… but courage has emerged! It happened at this conference with: - Dese’Rae Stage and livethroughthis.org - Craig Miller and Thisishowitfeels.com - DeQuincy Lezine and The Way Forward Report Eric Hipple, Heidi Bryan, Kevin Hines, Kita Curry, Cheryl Sharp, Cara Anna, Siloan Green, William Styron, Terry Wise, Sabrina Strong, Tom Kelly, CW Tillman, Leah Harris, Katie Ayotte, Ursula Whiteside, Marsha Linehan, Eduardo Vega and many others…
- That Measles outbreak that we talked about earlier… now – there’s a contagious disease, and it prompted a national debate over immunization. There’s a concept called “community immunity,” and it comes from a sufficient threshold of inoculated people in the herd (92% for measles). We can protect when we have it… and frankly… we have instead isolated individuals or forced them to stay in the closet. I just came from the annual American Association of Suicidology conference and it had only a few points of light in this regard for decades. Two years ago the Los Angeles conference became a safe place, and this year Atlanta became a BRAVE SPACE. It’s the stories of survival and courage that spread and infect and inspire and inspire a Zero Suicide philosophy...
- Courage spreads. It’s contagious! Help us get the news out. Give a voice to those with the lived experience of facing down unbearable pain, and surviving. What if we had understood the facts of Ebola? Maybe we would have avoided a national panic. Perhaps even the healthcare workers who contracted the disease would have been protected. And, what if… what if those three young teenage girls outside Dublin had heard someone like Dese’Rae Stage talk about how she found a way to cope. Perhaps they would have held on long enough to live. It’s time to flip the metaphor. I used the example of clearing the wall in the Spartan race, but each event ends with a jump across the fire. Let’s end the silence. Let’s share the message that suicide attempt survivors… survive. And, let’s start an epidemic!