APA 2019 Main Stage: Ursula Whiteside on Suicide Prevention

So that really was the perfect note on
which to end that first conversation and the perfect segue to someone I’d love to
have you hear from next I want you to please welcome dr. Ursula Whiteside and
Ursula is clinical faculty at the University of Washington and CEO of now
matters now.org and Ursula is going to share her perspective as both a
researcher and a clinician and she’s really going to deepen our dive into how
we can use data to improve and strengthen your clinical work so please
welcome Ursula in 1999 I’m 20 and I’m sitting at my rounded desk and my really
blue office in Marshall enhance research laboratory and I’m on the phone with a
woman who’s in her late 40s who runs her own business in Seattle I’m going
through the questions I’m asking her when was the last time you had a suicide
attempt and how many suicide attempts have you had and her monotone responses
really don’t convey any emotion if she is having any emotion when we get to the
end of the call after me consistently being on the edge of maybe too perky as
many as thus are at that stage in our career when we get to the end of the
call I asked her her scheduling her appointment there’s anything else that
she would like to tell me before we get off the phone what she says after a long
pause is if you could just take the phone receiver and put it on your desk
so I could hear you type I would feel less alone and without hesitation I did
that I was one of marsha linehan students the the director of and
developer of dialectical behavior therapy and we were taught to be
fearless and at least fearlessly compassionate if
nothing else but as I went through my graduate training when I did my work
outside of the research lab it was more in a training that created more fear
over time I lost some of that fearless compassion and replaced it with worry
about other things I don’t know if others of you have had similar
experience of becoming more afraid over time
it’s certainly true for me what do we do with that fear because we know that it’s
getting in the way of our best work with our patients that’s what they tell us in
anyway so I start with asking questions and the question that I find useful in
the situation that I’ve learned from people who’ve been there is what is it
like to be unseen like if you have ever actually been in the situation where
something was really important and painful and it was not recognized or
maybe even worse it was you were told that it wasn’t true and this really fits
into the story of suicide when you think about those who are at highest risk when
you think about our trans youth who who when people don’t use their preferred
name are a greater risk for suicide or when you think about our native and
black partners who have experienced such injustice in the history of our nation
that could never fully be recognized or seen or what if it’s the miner in
northern Minnesota who’s about to be laid off from his job and is going
through a divorce and feels like this society is rejecting him being unseen
contributes to suicide and as we become more anxious in our sitting with
suicidal patients we also become less able to see them as they truly are ten
years later I’m at the University of Washington working with patients who
have on clinical internship who recently attempted suicide and I’m working
desperately to get them into some kind of mental health care much less
dialectical behavior therapy and they’re like desperate for help and we are
failing our health system is failing and at that
time I experienced suicidal thoughts myself in part due to the experiences
there it it isn’t so much that we aren’t there it is that we don’t necessarily
know what to do and 20% of people who die by suicide saw a mental health
provider in the month before their death and nearly 50 percent saw a primary care
provider so we have a funnel we have we have a way to find people and to work
with them and in 2011 2012 a new approach to suicide and health care
arose and it’s called the zero suicide approach have you ever heard of zero
suicide if you haven’t I’m so excited to tell you about it it is the first ever
approach to suicide in health care that was a line item in the president’s
budget so first in Obama’s budget and then now in the current president’s
budget this is recognized by our federal government and there’s funding and Samsa
CDC NIH and the American Foundation for Suicide Prevention all support this
approach but what it is is helping health systems prevent people from
falling through the cracks it’s a systemic systems approach what this
approach led to is something called the recommended standard of care so never
before in the field of suicide had there been standard guidelines national
expectations for what to do and can you imagine if you’ve shown up in the
emergency room and you were experiencing cardiac symptoms or symptoms of a
cardiac arrest and if there weren’t a standard process
in place how insane would that be if that were the case well the same that
actually is true with suicide that there was no standard of care clear
expectations across health care settings about what do you do when someone’s at
risk for suicide so in 2018 in April national standards were released and
essentially what they are is the minimum standard of care for work with patients
who are suicidal and they provide three expectations
evidence-based approaches that we all should be using so if you haven’t heard
of recommended standard of care think of this how great it is is it that you
could have national recommendations that you could rely on that if you followed
you could say I’m following the National recommended standard care guidelines and
not only are these supported by the the Commission around suicide prevention the
National Coalition they’re also supported by organizations like the
Joint Commission who do accreditation for health care organizations so what
are they again they’re the minimum so they are asking the question identifying
who’s at risk there are safety planning including lethal means assessment and
their follow-up caring contact there are all things that we know can help prevent
suicide when we’re talking about screening and assessment Jane mentioned
earlier the patient Health Questionnaire what we know about the last item on that
question which asks about suicide is that it is as good or better a predictor
of suicide attempt as cholesterol scores are of heart attack so you can use that
imperfect non-proprietary tool to identify who in your practice might be
at greatest risk for suicide and those would be people who are saying more than
half the days or nearly every day I’m having those thoughts with safety
planning you’re creating a plan for people to follow the steps to take for
what they should do when the when the urge hits them and there’s no reason why
you couldn’t put DBT skills in a safety plan and then finally you’re doing the
follow-up with caring contacts at the same time as the zero suicide approach
was coming up Marsha Linehan came out in the New York Times in 2011 about her
suicidal experience and she talked openly about this and I remember her
saying she was terrified as she was absolutely terrified although you would
not be able to tell that from the outside when she was speaking about it
and her wish now when I visit her on Saturday mornings is that people know
how to go about doing this her memoir comes out early next year and
essentially this – if I can do it you can do it and and
here’s how I did it this is what she’s most passionate about
at this point in her career so stories like marshes and especially Marceau’s
led the way for many people to come out about their own suicidal experiences and
the field of suicide has completely transformed because of this and gotten a
lot better I would add one of the things it helped create was something called
now matters now org this is a free public resource that was funded by the
National Institutes of Health or NIH and the American Foundation for Suicide
Prevention and it was created by and with people with lived experience of
having suicidal thoughts they were consultants they were paid
consultants in the same way you would pay any other advisor or collaborator on
a research study and what it is is that stories of how people got through
suicidal times using strategies from dialectical behavior therapy it’s a
video based tool and as a leader creator of this website what we recently
published is a finding that people who report suicidal thoughts while visiting
this website including those who say that they are completely overwhelming
have reductions in those suicidal thoughts in under 10 minutes so it’s a
free public resource intended for you to provide to patients so they can get a
little bit more information about how to cope with suicidal thoughts using an
evidence-based strategy in the work that I do training providers in how to work
effectively with suicidal patients across the globe I do these 6-hour
trainings but when I have my team or a team now matters now the group of people
who advise the development of that resource when I have them review the
content that I’ve developed what they say is yeah Ursula great you can talk a
lot six hours is a long time but if they leave and they they don’t know these
three things then you really haven’t succeeded so what they say is what’s
most important to them when they’re going through a suicidal time are these
three things and that is that you don’t panic
your present and you offer some kind of hope and one way that you can offer hope
providing a caring contact card so underneath your seat or on your seat was
a card and that is a caring for you to use as a caring contact and a caring
contact card is a way that you can communicate expressions of care support
and hope hope being really key in addition one of the things that we
learned from people with lived experiences that some people have an
overwhelming urge to die that arises very rapidly they didn’t wake up with
him and so we haven’t really developed interventions for what to do in that
situation except for to call a crisis line but what people are describing is
that that state is so uncontrollable that it’s really difficult to think
clearly and that reminds us of when you’re on fire physically it’s very
difficult to know what to do and if you didn’t you would run through the halls
screaming if you were on fire physically but what if we learned what to do when
you were on fire emotionally from when we were children what if that went right
alongside that we had steps to take so we we crowd-sourced a drop a stop drop
and roll we ask clinicians we ask people lived experience we asked crisis for
sponsors responders these are the three steps you can learn more about them and
now matters now org that we came up with one includes dunking your head in cold
water there’s a great video on the now matters
now website so there were two themes in the last 20 years that I found working
with suicidal patients training clinicians and what those are is that we
often feel powerless and afraid because the problem feels so big and that
patients find simple things helpful well the four percent of Americans seriously
consider suicide in in a given year we need to get on our game what I’d like
you to do now is just take a breath and pull out that car that’s under your
chair or that was sitting on your chair it may it may look like this it may just
be a card and if you don’t have one look harder
but no if you don’t have one send a text message to someone we know that carrying
messages at least four people who are really really suicidal our associations
with reductions in suicide there non-demanding expressions of support and
usually they my guidance around these is that they say something about I see how
strong you are or I have hope for you or I’m looking forward to seeing you again
I’m looking forward to seeing you again I have hope for you I see how strong you
are putting something like that in the context of a message for somebody who’s
suicidal is such a simple thing and and there’s research just to suggest that
that could prevent suicide so I hope you’ll consider some of these simple
things as you move forward today and write a caring message either to a
friend to yourself or to a future or current patient thank you so much for
your time today

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