LivingWorks Transcription: Episode 3
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Podcast Episode 3: “Young People and the ‘S’ Word” TRANSCRIPTS
Welcome to A World Where LivingWorks, stories of science and survival bringing together our heads and our hearts to build a suicide safer world, talking openly about suicide is so important but we also recognise that listening to this series may bring up some tough emotions, if so please talk to a trusted family member, friend, or local support service about how you are feeling.
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This podcast is brought to you by LivingWorks, a network of local suicide first aid trainers in your community and communities around the world. Visit livingworks.net to find out how you can play your part in suicide prevention.
KB: You’re listening to A World Where LivingWorks and I’m your host Kim Borrowdale.
First of all I’d like to acknowledge the traditional owners of the lands we are meeting on today from whatever beautiful lands you come from across the world, and also like to acknowledge the lived experience that people bring to this suicide prevention, so the personal experiences of suicide and the pain it brings to our lives but also the drive to make a positive difference.
Today’s episode is all about suicide prevention in schools, how can we safely and effectively build suicide intervention skills in young people, what have we learned about doing this in schools, and what about those around young people, how do we support skills development in teachers, parents, carers.
I’m talking today to Associate Professor Jo Robinson at Orygen, an Australian youth mental health organization, where she leads a program of work focused on youth suicide prevention. Jo has also undertaken evaluation of the efficacy and acceptability of the safeTALK program for secondary school students, welcome Jo.
JR: Hi Kim, thank you.
KB: Also with us today is Kathleen Snyder Senior Training Coach of ASIST, training for 31 years and a safeTALK instructor. Kathleen has a Masters of Social Work, is a Law Enforcement and Community Chaplain and is the California representative with Living Works education, supporting more than 500 trainers in that region, thanks for joining us Kathleen.
KS: My pleasure.
KB: So first of all, I thought we could tell our audience a little bit more about you, your professional background, your organisation’s focus on suicide prevention and mental wellbeing, and just a bit more about your why, so how did you come to be here today talking about this subject? Perhaps we could start with you Jo.
JR: Sure, so I’m Jo Robinson and I work at Orygen which is a combined sort of research and clinical service that operates across North and West Melbourne but we also have sort of a National remit when it comes to things like advocacy and policy and training and those sorts of things. We offer a clinical services to young people aged 12 to 25 across our catchment area and we also have a integrated research centre, which does research into kind of all sorts of different things that effect young peoples’ mental health and wellbeing, so mood disorders, early psychosis, substance misuse and suicide prevention and I guess I have been at Orygen now for sort of 15-16 years and growing the research group from an n-of-1 when it was just me, to a team of about 50 staff and students and we have a research program that spans all sorts of settings, I suppose, where we interact with young people, so we do lots of work in clinical settings, so we’ve got work going on for example in GP Primary Care settings, in Emergency Departments, we do a lot of work around online safety when it comes to suicide prevention with young people, so how to enable young people to have safe conversations about suicide online and on social media platforms and we’ve also got a big and expanding program of work in schools and that’s kind of partly in schools across our clinical catchment area but we’ve also done bits and pieces of work in other settings as well and in schools I supposed in other parts of the country.
KB: Great, fantastic, thank you for that background, and Kathleen, tell us a bit more about your professional experience in this area.
KS: Thank you. I have been privileged to be a part of LivingWorks training since February 1989. I was a volunteer with Sacramento Suicide Prevention following the death of my husband, a couple of years after I lost my husband to suicide, I started volunteering.
I became their youth suicide prevention coordinator and then there was this opportunity, LivingWorks came to California, it was the first place outside of Canada, and they wanted two people from every county to become trainers and so the county I lived in, I became one of their trainers, fell in love, and had the privilege of being trained by the developers, I’m so glad, Richard Ramsay and the whole team of developers.
And it was just an amazing, amazing experience and so, going out and talking to people about suicide, helping to empower them to have conversations that they feel like this is not this dirty ‘S’ word and to then to feel better equipped to have that difficult conversation with somebody, we get rid of some of those myths and so that has been just profound to me, those ‘aha’ moments that people have and then I’ve been privileged enough that LivingWorks got a contract through, it’s called CalMHSA [California Mental Health Services Act]-it’s a 1% tax on millionaires and so back in 2011, LivingWorks got a contract to support bringing more trainers into California which is why we have such exceptionally high numbers and then support them and then support the counties, we have 58 counties in California.
So as they’re developing suicide prevention strategies, as they’re being impacted by losses and they are not quite sure what to do, we will have conversations about where they are at, figuring out what it is that they might want to do and work with them without trying to sell them anything because most of our counties have trainers, but even the trainers get overwhelmed, and then this pandemic has caused a lot of grief, but the providers, they’re meant to be helping the community and they’re grieving as well because this is a whole new thing to be able to do telemedicine and therapy long distance, so I’ll call just to see how they’re doing and they’ll break down in tears, so I think having a friendly voice, I think my graduate degree, I spent far more of that as a trainer supporting people than I ever would have done in private practice.
My why about suicide is, my grandfather died by suicide before I was born, when my mother was young. My mother attempted when I was the same age she was when her father died, and then I lost my husband to suicide, so it has been many generations and when I read the early research, not online it was on paper, back in the 80s, I started to see that my family was at risk and wanted to figure out how to break my family’s coping mechanism and to see what I could do to reverse the trends that were taking place in my family. So I had to look and read and research and learn what I didn’t even know and it has been quite a journey and I’m happy for the gifts that came out of the tragedy, I don’t like the tragedy, I wish that no one had to go through it, but yet I’m grateful on the other hand for what I have learned about myself, what I’ve learned about people who are struggling and the hopefulness for someone who - because I didn’t want anyone else to go through what I went through, sadly they do and I can come alongside of them, which is where I also serve as a Chaplain.
KB: Thank you, Kathleen. Thank you for sharing your personal experiences, I know many of us come into this space with our own experiences and as you say, wanting to stand alongside people and find a way to not only to understand but also prevent other people from experiencing that, so thank you.
KS: My pleasure.
KB: So, in terms of the young people in communities, perhaps it might be helpful to, you’ve both got a lot of experience working with young people, is to talk a bit about what we know in relation to suicide prevention and young people in terms of risk factors and protective factors, we will talk a little bit about suicide prevention in school settings and what we know about that.
But I thought it might be good for our listeners to hear a little bit about what we already know from young people themselves and the work that you’ve both done, what that experience is like for them and what, as you said Kathleen the coping mechanisms and tools and skills that we can help young people to utilise when it comes to managing their own wellbeing.
Jo, I know Orygen works with a lot of young people and are really driven by their experiences. What can you tell us about the things that you’ve learned, about the risk factors and protective factors?
JR: Yeah so, I guess talking to young people about their experiences and what they think the problems and solutions are, is probably part of Orygen’s DNA, I think it’s what you call our core business and I guess the perspectives that we’ve got is probably come, and certainly the things that drive our work or underpin the work that we do come from a couple of different perspectives I suppose, one is the research literature, I’m a researcher so I can’t help myself but to go off and find out kind of what does the evidence tell us and what does the literature say about what the key risk factors or protective factors are or the drivers that lead a young person to a suicidal crisis and then the other side of things is what young people tell us themselves, so I think probably there are a couple of things to say really.
I think one of the things that we know, one of the key risk factors for a young person finding themselves in a suicidal crisis is the presence of mental ill health, we know that the majority of young people who do end up taking their own lives have a mental health problem of some form, whether that is diagnosed or not diagnosed, there tends to be many young people who die by suicide will be in contact with services, they’ll have a diagnosable disorder, often depression or anxiety, something like that, often other disorders like Borderline Personality Disorder and those sorts of things are very common in young people who tragically take their own lives.
We also know that there are a lot of young people from different types of studies that we’ve done, that do have probably what we would call a diagnosable disorder or signs or symptoms of mental ill health but might not necessarily have been picked up by mental health services. So it’ll be a lot of young people who would be out there struggling in the community but aren’t getting help for a whole range of reasons and that might be because they haven’t yet worked out that they need help, so they haven’t sought help and there are lots of reasons for that. It might be because they’ve tried to get help and help hasn’t worked very well for them so again one of the things we do at Orygen, we’re very driven by service reform and we design a service system that meets the needs of young people, so that is able to respond to young people in a way that they may want to be responded to, when they want to receive support. Unfortunately, I think we do know that lots of young people that seek help don’t necessarily get it so we’re kind of very driven by trying to improve that experience for young people.
I think that presence of mental ill health or mental disorder is a big deal, we also know that one of the other key risk factors that we see is previous suicide related behaviour so that we know if a young person has engaged in a previous suicide attempt or engaged in self-harm that’s a key indicator, I should say as a potential for future risk, again for all sorts of different reasons and one of the things that we spend a lot of time advocating for is the fact that if a young person does find themselves in a suicidal crisis or engaging in suicide attempt or self-harm and seeks help, that they get the help that they need and we know that all too often, young people particularly young females I think who engage in self-harm type behaviour and they might try and reach out and seek help, don’t necessarily get help that they need for all sorts of reasons associated with stigma and shame and judgement and perceptions about what self-harm means across the community but again we spend a lot of time advocating that if a young person is engaging in self-harm and certainly expressing suicide risk but they get the help that they need because that does place them at higher risk in the future and it’s an opportunity for intervention if you like.
But there are all sorts of other things that I think that lead a young person into a suicidal crisis that might not necessarily be related to things like psychiatric problems or past self-harm and you know there are things like interpersonal crisis, lifestyle stresses, and we are living through a pandemic at the moment, so lifestyle stresses are very high for young people, there are high rates of kinds of feelings of anxiety or people are anxious about things like employment opportunities you know, or they might be struggling more at school than they would usually. We know that interpersonal conflict, like trouble with friends or partners or parents and those sorts of things, can often tip a young person into a suicidal crisis when they might not necessarily have those coping skills or problem solving skills to manage those difficulties in an alternative way.
I think there are lots of reason why a young person finds themselves in a suicidal crisis and they can often kind of happen together and I think that none of those individual risk factors or what’s the best way to say it, I think it doesn’t mean if you’re feeling or experiencing any of those things that you are automatically going to find yourself in a suicidal crisis, but many people that do are experiencing those sorts of difficulties, if that makes sense. And they can act cumulatively, so what you might have is a young person that has been living with depression or anxiety for a long, long time and managing that reasonably well but that then might get overlaid by what we might call sort of more proximal risk factors like periods of conflict or particularly adverse life events and lifestyle stresses and then taken together those things might tip someone into a crisis point, if that makes sense.
KB: Absolutely, and similar to what we know in many ways about adult life stresses and the combination of those as well so it’s interesting to hear about young people and thinking about what sort of problems solving skills and coping mechanisms they’ve got and what we can learn across different age groups.
JR: Yeah probably the other thing that I might add is that you know that we do know that young people who have survived traumatic past experiences, you know, whatever that might be, so that might be childhood abuse and those sorts of things might be more vulnerable and the other thing that I should have said is that young people who have been exposed to the suicide of somebody else are also quite vulnerable to suicide. We know with young people that they are quite susceptible to what other people are doing and they do learn a certain type of coping strategy if you like, we do know that exposure to suicide of a family member, you know, reflecting back on your story Kathleen and you know that young people who have been exposed to a suicide of a parent or a friend might be particularly vulnerable and will need some additional attention and some help bolstering some coping skills so that they have different resources up their sleeve, if you like, when they have a tough time but we also do a lot of work in looking at, you know, how we might interrupt that cycle for young people who might be exposed to suicide or suicide related behaviour in a friend or in a peer, how we can sort of identify that they might be vulnerable and offer them some alternative strategies.
KB: Great, thanks Jo. And Kathleen what would you like to add in terms of your experience in relation to young people and people around young people?
KS: I appreciate all that Jo was saying and I find it quite fascinating because if we pull out the DSM which is what we use in the States, I’m not sure what diagnosis materials or tools. Many people have a diagnosable mental health issue, majority of people have a diagnosable mental health issue, I don’t sleep well, so I would be in the DSM.
Many people, most people function, in some form or fashion with whatever their mental health issue diagnosis is and yet there are those many as Jo said, never have been diagnosed who are struggling. What we know is that person perception of pain, whether it’s pain that’s physical pain, mental pain, psychological pain, Ed Shneidman coined the term ‘psychache’ back in the 1960s, that psychological ache that is so deep and so profound and feels untouchable and one thing for us as parents, if I can speak to them for a moment, sometimes we share a lot of our successes but we haven’t necessarily shared with them where we failed epically and how we got through that epic failure and I think if we could help young people understand, ‘oh you blew it, it feels awful and I’m so sorry you’re in such pain and let’s get through this together and then when we are through this, I’d really like to talk about my epically failed event and the people who came alongside of me so that I could get through it too because I didn’t see a way out and they helped me see it and if you let me help you see it through.’ Some ways that might be able to help because I don’t think what we know about suicide is most people do not want to die, they want to make the pain go away and they want to live but they don’t know how to live with the pain and so if we can help them figure out, yes this is a moment in time and maybe that moment in time is months, maybe for some people that moment in time is years that they’ve been struggling, if they can let us and that’s hard sometimes to let someone in because they’ve been betrayed because they’ve had false promises, any number of reasons but if they’ll let us in and sometimes it’s, well you know, I’ve had so many promises before and no one helped, it sounds like you’ve been really disappointed, I’m wondering if you’ll just try one more time and you’ll allow me to come alongside of you and it’s going to be hard and messy, kind of like you clean out your closet and you have this huge mess before you figure out what needs to be tossed, what needs to be kept, what needs to be donated, we can do that with our own personal crap, if I can use that term and get rid of that crud that we are carrying around because we are so afraid of somebody seeing it or judging us because who knows what they’ve judged us for, I think if we are able to help them understand, we didn’t get through it because we’re altogether, my blessed mum who has since passed but she used to tell my daughter, ‘oh your mother got straight A’s’ and my daughter would come in and I’m like no dear one semester I got straight A’s because it was easy that semester, I didn’t get straight A’s, I struggled like everyone else, it’s ok, where you are is ok and I would like to help you get to where you want to get to and I think if we are able to help parents understand, we’re able to help the young people understand.
I’m 63 and I can assure you I have never had an employer ask me what my GPA was, what is your Grade Point Average, no one asks that and yet kids are so bound up that they have to get the highest grades to get into the best college, you can get in by some of your community involvement, you can get in by other things, helping parents understand that, helping young people understand that, that there are other ways to get through this world, we need the garbage collector and we need the mechanic, we need the cook as much as we need the doctor and the psychologist, we need them all and sometimes I think we forget and we start cherry picking who should have this degree, who should have that, instead of allowing them to be the artist, the dancer, whatever it is that they’re gifted at and helping to cultivate that.
KB: Great point, thank you Kathleen.
In terms of schools and the pressures and you talk about grades and Grade Point Average and things like that, we were discussing about suicide prevention and mental wellbeing in schools and if school is a place of pressure as well as support, how do you use that setting as a place where you can support young people to do the peer support or stand alongside each other plus have the teachers and parents stand alongside them.
I’m interested to know, Jo, from the research side of things, what does the evidence tell us about the school setting as a suitable place to, you know, it’s the environment that young people are in for long periods of time every day but I understand that the dichotomy of pressure and support, what does the research tell us about suicide prevention in schools?
JR: Yeah, I think it’s a really important point actually. I think young people more and more are under so much pressure to perform, I see it now with my own daughter and certainly with the young people that we work with, it feels very different to when I went through the school system, where it kind of - I hate to say this, certainly someone who is now an academic, you know, but where it didn’t really seem to matter and you kind of just scraped by and we were really mostly driven by just getting a good enough grade to get to Uni so we could get out of home and away from our parents and those sorts of things and it didn’t feel like there was quite so much pressure and there was quite so much competition as there is now, so I really do feel for some of the young people that we’re supporting in terms of that drive to get the best grades and Uni places are so hard to get and employment is so hard, home ownership feels so unachievable for young people these days, I do think the pressures are very different and a lot of those pressures are cultivated come from home and a lot of them come from school settings themselves. But I think probably, certainly going back to what we know from the research is that schools are an excepted place to do suicide preventions - increasingly we’re seeing a lot of suicide prevention activities and research programs operating in school settings.
We did an activity a few years ago were we looked at suicide prevention policies, here across Australia but also around the world and most policies identified young people as a vulnerable population that needed a particular kind of response and most policies identified schools as a key setting for intervening and supporting young people, when it came to suicide prevention activities, I suppose. I would say definitely schools are seen as an acceptable place to conduct suicide prevention activities. I think there is a range of different types of activity that are important to deliver in schools which range from kind of those types of activities that really focus on building resilience and building coping skills, so that young people are better equipped to cope with life’s stresses, whatever they may be but they range right through to then sort of all pointy end kind of interventions for young people who are presenting at risk of a suicide, I think there is a range of approaches that are now acceptable in school settings.
I mean there are probably a couple of things to say, certainly there has been a little bit of a shift, I think, as to what I can see in terms of willingness to address suicide directly in a school setting and to actually use the ‘S’ word, Kathleen as you referred to before, there is a real issue around the language that we use when it comes to suicide and the willingness to talk about it openly and that’s been really pervasive in schools but I do feel there is a little bit of a shift and I’m happy to talk a bit more about that actually.
But I also think the other thing that we do see in schools settings and certainly what the research tells us, is the most effective programs that operate in schools tend to be these multifaceted programs. Often we apply a public health kind of framework to suicide prevention activities, where you’ve got universal kind of activities that target whole populations regardless of their level of risk or propensity to risk, then you’ve got selective interventions which might target your gatekeeper, your teachers or the school counsellors or might kind of serve to better detect young people who may be feeling vulnerable to suicide and target them and then you’ve got your indicated intervention or targeted interventions which are directed at young people who are already showing signs of risk of suicide and certainly what the research tells us, is that research programs that target each of those levels, if you like, tend to be the most effective, so where you’ve got, for example an education program and we’re doing some work around this in schools at the moment, which I can speak to if you would like, but you know, for example, a program where you’ve got a universal intervention where you are perhaps providing education to all school students around identifying vulnerabilities or risks in themselves or boosting resilience and those sorts of things, generating mental health awareness and education, those sorts of programs combined perhaps with a case detection type intervention where you are then identifying young people who might be vulnerable to suicide and then providing some support or referral for those young people.
Those sorts of programs when operated or when delivered kind of in a combined way, tend to be the most effective and the most acceptable to young people and to school staff and we’re testing a program like that at the moment, I should say, pre-COVID we were testing a intervention that operated a bit like that and that’s where our work with safeTALK kind of started a few years ago, so that’s our universal intervention where we are delivering safeTALK training or we will be once we’re allowed out of our houses again, when we deliver safeTALK training to all school students, regardless of risk but in our attempt to evaluate that and make sure it’s working for people and doing the things that it seeks to do. We’re also able seek to identify young people that might be at risk of suicide and then those young people are then eligible for a more target intervention but specifically is delivered to them via the school counsellor to help manage their suicide at risk or what have you.
I think what the evidence tells us is that sorts of programs that are kind of delivered in tandem tend to be the most effective, I think.
One of the other things that I might say for a long time I think schools were very nervous about talking openly about suicide and using the ‘S’ word in a school setting and I think that was the result, it was very well intentioned and I think it was the result of some very early works that identified that there was the potential for harm by talking about suicide, we didn’t necessarily know how young people were absorbing the information that we were giving them and we didn’t know what was going on for those young people and we didn’t know how they might internalise that information, what they might do with it, for a long time schools were very nervous to talk directly to young people about suicide and they were afraid that it might put ideas into people’s heads and those sorts of things.
We’ve done a lot of work at Orygen but so have other colleagues from around the world to really nut that out I suppose and what we’ve been able to identify is that that’s not the case and it is quite safe to talk to young people about suicide, in all sorts of settings including in school settings, providing it’s done with care and sensitivity and compassion and those young people who might be vulnerable then are able to get the support that they need, so it’s been good to be able to sort of bust that myth if you like that it’s not ok to talk about suicide and when we’ve done consultations with young people and we’ve talked to them about their experiences, one of things they have repeatedly said to us, we want adults to talk to us about this topic and we don’t want to be patronised, you know if adults can’t talk to us about this topic, how can we then go to them to seek help if they are telling us that it’s not ok to talk about this, I think that it’s important, you know and it might be important for the listeners as well, to be reminded that it is ok to talk about suicide publicly as long as we do it with the care and compassion it deserves.
KB: That’s a fantastic message, if people take away just one thing, I would hope it would be that from this podcast episode, because I think we’ve gone a long way in smashing that myth but there is still a ways to go for sure.
Kathleen what about your experiences in California and the work that you do supporting people across the world, have you seen a similar thing with the recognition from people in school settings that they want to be talking openly about suicide with students and among the student population, of course in a safe way but have you seen that increase over time in recent years?
KS: Yeah, Jo did an outstanding job of talking about this progression because in my earlier years of doing this in the 1980s and even 90s, there would be somebody on the campus that would go, oh we can’t talk about it because if we talk about it, we’re going to cause it and that myth was just busted a long time ago but the fear at this being that dirty ‘S’ word and it’s interesting kids will get more attention using the four letter ‘S’ word as opposed to using suicide and as Jo eloquently said, that if we’re not willing to have an open, honest conversation about suicide with our colleagues and the students, then why in heavens would they come and talk to us and unfortunately after there has been a suicide on some campuses still to this day, we won’t talk about it because then we’re giving attention.
I’ve been working with a county here in California which had a number of suicides and so when I went and met with superintendents of the schools and behavioural help, what we ended up talking about was that they really needed some grief work and even, and this is just earlier this year when we met, they said, well we were told that you can’t this and you can’t do that, you can’t talk about it and you can’t honour…I said how would you honour the death of any other student, in a car accident or of a terminal illness, it would be the same way you honour the death of this student, you don’t make them a hero, you don’t make them a villain, somebody that was on your campus and a part of your school family has died and you need to mourn them. With that said we also need to be mindful that a lot of the teachers are struggling and who can they talk to them if they are carrying thoughts of suicide and then there are students that are worried about their parents or their grandparents.
I remember at one junior high school a girl shared that her grandfather had taken his life on her birthday and her question was, didn’t he love me so here you have this precious little child who is carrying around this pain and this grief and some of the kids, excuse me young people, will tell their friend and their friend doesn’t know what to do with it, now you have a friend who is carrying this burden and so equipping them to say, there are good secrets you know, who do you think is cute, that might be a secret you keep, but if your friend is talking about suicide about wanting to end their life, this is not a secret that we keep, so you have to find a safe and trusted adult, clearly as a parent I would hope that my child would want to come and talk to me but if they didn’t feel that they could talk to me, they need a safe and trusted adult, who would that be?
I remember when my daughter, my daughter almost 30 now but when she was in high school one of her friends came over to the house and it was like 8:30 at night and he said, I don’t want to talk about it, ok and as I sat there letting him not talk about it and he talked and he talked and he talked because he didn’t want to talk about it, so sometimes for us as adults we just need to create a safe space and all I had to say was, ‘well that sounds rough’ well then another thing but I don’t want to talk about it, ok, so he didn’t talk about it for about an hour, while he shared all he needed to share, we don’t have to have an advanced degree, as Jo said, that caring, that respect, that safe environment that doesn’t say there’s any judgement, it’s probably that person beating themselves up over something that they didn’t do, that they did do, that they wish they’d done differently but to say, regardless of what it is that has happened, right here in this moment, how are you doing, are you thinking about ending your life, are you thinking about suicide, if so then that’s what we need to talk about and have that safe, honest conversation, that you’re not in trouble, I’m not going to hurt you, I want to get the right kind of help for you.
The schools here in California have made a lot of progress, we’ve had the legislation over the last several years that has mandated schools have policies and procedures, protocols, many of them have done due diligence, many have done a quick, here’s a four page, if this then go here, which is trying to cover their liability, not necessarily training people as fully, many of them have done fabulous work, so I don’t want to deny that and then right now LivingWorks has an agreement that we’re reaching out to all the middle school and high school students and staff providing our online training Start, which is 90 minutes and it’s designed for ages 13 and up and that’s exciting because we’re starting with all the teachers or the school staff, not just teachers but school staff, so we have that network of safety, we’ve got some gatekeepers if the students bring up their thoughts of suicide and then next month we’ll roll it out to students because we want to know that if they have thoughts of suicide they have some identified safe people on their campus, I wish this legislation had provided funding for parents, it did not, but we want to get all those people, you know, maybe it’s a coach, maybe it’s a parents, maybe it’s a grandparent, maybe it’s your best friend’s parent who is really a safe person to talk to, so that we all have some sort of common language and know where to go to get help on behalf of this student and maybe for us because we’re scared, what if I say the wrong thing and what I’ve told people to say is, what if you said that, I don’t want to say the wrong thing and I don’t have all these skills and I don’t have a degree and I’m not a counsellor but you really matter to me and I want to help, if we could have this conversation, I would really like to help you.
I think if we could just have that kitchen table kind of conversation it would really take away so much of that stigma and taboo around suicide so that people can go, ‘oh you’re having those thoughts, I’ve had those thoughts too’, ‘no not you’, ‘well yeah’ ‘what helped you get through, blah, blah, blah’ and maybe then it will help you but instead of us fearing, we could be transparent and authentic on both sides, I don’t have all the answers and I don’t care how many initials I have before or after my name and when it’s been my own child who has had thoughts of suicide, quite frankly, she said, I don’t need a counsellor mum, I need my mum, well crud, because I didn’t realise that I had that protective veil on and she needed me to feel her pain, then when I felt her pain, then the tears came from me because that’s my child but then there was a connection that was different when I was in my head and in my therapeutic mind as it were, had to let my guard down and be real and accessible to my child, so I think that’s, for me it’s a lesson that says, I just need to be as present and real, mindfulness, present and real with the person that is in front of me, whether you’re a teacher, student or parent, whatever role you are playing, a bus driver who sees the kids and sees the kids who are struggling.
JR: I think you raise a really interesting point actually and I think a lot of the reasons we hear from young people that they don’t want to tell somebody they might feel suicidal is partly because they don’t have the language and there is a stigma and a fear of being judged and those sorts of things but they are quite anxious about how the person they tell will respond and so that kind of nervous that they may kind of freak out and won’t know how to respond and I think what we hear from adults we talk to and we’ve been working in schools for a long, long time is that one of the reasons that people don’t ask is partly because they don’t want to put ideas into people’s head, as we’ve spoken about but they’re also afraid of saying the wrong thing, as you mentioned Kathleen and they’re afraid of the answer, they’re afraid that they won’t know what to do if the young person says, well actually yes I have been feeling like that and I think that’s a real barrier for people, they don’t want to raise the conversation because they don’t know what to do if the young person says yes and again another kind of message that I always like to try and get across to people is, it’s pretty hard to say the wrong thing and actually what you need to just do is be as you beautifully said really, is to sit with that young person and sit with their distress and listen to them without judgement and actually often that is a great first step, you don’t have to have all the answers, so don’t be afraid to ask because you think that you can’t fix the problem, you don’t have to fix the problem, you don’t have to have all the answers, be willing to support the young person, listen to them without judgement and then be willing to walk with them to get that next step of help, whatever that might look like for them and I think that is really critical and I think that if people can get past the idea that you’ve got to fix everything, I think then it will make people feel much more empowered to be able to ask people these questions or have these conversations.
KS: And I think to that end, I love what you said Jo, is that if it was so easy for us to fix, they would have already fixed it and so in some ways if we go in and say, all you need to do is…we’re really minimising that struggle and as Jo said is to help walk with them through it and to say, this is really rough and I can see that you are in a lot of pain, just don’t have to go through it alone and I’m willing to come alongside of you through this, that’s such a powerful thing.
I think at any age isn’t it, to think you don’t have to face whatever it is by yourself, especially let’s think back to puberty, it was not fun, you would not go back, when I ask adults how many of them if given a choice would go back through puberty again and probably in 30 years, I have had less than a dozen hands - I’d go back to high school but puberty was not fun. If we can acknowledge that and remember that it was awkward, we were clumsy and as Jo said, they may not have the language to say what they’re feeling and they’re feeling like they don’t belong, they can’t handle it anymore, it’s too much and maybe if we can help them, create that safe place where they can say whatever it is that’s going on and maybe even translate some of it as it were, to bring forward what is going on with them and to normalise that they’re not the first and not the last, right now in that moment they’re the primary focus and that’s really important for them to know that we see them, we hear their pain and we want to help them get through it.
KB: Absolutely, thanks Kathleen.
I think that’s probably a couple of elements for our listeners to be aware of there and one is actually looking from an individual perspective as people around young people and helping to understand and have that compassion and care but I wonder, I could talk to both of you all morning but I’m sure you’ve got other things on your plate today, but I wonder if someone’s listening as a family member or a parent or carer or teacher, someone who has young people in their lives that they want to be open to those conversations and they’re thinking that they want to be that person that someone could come to and they want to open themselves up to have that conversation. What are some things that they could do to better educate themselves on some of that language, I know you’ve talked about a couple of courses but are there any tools and things that people should look at to better just educate themselves on how to have these conversations safely?
JR: Is this where I get to plug some of the work that we’ve been doing?
Look there are lots of courses and tools and guidance out there for people who do want to have these conversations carefully or safely with young people and I mean we’ve been working with parents and educators, as well as students, around how to talk about suicide safely, how to identify that somebody might be at risk or vulnerable and then how to respond to that, so the work certainlythat we’ve been doing with Living Works has been around equipping young people, so we’ve been testing and evaluating the safeTALK program with school students but at the same time as doing that we’ve been providing ASIST training for educators who are around those young people and then online training for parents of young people, what we’ve taken is this very holistic approach to making sure that everyone is equipped to talk about suicide safely, everybody is using the same sort of language and taking the same sort of approach because I don’t think it would necessarily be the right thing to do to be equipping young people to talk safely about suicide or to be able to go and encouraging them to reach out to the adults in their lives and say they feel suicidal, if those adults don’t feel equipped to respond carefully and safely and feel comfortable themselves, so we’ve definitely taken that approach.
We’ve also sort of taken the approach that young people often like to other young people, so that was kind of part of our philosophy about the work we’ve been doing certainly in school settings, which is around making sure young people can talk to their friends or that people can spot the signs that their friends might not be travelling so well and know how to respond to that.
The other bit of work that we’ve been doing has been online and that’s where we’ve developed all our chatsafe suite of resources because the other environment where young people have these conversations is online as opposed to face-to-face and particularly currently living through a pandemic, where most of us are living most of our lives online, it felt more important now than sort of ever that young people felt capable and equipped and confident and comfortable having these sorts of conversations with their friends in an online environment, so we did develop a suite of resources called the chatsafe resources that we developed to help young people talk safely about suicide on social media platforms and we developed these kind of guidelines that we were very proud of, they were evidence-based guidelines because again we are crusty old researchers, so we did this whole piece of research to inform the development of the guidelines and we love them and are very proud of them but we were aware that young people might not read reams and reams of guidelines, however proud we might have been of them, so we then brought them to life with a co-designed and co-created social media campaign, so all the content from the guidelines has now been translated into tiny videos and animations and those sorts of things that get pushed out through Snapchat and Instagram and platforms like that, to make them much more accessible for young people.
But the other thing that we’ve done and we’re about to launch is actually a resource that’s based on the chatsafe content that’s specifically for educators, so again we know that school staff are often the people that will be, often the first to notice sometimes that a young person might not be travelling very well or certainly the schools that we’ve been working with have told us that they might know that young people are talking online about a suicide death particularly if there has been a death in the school community or the death of a celebrity or public figure. We then wanted to develop some resources for school communities or school staff so that they could support young people to have these conversations safely, rather than just shut the conversations down, which I think is historically what used to happen. We know that young people do turn to social media platforms to have lots of conversations including about suicide and that is often a very important outlet for young people, they might want to have these conversations, they might find social media platforms very accessible and they’re freely available and they can talk to their friends 24 hours a day and they can also help their friends, as well as receive help which I think young people find important. We didn’t want to shut the conversation down, we didn’t want to say, no this isn’t a safe platform for you, we wanted to give young people the tools and the agencies to have these sort of conversations safely but we also recognise we needed to equip the adults in young people’s lives to be comfortable to be having those conversations safely hence the resources we are just about to kind of finalise and launch now.
KB: That’s fantastic both of you, I actually think that’s an important message for people listening, is that talking about suicide prevention and young people living well, always needs to focus on the people around young people as well, so it can’t be done in isolation, we can implement as many programs as we like for young people but as you say, if adults in their lives and the teachers, the educators, the bus driver, if they’re not equipped as well both face to face and online communications, then it won’t be as effective, so thank you for reinforcing that to look at what young people need but also the supports around them.
Is there just a final thought or piece of guidance for people who might be listening, either a young person or someone who is in a supporting role for a young person, Kathleen.
KS: One thing, people come to a workshop, an ASIST workshop, safeTALK workshop, any workshop that I have done, it’s a great opportunity when you go home to say, just went to this workshop about suicide, I’m wondering do you know anybody who’s had thoughts of suicide, have you ever had thoughts of suicide and it opens up the conversation to be able to go, well yeah or no why would you ask, well I went to this workshop and I just wonder because I think I learnt some things here today.
It is just an opportunity again, we go to a movie, did you see this movie, oh yeah, just taking it again out of that dark space where we’re afraid to have the conversation and to be able to say, I’ve learnt some things about it that I didn’t even know and maybe you do and as Jo said, these young people are very savvy, when I get a new phone, I have to have my children help set it up because I can’t figure it out, so they are tech savvy, they’re far more willing to be open and authentic and transparent, I think sometimes we as adults are comfortable with, so whose issue is that really, and I think for us to be able to say, wow it is so different for you, when I was growing up, women had to wear dresses all the time to work, isn’t that kind of funny, it wasn’t that long ago, for you it might seem like the dinosaurs were still roaming the earth but it wasn’t that long ago.
This workshop kind of maybe the same thing to say, we can have a conversation and I just want you to know that if you’re ever having thoughts of suicide or somebody you care about, I’d really like to help because you matter so much to me and I don’t want you to go through it alone and if you’re helping a friend I would like to help support you as you help them.
I think just to be able to be used today, use as an excuse to be able to have a dialogue about suicide would be my message.
KB: I love that idea, I think anyone could do that after any of the course or workshop they’re doing, is not think about the application of it, just use it as an icebreaker to get the conversation going, so that’s a great idea, thanks Kathleen. Jo, final thought from you.
JR: Yeah, I think, I think maybe one of the things I would say is, you know, we often paint suicide as a complex thing, we often say and we began this podcast with me talking about lots of complex risk factors that will lead a young person or anybody actually to a point of a suicidal crisis, so we do paint suicide as a, you know, it’s a complex process, but what I would say, is that with each of those kind of risk profiles, with each of those kind of risk factors comes an opportunity for intervention.
I think my final words would be, to not feel pessimistic about that and not feel overwhelmed by a sense of complexity, that actually underneath everything we are all human beings and that suicide is preventable and we all have a role to play in that, whether that is as a clinician or as a policy maker or whether it is as a parent or an educator or a friend, so I think that’s probably where I’d finish.
KB: That’s a fantastic place to finish Jo, thank you.
I’m really inspired by the work that I’m seeing from both of your organisations and in schools and the uptake from young people being involved in their own solutions as well as the administrators and the policy makers, so I think we can be optimistic, on an individual level and as a population or demographic of young people and I like what you had to say about that, thanks Jo.
Thank you both for your time and your insights today, I really appreciate you meeting with us and joining the podcast, I know, as I said earlier I could talk all day about this but if people would like to learn more about the work you’re doing, can visit Orygen’s website and also LivingWorks and lots of other mental health organisations working with young people across the world doing a great job, so thank you so much to you both.
JR: Thank you.
KS: Thank you, thank you so much Kim.
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