Reposted with permission from the American Association of Suicidology
On March 6, 2014, a historic moment occurred in San
Francisco. The first ever National Summit on Lived Experience in Suicide
Prevention convened – suicide attempts survivors, suicide loss survivors and
people representing mental health service systems came together to explore how
we can “light the way forward.”
The meeting was hosted by the Mental Health Association of
San Francisco with support from the Substance Abuse and Mental Health Services
Administration (SAMHSA), the National Action Alliance for Suicide Prevention (“Action
Alliance”) and the National Suicide Prevention Lifeline (NSPL). The goal of the
meeting was to open up an open and honest conversation about how best to move
the goals of the Action Alliance’s Suicide Attempt Survivors Task Force and
Zero Suicide Initiative forward with coordination and compassion.
The meeting began with Dr. DeQuincy Lezine sharing an
overview of the Suicide Attempt Survivors Task Force soon-to-be released guide
for how the suicide prevention field can best incorporate the “lived expertise”
of those who have survived their own suicide attempts.
The guide underscores
the importance of real-world wisdom that people gain through surviving and can
share with others to guide best practices in research, treatment and prevention
efforts. A main message of the document is to include attempt survivors in all
areas of suicide prevention – as leaders and in critical masses. In addition to
covering key policy, practice and program suggestions, Dr. Lezine described the
core values of the task force:
- Inspire Hope, find meaning and purpose
- Preserve dignity, counter stigma, stereotypes
discrimination
- Connect people to peer supports
- Promote community connectedness
- Engage and support family and friends
- Respect and support cultural spiritual beliefs
and traditions
- Promote choice and collaboration
- Provide timely access to care and support
Next David Covington from the Zero Suicide Initiative shared
the concept and practices of this high priority focus of the Action Alliance. The
Zero Suicide Initiative is a “commitment to suicide prevention in health and
behavioral healthcare systems aligned with a specific set of tools and
strategies. It advocates for a systematic approach to improve outcomes and fill
gaps to relentlessly pursue a reduction in suicide death and calls for visible,
vocal and visionary leadership. Additionally, the initiative strives to develop
of a competent, confident and caring workforce within behavioral health.
“We believe that suicide is preventable always, up to the
last minute,” said Covington. “Let’s create a suicide deterrent system.”
Most of the conversation over the course of the day centered
on how these two groups could reduce the fear each has about the other. Suicide
attempt survivors expressed fear about being misunderstood, stigmatized, and
punished in many forms when trying to access professional care. Mental health
providers have fear about not knowing what to do, about getting sued, and about
having someone “die on my watch.”
The dialogue continued through the morning and encouraged
both groups to look forward and find ways to improve collaboration and
understanding. Here are some moving sound bites:
·
“People need to know they can disclose suicidal
thoughts and that they will get help, not get punished,” Shari Sinwelski,
National Suicide Prevention Lifeline
·
“Every attempt survivor should define the
support network for himself or herself.”
·
“Emergency care providers need to improve
practices to preserve dignity of people in the middle of a suicide crisis.”
·
“Most clinical care work is focused on assessment
of risk; we need to shift this focus to collaborative care,” David Covington
·
“The problem is clinicians don’t feel safe and
they don’t know what to do,” Shari Sinwelski
·
“To start with a place of assessment creates
disconnection,” Leah Harris, National Empowerment Center
·
“Stop assessing the symptoms. When we do that we
are working from a deficit model rather than a strength model. Rather than
creating a treatment plan create a hope plan and assess for that. Find out what
brings meaning and purpose and create a plan for that,” Tom Kelly, Magellan
Health Services of Arizona
·
Tom Kelly, “I haven't had a suicide attempt
since 2001. Since then I became an advocate, and I developed meaning and
purpose.”
·
“How do we fill the middle gap in services when
people are not feeling home provides enough support but don’t need inpatient
care? Peer support can fill this gap. Right now the system is insufficient – we
just evaluate, medicate, vacate,” CW Tillman, Consumer Advocate
·
“Let’s build a strengths-based approach – rather
than ‘what’s wrong with you’ shift to ‘what happened to you.’ Let’s provide trauma
informed care. Change some primary assumptions,” Leah Harris.
·
“The concept of Zero Suicide is really
transformative. I like the fact that people react so strongly to it,” Eduardo
Vega, Mental Health Association of San Francisco. “We can take the outlandish
out of the picture by saying our goal is that no one in this building kill
themselves today. Then we can expand to ‘can we work to stop suicide in this
town this week?’”
·
“The field has talked too much about the
difference between suicide attempt survivors and those who die by suicide. The
intrapsychic experience is the same,” Covington
·
“Over the decades, individual mental health
clinicians have made heroic efforts to save lives but systems of care have done
very little,” Richard McKeon, SAMHSA.
·
“People who go through training for suicide
prevention get increased confidence and change culture within a system. People
become less afraid and are more likely to reach out,” Becky Stoll, Centerstone
·
“Suicide prevention has not been informed by
peers who have experienced the agony and decision making. They can provide
support that can be magic,” Eduardo Vega.
·
“Suicide attempt survivors should not just be a
token presence in the conversation of how to prevent suicide. If have 25% each
of researchers, care providers, loved ones at the table, we also need 25%
attempt survivors. Critical mass offers meaningful input. Like 32 degrees.
Below water freezes, above water is just cold,” David Covington
·
“How do we infuse recovery oriented perspectives
– a spirit of optimism – in systems of care?” Leah Harris. “How do we focus on
what’s strong rather than what’s wrong?”
·
How do we reframe safety from something that is
more about the clinician’s need for assurance to something that’s more about
connectedness, hope and meaning?
The meeting concluded with a brainstorming session on key
messages to promote the goals of these two groups and how we might best
invigorate the field around these goals. The following list of ideas emerged:
·
Establish partnerships and communities of
support
·
Move beyond fear to optimism
·
Introduce behavioral health professionals to
people’s stories of hope and recovery and show the value, “your experience can
help me help other people”
·
How do value peers in suicide prevention work?
We can pay them well and identify them as leaders/professionals
·
Let’s move behavioral health systems from
precontemplation to contemplation and get them to think about, “Maybe the
system doesn’t work”
·
Attempting suicide didn’t destroy my life; it
transformed it.
·
Sometimes when things make you angry you pay
attention. Language matters.
·
Crisis is an opportunity. If in the middle of a
transformative moment you are punished, it stops the process in its tracks.
·
Coercion is system failure.
·
People don’t send you flowers and cards when you
are in the hospital for a psychiatric condition.
·
“Continuity of care is really about not giving
up on someone,” John Draper, National Suicide Prevention Lifeline
·
“When we create system change, don’t bolt it on,
bake it in. Change will only last as long as there is energy around something.
When it is bolted on it won’t stick; baked in means here to stay,” David
Covington
·
Board members and other leaders for behavioral
health organizations can act as secret shoppers by visiting behavioral health
care as undercover bosses. This experience can be eye opening.
·
Ask suicide attempt survivors, “How can we
celebrate your survival?”
·
“I am not a lost cause. I am a person.”
The meeting closed with a round robin discussion of what
people were taking away from the Summit. Many tears were shed as people
disclosed the momentous opportunity created by the shared understanding that
commenced on that day.
