By ERIC A. HOWALD
Of the Keizertimes
News of Anthony Bourdain’s death by suicide was the first alert on my tablet when I awoke Friday, June 8. What followed was hours, then days, of would’ves, could’ves and should’ves voiced by people who knew him well and those that didn’t.
I’ve written previously, and in hyperbolic fashion, about the hardest words to say in the English language, but time and experience are still teaching me that such difficulty is the direct result of context. When someone angers us, we have to find our way back to “I love you.” When someone we love is being abused, we need to silence doubt and say, “I believe you, and it’s not your fault.” When someone is under assault by their own mind and looking for a way out, we have to ask, “Are you thinking of killing yourself?” And then, if the response is “no,” ask again.
Under the right circumstances, each of those phrases is an oversized elephant in a claustrophobic room and knowing what to do when the moment arrives can be a matter of life and death. Unfortunately, we often wait until life doles out a hard lesson before seeking out what we might do to prevent tragedy. I’m weary of tragedy, in my personal life and in the more difficult aspects of my job. It’s why, less than 24 hours before news of Bourdain’s death broke, I was in Corvallis taking a class in mental health first aid for youth.
Developed in Australia, the Mental Health First Aid curriculum is now taught internationally and throughout the United States. It is a free, eight-hour crash course in what to do when someone you know, love, or barely know, is experiencing a mental health crisis. The course is offered occasionally in the Salem-Keizer community but more frequently in Corvallis and Portland. There are courses that focus on adults in addition to the ones that focus on youth as well as Spanish-language options. A full list of upcoming free classes in the area can be found at www.mentalhealthfirstaid.org.
I opted for youth curriculum because I’m the parent of a teenager and because I volunteer with a group of creative writing enthusiasts at McNary High School. I don’t want to be wondering what to do if confronted with a crisis in either circumstance.
Like most things in modern life, Mental Health First Aid has been reduced to an acronym, ALGEE. It stands for: Assess for risk of harm or suicide; Listen non-judgmentally; Give reassurance and information; Encourage professional help; and Encourage self-help and other support strategies.
Assessing is one of the trickier aspects of the technique because, as adults, we are given to chalking up out-of-the-ordinary signs and signals to teenage angst when darker forces might be at play. However, look for physical signs of distress like uncharacteristically high energy, binge activity, excessive crying or long periods of isolation in a bathroom or bedroom. Pay particular attention when those signs present themselves as wild swings in mood or interfere with motivation, appearance, or social abilities.
Listening non-judgmentally is another place where people tend to stumble. Responses to pain we cannot quantify typically fall into neat categories such as telling the person they are wrong to feel what they feel, trying to coach them up by pointing out the things they have going for them or being dismissive of the emotions at play all together.
Instead, maintain eye contact; reiterate what the person is telling you so they know they are being heard and understood. Ask questions about what they are feeling while realizing there are elements to mental crisis, like cultural backgrounds and experiences, that we, as first aiders, have no equivalent for. Acknowledge that what the person is feeling is real, and be empathetic and accepting even though you may not agree.
When giving reassurance and information, focus on hope without making promises. Remind the person that others have found healing and that assistance can come from any number of sources. Instead of telling a someone that “it gets better after [insert current life obstacle],” try telling them that their world is going to get bigger. Refrain from telling the person what they need to do or should do. Look for commonalities between your experiences and theirs. Talk about your experience and invite the person in crisis to talk about theirs and how the two differ. Don’t fixate on outward things like weight, injuries or substance use, try to understand the underlying issues.
Encourage professional help without trying to fix things. There are numerous local avenues for support ranging from hotlines to group therapy. Encourage the person to reach out to one of them. In addition to counselors, psychiatrists, and primary care physicians, social workers, drug and alcohol specialists, dietitians and certified peer counselors are options. The number for the National Suicide Prevention Lifeline is 1-800-273-8255 (put it in your phone contact list now).
Encouraging self-help means identifying the people or activities in the person’s life that might be of the most assistance. Help them explore activities that might bolster their mental health, like regular exercise. Engage family members as well as the person experiencing the crisis. The most important protective factor for a youth against a mental health crisis is feeling close to at least one adult. You may be that person or you might be able to help identify that person. Don’t underestimate your potential impact.
Despite all your preparation, the person you are dealing with may be at wits’ end. If you think there is a chance to intervene, ask the person directly if they are thinking of killing themselves. (You should practice this before you need to do it in person). It’s unlikely anyone has killed themselves because someone asked if they are feeling suicidal, the idea was already there, just unvocalized. If they say “no,” ask again. Someone might be able to shrug off the first inquiry, it’s harder the second time.
If they say, “yes,” ask if they have decided how. If they know how, ask if they’ve decided when. If they know when, ask if they’ve gotten the things they need pull it off. The more answers they have along this line of questioning, the closer they are to a suicide attempt. Be comfortable in silence while waiting for answers. Sit with the person while they talk to someone or until someone else arrives who can relieve you, but do not leave them alone if you believe self-harm or harm to others is imminent.
Finally, if you are concerned that harm is imminent and it’s beyond your abilities, call 9-1-1. You don’t have to walk someone through the whole process, but being there at the right time for the right person can make a difference even if it is only a short contact.
Please don’t take reading this article as a be-all, end-all training. The course takes eight hours to complete and it will leave you feeling better prepared, but there is always more to learn. Mental illness and mental disorders take varying forms and participants in my class were also given a free textbook that detail support strategies for many of them.
It would be disingenuous to think that we might prevent every death by suicide, but suicide rates in the United States have shot up 30 percent in the past 19 years, according to the Centers for Disease Control. Being prepared to have a difficult conversation with someone in crisis might help reverse that trend.