Wrapping up Spring 2021!
Since our last newsletter, The NAN Project has continued our virtual presentations to students, educators, and community groups throughout Massachusetts. As we near the end of another school year, we’re proud to say that since March 2020, our team has provided programming to 2,837 students and 1,585 adults that support them! While we’re hopeful that next year’s presentations might be done face-to-face, we wanted to take a moment to recap the incredible work The NAN Project Team, and our Peer Mentors have done over Zoom – from their bedrooms, living rooms, and kitchen tables!
MASCA Conference The NAN Project team presented one of our professional development workshops at this April’s conference of the Massachusetts School Counselors Association (MASCA.) The workshop, titled, Building Resilience in the Shadow of COVID covers our tried and true strategies for the months of transition ahead. In total, 65 educators and counselors from all over the state tuned in to watch our presentation, which offers practical tips for both educators, counselors, and the students they serve!
La Colaborativa This spring, TNP had the opportunity to create connections with many communities and student groups. Interns from La Colaborativa’s Mental Health Internship program completed targeted micro-internships for mental health organizations, including The NAN Project! These interns attended our Peer Mentor presentations and received QPR Suicide Prevention training, then got straight to work creating materials to promote our programming to their school administrations – see them below!
These interns opened the doors to Chelsea High School and Excel Academy, and we’re looking forward to working with these schools, and the greater Chelsea Community, more in the weeks and months to come!
QPR trainings for DPH & Eliot This year, our team has offered a total of 18 Question,Persuade, Refer (QPR) Suicide Prevention trainings for employees of Eliot and the Department of Public Health, with more on the books for this spring and summer! It has been a pleasure to work with so many professionals, and to offer QPR as a refresher course for the critical skills the training offers. One audience member reported that, “The webinar was engaging and showed how to directly apply what we learned in our specific workplace environment.” We’re thankful to receive such positive feedback, and look forward to the trainings to come!
PD for Lawrence The NAN Project is excited to take its first steps into the Lawrence Public School System! Last week, we provided our Professional Development workshop, Building Resilience in the Shadow of COVID, to over 200 educators and faculty serving Lawrence High School. Our team were described by participants as “honest, helpful, and succinct” while offering “great content and helpful strategies.” One educator shared learning “that we are not alone in what is happening with our students.” We couldn’t agree more! Thank you Nelson Butten, Caitlin Gilligan, and Principal Victor Caraballo for making this new partnership possible!
This spring, we’re excited to see our partner schools taking steps towards ‘normal,’ as many students return to their classrooms for the first time. As students, families, and educators reflect on a strange school year, and prepare for the fall, we know mental health will be on their minds – and The NAN Project will be there to start the conversation!
Peer Spotlight: Manny Hernandez
Could you tell us a little about yourself?
I am from the inner-city of Lawrence. Growing up in my community was a beautiful experience, but it was also very challenging. My mom is an immigrant from the Dominican Republic and I am a first generation American. Coming to the States was what she dreamed of, to be able to provide for me and her family. Over the years we’ve overcome some extraordinary challenges and met a great number of people who were willing to give us a hand.
What made you want to work as a Peer Coordinator for The NAN Project?
During my first year of Community College, I met an amazing mentor. He taught me so much about the struggles my community and I were facing and why it’s so important to overcome them. I was inspired to learn more about social services and community work. I was determined to help others build connections and maybe become a mentor myself someday.
What strategies do you use to deal with your own mental health?
When people learn about my mental illness I often get “nah, you don’t got that.” As if I am supposed to look a certain way if I say I struggle with psychosis. I gladly, reply back and say “well, what do you know?” Mental health is something that can affect anyone. Sometimes the struggles we go through push us to unhealthy coping mechanisms and not everyone you meet is willing to talk about these things. The truth is, if we were more accepting and more open as a community, we could break down many barriers for individuals in need of service.
What is an example of something you did to help a student or a friend?
Whenever I talk to friends about their challenges, I come from a mindset of curiosity. I simply want to learn. Most people have the answers they’re looking for somewhere inside of themselves. By having a conversation with them and being open, vulnerable and non-judgemental, much of what they’re searching for can come to the surface.
What hopes do you have for your own future?
I think someday I’d like to write a book on my experiences. I believe that it could truly help someone who is struggling with psychosis understand that there are other people out there who’ve been through it too.
What commitments do you have for the year?
This year I am focusing on one thing. Finding healthy ways to cope and be a better resource to those who may be searching for an answer.
What do you like to do in your free time?
Some of my interests include sports. I love playing basketball with friends I’ve made through work. It has been a great way to meet people and get to know the Greater Boston community better. Some of the folks I play with also have jobs in which they’re giving back. Knowing that I am surrounded by individuals who care about the kids is truly rewarding. Hopefully in the future we can collaborate on projects together and do some awesome things.
What advice do you have for our Peer Mentors?
One thing I always say to myself is “We gon’ be alright.” Kendrick Lamar couldn’t have said it any better. We have seen some amazing obstacles in our lives. But, as long as we stick together as a community we gon’ do just that.
Peer Mentor Spotlight: Alison Sabean
This month, The Nan Project would like to highlight Alison Sabean in our Peer Mentor Spotlight! Alison has been working with us for almost two years now, and her story leaves her audiences with a message of hope. She has presented her story numerous of times to schools all across Massachusetts! Thank you Alison for being apart of this Peer Mentor Spotlight!
Hi Alison! Thank you so much for taking the time to speak with me. I was wondering if I could start off by asking you how you heard about The NAN Project, and what made you join!
Hi Elli! Thank you for interviewing me! I heard about The NAN Project when I participated in a young adult program through The Department of Mental Health called GIFT. It stands for Gathering Inspiring Future Talent. Through that program, we all had a common theme of having past histories with mental health challenges that want to get back into the workforce. GIFT had a partnership with The NAN Project, so that’s where I heard about it, and the rest is history!
I decided to join because I was really struggling to hold a job and I felt like this was something that I was meant to do. I am really passionate about telling my mental health story; being able to do it AND get paid is a dream come true!
What have been some highlights/rewards you’ve gained working with us?
One of my biggest highlights was definitely speaking at the Night For NAN. I was really flattered to be asked to speak after working only less than a year with the project. I think it really speaks to me feeling accepted by The NAN Project, and it was a feeling I never felt with any other job.
I think another thing is a highlight is just presentations in general and really getting deep and speaking to the students, talking with faculty, and being able to educate people. I also like being able to meet some really cool people through working at this job.
What was your most meaningful presentation and why?
Definitely speaking at the Night For NAN and specifically because it was an opportunity I’ve never had before. I found it really meaningful to speak to a room full of almost complete strangers, considering there were so many folks who attended the Night For NAN. It boosted my self esteem as well. Also, the Night For NAN is such a meaningful event for The NAN Project, so it felt really good to be chosen to speak at a night dedicated to the project.
For readers who don’t know your story, what are some coping skills you’ve learned over the years to take care and overcome your mental health challenges?
There have been a lot of different coping skills I’ve learned over the years and I use different skills for different situations. I think my main coping skills that I use are playing with my cat, expressing myself by doing art, writing/journaling, and physical activity when I can. I also consider coping and taking care of myself by taking my medication on time, going to regular doctor appointments and therapy, and making sure to keep up with all my requirements.
What are you grateful for?
I am definitely grateful for The NAN Project for giving me a way to be employed. I am also grateful for my family and friends for being supportive throughout my mental health journey and now my physical health issues. I am also grateful for my cat Iris. In 2020 I started my masters degree in social work, so I am grateful to be able to be a part of their program at Boston College.
I know you talk a lot about your cat Iris, can you talk a little bit about her and why she’s so important to you?
Yeah! So I had a cat since I was in the third grade and he lived until he was 19 years old which is pretty impressive. We had to put him down and I was pretty devastated over it. I was really heartbroken after we put him down, so I kept begging my parents to let me get another cat and they finally caved! My cat, Iris is such a joy. It’s kind of interesting how animals react to mental health situations. I know she needed me just as much as I needed her. We are inseparable, to the point where she follows me everywhere around the house! She’s a cutie and I love her so much!
Aw I love that! Iris seems like such a great companion to have! The last question I have is: do you have any advice for students who may be struggling, especially during this crazy time during COVID.
I’d say that if you’re struggling, definitely reach out to someone. Whoever it may be, make sure it’s someone you feel comfortable with. Keep up hope that things will get better. There have been a lot of times where I’ve lost hope and something good can come my way. I also think that if you are in therapy or getting help in some way for a mental health issue, don’t give up. Just remember that you can do this and there’s so much more life to live than struggling with your mental health challenges. Maybe you won’t overcome it, but you will learn how to manage it, and live with it.
Thank you Alison for having this interview with me! I loved hearing a little bit about your life and how much you’ve overcome over the years.
Thank you so much Elli for interviewing me!
Presentations to Medford Senior Class
Each of our partner schools is using a unique blend of in-person and remote learning this year, which means all of our presentations have been adjusted to their scheduless to best accommodate our student audience.
This December, we had the opportunity to completely reorganize our typical presentations while working with the senior class of Medford High School. Our capable team ran three activities for students simultaneously, rotating students each week for a total of nine sessions.
In all, we reached over 250 students!
The Presentations:
Screening of 13 Reasons Why We Need to Talk About Suicide:
Executive Director Jake Cavanaugh and Senior Peer Mentor Andrew Christopher screened vignettes from our 13 Reasons Why We Need to Talk About Suicide series. These videos dramatize some of our core curriculum, and offer some engaging visuals that our remote learners definitely appreciated! The Depression and Anxiety vignettes show a fictional, but honest, portrayal of young people experiencing these mental health challenges, and describe how common symptoms may look or feel for students. These videos are a great jumping off point to discuss some of the signs and symptoms of anxiety and depression, in a slightly different way than our Comeback Stories. Jake and Andrew also lead a discussion around our Coping Strategies video, where some of our own TNP Peer Mentors describe their self-care techniques!
Creating a Self Care Toolbox: Peer Coordinators Elli Peltola and Shilpa Thirukkovalur lead students in an interactive, hands on activity focused on creating a Self Care Toolbox. The activity taught students about different types of self-care, such as physical self care, or spiritual self care that, together, create a well rounded set of skills that can be used across different scenarios – like a toolbox! Shilpa and Elli reported a lot of great interaction in the chat with students, discussing different self-care activities they are doing during the pandemic as well as how their self-care has changed.
Stress relief was a popular topic, and students recommended going on walks and spending quality time with their dogs, cats, and other furry friends. Sounds like a good idea to us!
To check out the activity Elli and Shilpa used, check out Virtual Hangout #10 in our Lesson Plans for educators!
Peer Mentor Presentations:
Clinical Director Donna Kausek and Peer Coordinator Lizzie MacLellan lead our Peer Mentor Presentations to students, using two breakout rooms to create smaller, more personal groups. Peer Mentors shared their updated Covid Comeback Stories, which focus on the strategies and supports they’ve found most helpful in managing their mental health this year. Students were so appreciative of these stories, and asked some thoughtful questions about the challenges our Peer Mentors discussed. Medford was the first student audience for some of our newest training graduates, but you wouldn’t known that from how skillfully they handled the fast-paced Q&A!
That’s four Nan Project presentations running all at once! This strategy was unique, but it allowed us to keep each presentation group small and interactive as our in-person programming. Most students made use of the chat feature to share their reactions and questions, and we were so impressed by their curiosity and insight. Though these students have had a strange senior year, we’re hopeful that this knowledgeable bunch will continue their conversations about mental health through the rest of the school year.
Our Peer Mentors once again rose to the challenge presented by remote learning, as they have all year! We’re excited to return in 2021, and to work with underclassmen in the future!
The NAN Project’s End of Year Recap
End of Year Recap
The NAN Project team has been super busy this school year with our Peer Mentor presentations, professional development trainings, and parent presentations. Since the beginning of this school year, we have presented for 16 schools to over 1,350 students and 770 caregivers, parents, and community stakeholders. That’s a total of 2,120 folks! While most of our presentations were to high school students, we really expanded our audience this year with a successful rollout to middle schoolers and parents. We recently finished up a round of presentations at Beverly Middle School and their students were so excited to talk with us. They asked our Peer Mentors questions about their stories and shared their own experiences and coping strategies. The conversations were enriching for both the students and our team. Check out what Beverly’s teachers had to say about us:
“Speakers were fantastic, love the new addition of the self-care kahoot, great education around strategies to help.”
“I thought it was great. Super well organized. I loved that you had 3 speakers and I think it was 3 others as well [to answer students’ questions]. It felt like you set it up for safe conversation. The speakers chimed in when students were more quiet making it conversational. “
What Does a Typical Middle School Presentation Look Like?
Three of our Peers present their COVID Comeback stories,which talk about how their mental health has been affected during the Pandemic and what strategies they are using to take care of themselves. Between each Comeback Story, we have a discussion with the students about warning signs they noticed in the story, the importance of reaching out to a trusted adult, and different self-care activities they could try. Every class has a guidance counselor come in to talk about their role and the mental health resources available in the school, so students know they have a trusted adult available if they need to talk. We’ve added a self-care Kahoot, which is a virtual trivia game , to engage students and make presentations more interactive.
Parent Presentations
We’ve also had big turnouts and lots of positive feedback about our parent presentations! Because we are doing everything virtually this year, our trainings have become a lot more accessible for busy parents. Schools have told us that parents they haven’t had any contact with all year have come to our events. One of our popular trainings is called Building Resilient Families, where our knowledgeable trainers go over different strategies to help families adapt to challenging situations and bounce back. We also provide many resources including hotlines and websites with mental health information. Since parents and families are a really important source of support to young adults, we are so happy that we’ve been able to connect with them more in the past few months.
We look forward to continuing our work in the New Year. We hope everyone has a healthy and safe holiday season!
My Anxiety and Self Image Got Weird in Quarantine
By Sarah Dickie
When I was first laid off from my receptionist job in March due to COVID-19 (with the promise of unemployment insurance), I was relieved.
I have social anxiety. I’ve struggled in environments my peers find ordinary – restaurants, waiting rooms, birthday parties, or really anyplace with unfamiliar people. My heart would beat faster in line at Starbucks as I rehearsed my order in my head. I would worry excessively about what others thought of me, especially those I was just meeting. I would examine what I say, how I sound, how I hold my body. I would decide it was all wrong; that nobody liked me, or could like me. I’ve struggled with disordered eating, partially due to poor body image. At the intersection of these anxieties, I found myself practicing obsessive grooming; always seeking reflective surfaces, or avoiding them; refusing to take pictures, or eat in front of others.
In this stage of my life these behaviors manifest much less often, and I can cope with them when they do – though sometimes I still struggle.
If you think this sounds exhausting, you’d be right. Given the shame-spiral I have historically been prone to in the company of others, it may come as no surprise that I’m quite introverted. (Is it a feature of the anxiety, or a true personality trait?) I spend plenty of joyful time with friends and loved ones, but at the end of the day, I recharge best in the company of myself. I had dreamt of shutting myself in, opting out of being perceived, only to venture out for food – and suddenly, when the lockdown began in March, to live like this was public safety. It was recommended. I breathed a sigh of relief – I could take off my carefully curated, public-facing mask for a while.
There was dissonance between the apocalyptic scene around me – desolate parking lots, entire strips of shops closed and darkened in broad daylight, shelves upon shelves emptied of toilet paper and disinfectants – and the relief I felt, privately, it seemed. I saw time stretch in front of me: day after day to do whatever, whenever, an indefinite vacation from the comfort of home, with no one to bother me and no one to judge me. I indulged in anti-productivity: I watched TV, I played video games; I danced around in my sleepwear. Sometimes I just did nothing. I got weird; I spoke out loud to myself, and made unintelligible noises just to hear them. I stayed up into the night and slept far into the day. I took my time eating breakfast. I smiled at myself in the mirror. I liked being alone – I liked me, if I wasn’t worried that others might not. I ignored calls and texts from friends and loved ones – social connection was no responsibility of mine anymore.
Summer came, though I never really felt it. My comfort in quarantine morphed into a maladaptive super-isolation, dissonant now with images online of folks flooding beaches and restaurants. Nothing tethered me to the passage of time. By August, I was outright avoiding speaking with family and friends. Conversation seemed too exhausting. I sent so many I miss you! texts, and ignored the responses. I couldn’t make sense of this myself, so I’m sure friends couldn’t either. I dreaded answering a how are you? – I didn’t know. I hardly felt present in my body long enough to assess that. I wasn’t moving much – maybe from my desk to the kitchen to the couch – so my own body felt foreign to me; it felt heavy. I was dissociating frequently. I scrolled endlessly through social media, absorbing bad news and others’ anxieties; engaging with others only superficially through “likes”, but never in real conversation. A voice in my head thought I might be struggling now, and it might be time to reach out for support – but I didn’t feel real, and I couldn’t imagine that other people were, either, if I couldn’t see them. I had unlearned object permanence. I had become so forgetful – what day was it? Had I eaten?
I showered only to replace old sweatpants with clean ones. I didn’t bother with my hair, or with makeup. I didn’t care how I looked. The NAN Project teaches middle and high school students that similar changes in hygiene habits can indicate poor mental health. Pre-pandemic, I was someone who found joy in fashion and hair; someone who was known in my social circles for my style – but in COVID-era isolation, I gave up on these things. Was it still a bad sign if my life was so different now? Was my obsession with appearance better than not caring at all? If I had nowhere to be, no one to see, did I still have to make the effort, or else have it mean something? It didn’t make me feel better not to get dressed.
In October, I asked myself another tough question: how did my body image change when no one was around to see me? How did my opinion of myself change when I was alone?
Now, in November, my pandemic unemployment assistance has long run out, and I am preparing to return to full-time, on-site work. I am afraid. All the anxieties I’ve worked so hard to quiet have reared their heads again. Will I do a good job? Will I make a fool of myself? Will people like me? I will make use of coping strategies I’ve learned and practiced pre-pandemic: grounding exercises, journaling, art as self-expression, seeking love and reassurance. There are some things, though, I cannot as easily cope with, like the fear that re-entering the public sphere will render me vulnerable to contracting COVID-19. How much of my fear of others is warranted now, to keep me safe? How much of it must I challenge in order to grow?
There is no right way to respond to this health crisis. (Except for wearing your mask and engaging cautiously with others in person, if at all – please continue to do these things.) No matter how you feel, you are not alone; no matter how strange your emotional responses, or the ways you’ve found to adapt, you are not alone. If you are overwhelmed by loneliness, or by fear, if you feel you are moving backwards (and then forwards, and then backwards) in your recovery journey, if you have asked yourself some heavy, existential questions – me too. Keep in touch with the people who lift you up and calm you down. Remember to remain present and take care of yourself in any way you know how. I am trying to remember, too.
A Night for NAN 2020
Due to the Covid-19 Pandemic, The Nan Project will not be holding our annual fundraising event, A Night for Nan. However, we know the need for suicide prevention and mental health education is more important than ever.
The Nan Project team prepared this video to thank you for your ongoing support, and show you how we’ve adapted our programming to reach students, educators and parents in this challenging year.
Until we can be back in schools again, The Nan Project will continue its work through every possible platform.
We hope you will consider donating to The Nan Project in support of our work, and we look forward to seeing you next year.
Grief Ripples Out, But So Does Hope
Trigger warning: this post discusses a suicide attempt.
In September of 2000, 19-year-old Kevin Hines attempted to take his life by jumping off the Golden Gate Bridge in San Francisco, California. He had been struggling with paranoia, hallucinations, and depression, he had been diagnosed with Bipolar disorder, and he had been convinced that he was a burden to all those who loved him. He saw only one way to escape his pain.
Still, just as he launched himself into free fall, Kevin felt instant regret.
God, please save me, he thought. I don’t want to die. I made a mistake.
Statistics show that one person goes to the Golden Gate Bridge to attempt suicide every 7 to 10 days, with over 98% of these attempts being fatal. The bridge has been nicknamed “the suicide magnet of the world.” It is estimated that only 26 people have survived the jump, one being Kevin Hines. Most will say they felt the same regret as Kevin – they didn’t really want to die.
For twenty years since that day, Kevin has dedicated his life to using his story to inspire hope in others struggling with mental health challenges. Suicide: The Ripple Effect offers a glimpse into Kevin’s life before and after his jump, chronicling his world-renowned career in advocacy and motivational speaking, and his personal journey through mental health and healing.
On the day of his suicide attempt, Kevin’s father came to see him in the hospital. Through heavy sobs, they immediately apologized to one another. Kevin recalls the conversation for Marcus Butler, a retired US Coast Guard officer who came to his rescue that day, as the two float under the Golden Gate bridge in a small motorized boat.
“Both of our immediate reactions for what I did there,” Kevin laments, looking up at the bridge, “Was guilt.”
Guilt, followed by rage and fear. Later, Kevin recalls how much rage his suicide attempt had sparked in the people he loved; he recalls the pain and the grief all around him. He once asked his father, years after the jump, if he still feared Kevin’s death by suicide. His response? Every time the phone rings.
“My actions did that,” Kevin laments. He imagines his father’s intense anxiety as he feels his cell phone buzz in his pocket.
It’s true that Kevin’s suicide attempt brought much grief into the lives of his loved ones. It’s true, too, that his survival, and his willingness to share his story, has inspired so much progress in mental health advocacy and in the lives of countless struggling people.
Among the many dedicated advocacy workers Kevin meets throughout the film is one crisis line counselor in Georgia, who happens to be a big fan. He had heard Kevin tell his story at a pivotal moment in his life.
“You saved my life, man,” he says earnestly. The two share a long, warm embrace.
Kevin has also inspired Christy Frecceri, a trauma nurse, to speak at conventions around the country about Golden Gate Bridge jumpers. She tended to Kevin in the hospital following his suicide attempt. She was shocked to read Kevin’s chart and discover what had happened to him.
“I hadn’t ever thought of such a thing in my career,” she says to Kevin, remembering that fateful day that changed both of their lives. She hopes to use Kevin’s story to educate other nurses about caring for a patient who has experienced physical and mental trauma.
“They call that the Ripple Effect,” Kevin says, smiling down at Frecceri’s presentation notes.
Likewise, Kevin’s father Patrick Hines became involved with the Bridge Rail Foundation, a non profit organization dedicated to erecting a suicide deterrent barrier along the Golden Gate Bridge. It is personal for many participants, having lost a child, a spouse, or a friend to suicide by bridge-jumping.
“They’re not going there to die in front of a beautiful bridge,” says Kevin of the bridge-jumpers, “They’re going because of a four-foot rail; because it’s easy.”
Most large buildings and high public attractions have suicide barriers – the Eiffel Tower does, as well as the Empire State Building – but the initial proposal to install such a structure at the Golden Gate Bridge was met with criticism. Patrick Hines says the main reason was preserving the bridge’s beauty. Still, according to the Bridge Rail Foundation’s blog, suicide deterrent structures will soon be installed at the Golden Gate Bridge.
Experts interviewed throughout The Ripple Effect emphasize that restricting access to physical means is just one piece of the prevention puzzle. We also need to change how we talk about suicide, and how we support one another in our journeys to mental wellness.
David Covington, President of American Association of Suicidology, criticizes our culture for waiting until we lose a struggling individual to suicide to talk about it.
“I think we have many, many more examples of people who’ve found a way to survive, to cope, to find supports, and in some cases even thrive,” says Covington, “But we’re not telling those stories.” He expresses his admiration for Kevin, who has used his survival story to touch other struggling individuals, and give them the hope to choose living. “I think there’s a huge opportunity as we talk about stories of survival to support people who are out there who are in pain,” Covington says.
Kevin Hines knows that hope is not an action plan, but it is a necessary starting point.
“If you can give a hopeless person hope, they can turn a corner,” he says. Now Kevin is equipped with the emotional tools and the loving support he needs to manage his symptoms, though his Bipolar disorder has not gone away. He is seen throughout the film sharing embraces with his wife, father, and friends.
“He actually goes through something — whether it’s mania, or depression, or paranoia, or suicidal ideation — something, every day there’s something,” Kevin’s wife, Margaret Hines, says of his life now. “But because he is taking care of his wellness, he manages it so well. He has a support system — me, our friends, our family — and he knows that he’s always in a safe place.” A mobile phone video plays of Kevin, formally dressed, dancing in the aisle of a pharmacy.
Though Suicide: The Ripple Effect engages with some heavy subjects, it is not a somber film. Kevin Hines teaches us that some good can come out of the trauma and tragedy of suicide. We feel the “ripple” of suicide for better and for worse: a whole community grieves one fatal attempt, but one recovery can inspire hope in so many struggling people. The Ripple Effect is an earnest, tender, enlightening watch — and Kevin hopes that it’s the beginning of a movement.
“No matter the pain you’re going through today, or the people you love are going through today, they can have a better tomorrow,” says Kevin.
To learn more about suicide prevention worldwide, visit the Ripple Effect web page here.
Rent The Ripple Effect on iTunes or Amazon. See Kevin tell his story for Buzzfeed here.
You Are Not Alone: What Local Experts Want You To Know About Suicide
Last Friday, The NAN Project Peer Coordinators Lizzie MacLellan and Shilpa Thirukkovalur sat down to speak virtually with Mayor of Cambridge Sumbul Siddiqui and psychiatrist Dr. Camilo Acuna from the Cambridge Health Alliance about suicide prevention, mental health, and COVID-19. Broadcast live on several social media channels, this conversation with local experts was meant to destigmatize mental illness and recognize the role each individual can play in preventing the suicide of a young person as part of the city of Cambridge’s Suicide Prevention Month efforts.
Mayor Siddiqui explains that the importance of this conversation is even more critical now: as we enter the seventh month of the COVID-19 pandemic, many of us are experiencing heightened anxiety and worsening depression due to social isolation, financial instability, and health concerns. Some of us may be experiencing these symptoms for the first time in our lives. The Center for Disease Control recently reported that a quarter of young adults ages 18 to 24 have seriously considered suicide during this pandemic.
When asked to weigh in on the impact of COVID-19 on young folks’ mental health, Lizzie refers to what we call “risk factors,” attributes or traits that make a person more likely to consider suicide. Lizzie explains that certain risk factors have been heightened by the pandemic, such as loneliness, aimlessness, and instability — especially for high school students, who are missing out on certain rites of passage and other coming-of-age experiences, now that many schools have gone remote. Lizzie also explains that the behavior of a person at risk might look different in COVID-times. The NAN Project teaches students to look out for a friend who is isolating from others. While we are all isolating for our physical safety, this might instead look like not showing up for virtual hangouts, not answering phone calls or texts, or an uncharacteristic absence from social media.
Lizzie advises viewers to look out for drastic changes in mood, behavior, or appearance, and to reach out right away to a person displaying these warning signs of suicide.
“Ask the question,” Lizzie insists, and what she means is it is vitally importantto ask a young person directly if they are thinking about suicide if you notice some of the warning signs. Most untrained individuals are hesitant to mention suicide to a young person in their life, for fear of putting the idea in the person’s head. The NAN Project teaches students that asking about suicide will instead give the struggling person an opportunity to open up about what they are feeling, which is the first step to getting support. The next step, Lizzie advises, is to take that information to a trusted adult.
On identifying a trusted adult, Shilpa says this is simply someone who makes the young person feel heard, validated, and safe. For Shilpa, this adult was her father. In a case where a young person feels uncomfortable to bring up a mental health concern with a parent, Shilpa suggests approaching a teacher, a coach, or the school guidance counselor.
Therapy is something this trusted adult might suggest. Dr. Acuna discusses the myriad of telehealth options available during the COVID-19 pandemic. He says he is surprised how many young people have found this mode of therapy helpful — maybe because it is less intimidating for a youth to try therapy from the comfort of their bedroom, rather than in the unfamiliar environment of the therapist’s office. Of course he notes that teletherapy comes with its own accessibility issues, such as young folks not having access to a stable internet connection or a private place to talk.
Mayor Siddiqui asks her guests to suggest how LGBT youth and youths of color might go about finding a therapist who fits their needs. Shilpa says that while there aren’t enough therapists of marginalized groups, it is important for young people to find a therapist who respects their identity and their culture.
“It’s not something you should compromise when looking for care,” Shilpa says. “Many therapists are still learning, and are willing to educate themselves – as long as the respect is there.”
“It’s something the field still needs to work on,” Dr. Acuna agrees. “There’s a long legacy of racism, of misogyny, of homophobia and transphobia in the medical system, and mental health Is certainly not an exception, unfortunately.” Dr. Acuna advises young people to feel empowered to change providers until they find someone who makes them feel safe.
Given the undeniable importance of mental healthcare, the speakers emphasize that you don’t have to be a mental health professional to support someone at risk for suicide.
“Suicide prevention is something we can all do – you don’t have to have all the answers,” Lizzie says. A young person supporting their friend can make a call for them to a suicide hotline or a mental health professional, walk with them down to the school’s guidance office, or simply be with them while they make their own plan to reach out to an adult. Further, we can all educate ourselves about the signs and symptoms of a mental health concern, as well as work to become more comfortable discussing mental health.
Lizzie uses the example of someone with a broken arm: people would show sympathy, help them carry their bags, ask how they’re doing or what they need — without judgement.
“Mental health and suicide don’t have to be different,” she says.
Mayor Siddiqui and her guest speakers leave viewers with an important message: if you are struggling, you are not alone, you are cared for, and help is available.
The full video is available to watch here.
ED-SAFE: A Study in Suicide Intervention
Original study by Edwin Boudreaux, Carlos A. Camargo, Ivan Miller, & “the ED-SAFE investigators.”
As we continue to learn from home during this strange fall semester, The NAN Project brings to you a quick bit of suicide prevention science.
The ED-SAFE study, published in 2018 by the Massachusetts Department of Mental Health, echoes some truths about suicide prevention that The NAN Project brings to high school classrooms: 1) the first step in suicide prevention is detecting risk; 2) persistence is the key to supporting a person at risk; and, 3) intervention led by the person at risk is most successful.
ED-SAFE began in 2009 in response to a critical need for a suicide risk screener for patients in emergency departments. Suicide is the tenth leading cause of death in the United States, with one million people per year attempting suicide. Many individuals at risk for suicide are seen in emergency departments (“EDs”) for unrelated concerns. The ED-SAFE team argues that these are underutilized opportunities for suicide risk screening, and that to prevent suicide, ED-based screening and intervention for suicide risk must be developed. ED-SAFE aimed to test an intervention in which emergency departments screen for suicide risk using a standardized test, and initiate follow-up telephone contact with individuals who screened positive.
1,376 adult ED patients were enrolled in this three-phase study, the third of which produced the most enlightening results. Phase three had testing sites implement a three-component intervention for patients who tested positive for suicide risk: first, a second screening to determine the level of risk; next, a personalized safety plan, with a guide to local outpatient mental health resources; and lastly, a series of phone calls to the patient by trained mental health advisors for a full year following the initial ED visit.
It should be noted that treatment was not assigned to the patients (beyond check-in calls), nor were they pressured to comply with a treatment they had no part in developing – it was the patients’ decision to reach out for help using the provided resources. We know that it empowers the struggling person to lead their intervention, and that they are more likely to stick with a treatment they initiated.
Results of ED-SAFE’s phase 3 showed that universal suicide risk screening within emergency departments almost doubled suicide risk detection. We know that identifying a person at risk for suicide is the first step in preventing suicide. The NAN Project teaches “signs of suicide” in our classroom presentations and professional development workshops, enabling young people and the adults in their lives to recognize these signs in their loved ones. ED-SAFE also found that the multifaceted, long-term suicide prevention invervention tested in phase 3 reduced suicidal behavior in patients by thirty percent. Persistence is key when supporting someone struggling with thoughts of suicide: this communicates to them that we care. The NAN Project highlights this in our QPR suicide prevention training, in which we encourage participants to ask a struggling person “the question” – namely, are they thinking of suicide – and to be sure that they follow up later on.
The results of ED-SAFE demonstrate that a multi-component, persistent, patient-led suicide intervention is most successful. The research team predicts that their efforts will inform and accelerate the adoption of best practices for suicide prevention across diverse health settings, which would save countless patient lives.
The official Psychiatry Issue Brief on The ED-SAFE study can be found here.
As we work to become better supports to ourselves and the people in our lives, let us keep these findings in mind. And remember that there is help, and there is hope!