Suicide Is Preventable

What I Didn’t Know Then, What I Do Know Now.

Donald Mingle (left) at 8 years old with Bryan Mingle (right) at 9 years old

By Bryan Mingle

CQI Specialist- LSF Health Systems, Jacksonville

 

I will never forget that evening in early April 1987, the week before Easter, when my dad called the newsroom where I was working in Orlando. When I walked over to the landline and picked up the receiver, I heard a halting voice fighting back tears. “We lost Donald.”

Almost immediately and for days, weeks and years after I heard those words, I thought back on conversations with my brother the previous months. One haunted me. Donald, the youngest boy in our family of 3 boys who was born on my 1st birthday, was lying on his bed in his old bedroom in our Jacksonville house. He was visiting from California where he was employed, at 27 years old, as a prison guard with a new baby boy in a marriage that wasn’t going well. He showed me the scars on his wrist and said he tried to kill himself after returning to the United States from Germany on a hardship discharge from the Army, where he had met his wife. My impulsive sports jock and jester clown of a brother began to cry. I was completely caught off guard. I felt helpless. Uncomfortable. I did not know how to respond. “Don’t be silly, brother. Don’t talk like that.” I quickly changed the subject.

For years after my brother’s suicide completion, my parents and other family members rarely spoke of the sudden loss. Risk factors were not in anyone’s vocabulary. People would say, “Donald was sick.”

Fast forward to 2015, after several years of my own moments of hopelessness fueled by escape, wonder and guilt, and I am working in a dream job as a Quality Improvement Specialist at LSF Health Systems (LSFHS). I had returned to Florida from California, where I moved to live six months after my brother’s death. After working as a co-occurring addictions counselor in Jacksonville, I landed a role at the first Northeast Florida Managing Entity. I embraced the LSF mission: to serve families and children and help to keep them safe. One day I found myself in a Question, Persuade, Refer (QPR) suicide gatekeeper training with my clinical staff colleagues. QPR is a staple of the aspirational Zero Suicide approach to suicide prevention, which was shaping up to be a priority in the under-funded and vulnerable Sunshine State. LSFHS was embarking on grant projects that continue to this day to make LSFHS stand out amongst its statewide peers.

My message today is about the life-changing information I learned in that QPR and subsequent QPRT (advanced) training. It is my calling to share it so that, 33 years after Donald’s suicide, you may feel encouraged to have a conversation with someone struggling in life. During these COVID-19 months of extreme anxiety and unknowingness, it is more important than ever. Once you’ve discovered you can overcome your own discomfort and fear about suicide, linking a person to hope is easy. I am grateful to say I’ve done it many, many times since I was taught how to do it.

Thanks to the elements of Zero Suicide, which addresses and increases the confidence level of anyone, licensed therapists included, Americans are starting to burst the many myths around suicidal thoughts. (You can’t cause someone to attempt suicide by talking about it; it is just the opposite, research shows.)

Donald Mingle, age 17.
Bryan Mingle, age 17.

Listen and observe

  • If the person has not confided in you but you sense there is something off in their behavior or demeanor, ask questions to start the conversation. Some examples:
  • “You haven’t seemed like yourself lately, is there anything going on?”
  • “I know you and something is going on. Let’s talk about it. I want to help.”
  • “I’m worried about you. Are you OK? It’s OK to not be OK.”

Ask if the person is thinking about suicide. Be direct and calm.

Some examples of questions:

  • “Have you had thoughts of suicide?”
  • “Do you ever feel so bad that you think about suicide?”
  • “Do you have a plan to kill yourself or take your life?”
  • “Have you thought about when you would do it (today, tomorrow, next week)?”
  • “Have you thought about what method you would use?

Listen without judgment.

  • Let the person talk without interruption and have them feel heard.

Avoid the following:

  • Minimizing their problems or shaming a person into changing their mind.
  • Sharing your opinion. Trying to convince a person suffering that it’s not that bad, or that they have everything to live for, may increase their feelings of guilt and hopelessness.
  • Avoid arguing or challenging the person.
  • Avoid preaching or prophesying
  • Avoid making promises (like keeping it a secret)

Respond and persuade with kindness and care.

  • Phrases that are helpful:
  • “You are not alone. I’m here for you.”
  • “I may not understand exactly how you feel, but I care about you and want to help.”
  • “We will get through this together.”

What to do:

  • Stay calm.
  • Acknowledge that they are in pain and that their pain is REAL.
  • Stay with the person.
  • Remove sharp objects or lethal means
  • Go with the person to the ER or mental health clinic

 

CALL 911 if someone has caused bodily harm to themselves or is actively threatening to hurt themselves or others

If they say they are NOT suicidal:

  • Reassure the person that you are not there to judge them or do anything that makes them uncomfortable. You only want to understand their thoughts and feelings so together you can make the best choice for their health. Remind them that if they ever have suicidal thoughts that you are there to listen and help.

Refer to Treatment

  • Call the National Suicide Prevention Lifeline: 1-800-273-8255

Listen to the prompts: press 1 for Veterans. A veteran will answer. You can also text 838255.

  • The LSF Access to Care Line can provide referral and information for mental health counseling and to continue the instillation of hope: 1-877-229-9098.
  • The NAMI Collier WARM Line is answered by certified peer specialists who each have personal experience with mental health and/or suicide attempts. Call 1-800-945-1355 between 4 p.m. and 10 p.m weekdays and weekends EST to talk because it’s OK to not be OK.

If you or anyone you know has lost someone to the completion of suicide, please know there are support groups and help for you. The loss and grief surrounding suicide is a known risk factor for an individual’s own suicide.

http://www.survivorsofsuicide.com/

https://suicidology.org/resources/suicide-loss-survivors/

https://suicidology.org/wp-content/uploads/2019/07/Resources-for-Survivors-of-Suicide.pdf

Thank you so much for letting me share my experience. The QPR training was so helpful for me and I hope all the resources I shared above are helpful for you.

LSF Awarded Grant to Prevent Suicide in COVID-19 Era

With mental health challenges on the rise in the wake of the coronavirus pandemic, LSF Health Systems recently applied for and was awarded an $800,000, 16-month suicide prevention grant from the Substance Abuse and Mental Health Services Administration (SAMHSA). LSF will partner with healthcare, housing and domestic violence providers in Duval County to implement emergency suicide prevention best practices for adults 25 years of age or older. Those partners include Mental Health Resource Center (MHJRC), Changing Homelessness, Hubbard House, and Baptist Health Emergency Department. The goal is to prevent suicide and attempted suicide among adults, including victims of domestic violence, by implementing Zero Suicide best practices. The project provides screening and care coordination.

“During this time of extended uncertainty and anxiety, many people who have coped with negative thoughts their entire lives are going to hit a wall, and some will feel trapped and desperate,” said Dr. Christine Cauffield, CEO of LSF Health Systems.  “With this additional funding from SAMSHA, the safety net will be expanded with more screening tools and compassionate trained staff.” The grant’s Suicide Prevention Team will receive referrals from inpatient crisis stabilization units (CSUs), emergency departments and the region’s domestic violence center. Individuals deemed at risk of suicide will receive a comprehensive assessment by the MHRC Suicide Prevention Team and a Safety Plan with lethal means counseling as part of the assessment. Training will also take place to help healthcare, housing, and domestic violence center workers recognize the signs and symptoms of suicide. In addition, training will be provided to healthcare and housing provider agencies to help team members recognize the signs of abuse and domestic violence. With the grant, partners plan to screen up to 1,200 individuals and provide intensive care coordination services to up to 500 participants over the 16-month grant period.

Partners Honored for Impact in Local Communities

The Nonprofit Center of Northeast Florida, The Community Foundation for Northeast Florida, and the Jessie Ball duPont Fund awarded their annual “Local Focus. Lasting Impact.” awards the week of June 14 in Jacksonville. Changing Homelessness and the Mayor’s Taskforce on Homelessness won the Collective Power Award while Gateway Community Services took home the Social Innovation Award for its Project Saves Lives.

Dawn Gilman, Chief Executive Officer, Changing Homelessness and Board Chair, LSF Health Systems

Changing Homelessness and the Mayor’s Task Force on Homelessness collaborated to screen nearly 700 homeless Jacksonville residents for coronavirus. The Sulzbacher Center’s Urban Rest Stop program and the Salvation Army of Northeast Florida added resources to assist as well. “It is an honor that the Shelter Task Force has been recognized for the COVID-19 response. In less than 90 days this group of service providers, health care professionals, and government agencies were able to create the screening protocol for homeless shelters. This included creating telehealth and isolation options when necessary, coordinating with all local hospital systems on discharge planning for medically stable COVID-19 positive homeless persons, and offering COVID-19 testing to all shelter residence over a 5-day period. Normally work of this scope and coordination would have taken two or more years to complete,” says Dawn Gilman, Chief Executive Officer of Changing Homelessness.

Gateway’s Project Save Lives (PSL) is an opioid overdose intervention program delivered in hospital emergency departments (ED). Trained peer specialists work with individuals who have been revived from an overdose to create a warm handoff, helping them properly transition to treatment services for substance use disorders and mental health challenges after leaving the ED. The program began as a 6-month pilot at Ascension St. Vincent’s Riverside in Jacksonville and has since expanded to 6 EDs across Duval County, with Clay Behavioral Health and Starting Point Behavioral Health using similar models in their local ED’s based on PSL. Dr. Candace Hodgkins, Gateway’s Chief Executive Officer, thanked many: “Gateway would like to thank all of our funding sources for supporting us since November 2017: The City of Jacksonville, Councilman Bill Gulliford, who championed the project in the beginning, and Councilman Ron Salem who has continued the effort, JFRD, LSF, the State of Florida, Duval and First Coast Delegation and Florida Blue. I would like to thank my amazing staff, especially our Chief Medical Officer, Raymond Pomm, MD, that created the program with community stakeholders.” Dr. Hodgkins says peers are on the frontline every day sharing their lived experience to help others find a new life.

Members of the recovery peer support team at Gateway Community Services.

Five additional organizations were honored with a new “Moments Recognition Program” created in the wake of the coronavirus pandemic. In a recent Florida Times-Union article, Nonprofit Center CEO Rena Coughlin said, “Each of these nonprofits is an incredible example of the vital work being done in the local community day in and day out. Though their services and programs are varied, each organization meaningfully enhances the quality of life for participants, creating lasting ripples of impact across our community.” The five additional organizations included:

  • Ability Housing, recognized for working directly with homeless individuals who are often disqualified from permanent housing because of low income, low credit scores and previous evictions.
  • Starting Point Behavioral Healthcare in Nassau County, recognized for its efforts to reduce readmission rates among individuals experiencing mental health and substance use disorders.
  • Youth Crisis Center, recognized for purchasing technology for staff members to provide mental health counseling and other services virtually during the pandemic.
  • Feeding Northeast Florida for Project SHARE, a collaboration to hire out-of-work kitchen staff to prepare thousands of hot meals for seniors.
  • The Arc Nassau for a new job-task demonstration component for its Job-a-Palooza event, which matches employers with potential employees who have disabilities.

Congratulations to all for this well-deserved recognition!

Prevention Manager Dispenses Knowledge at Tele-Town Hall

While the coronavirus pandemic has brought new challenges, it has also given behavioral health providers the opportunity to find new ways to reach out to communities and hear from stakeholders on how to provide community support. The Community Coalition Alliance and its network of partners across the state hosted their first-ever tele-town hall to provide Floridians with education about the safe use, storage, and disposal of medications at a time when Americans are spending more time at home.

LSF Health Systems Prevention Network Manager Elizabeth Nettles

Elizabeth Nettles, Prevention Network Manager at LSF Health Systems, was one of the featured speakers during a telephone town hall of more than 1,500 attendees. The town hall was hosted via telephone to allow a greater number of participants as some communities’ access to the internet is limited.

Nettles spoke about the importance of discarding old and unused medications. She says while insightful information was exchanged, educating others remains important. “More information is needed regarding how to properly dispose of prescription and over-the-counter medications. Only 10% reported using disposal kits like Deterra,” says Nettles. As a result of the pandemic, the annual Florida Drug Enforcement Agency’s ‘Drug Take Back Day’ was not able to take place this year. Last year the DEA collected more than 70,000 pounds of drugs across Florida at the event. About 60% of Americans who are prescribed prescription pain medications keep leftover medications, more than 6 million Americans have misused prescription medications, and each day 2,500 youth abuse a prescription pain reliever for the first time.

The town hall, organized by Community Coalition Alliance and Rx Abuse Leadership Initiative in collaboration with Drug Free Duval and the PACT Prevention Coalition, featured other speakers including: Kathleen Roberts, Executive Director, Community Coalition Alliance; Lee Ashlock, Assistant Chief of Police, St. Augustine Beach Police Department; Susan Pitman, Northeast Florida Polysubstance Task Force, Drug Free Duval; Laura Viafora Ray, MPH, CPH, Project Director – The Safe and Healthy Neighborhoods Project, the Jacksonville Fire and Rescue Department; and Ben Cort, author and addiction treatment specialist.

Further information and resources about the Community Coalition Alliance to make Florida communities safer, healthier and drug-free can be found at http://www.ccafl.org/.

NAMI Hernando Reinvents Itself During Pandemic

Executive Director Tina Kinney describes how her chapter quickly pivoted to a new way of doing business in the wake of the coronavirus pandemic.

“Social distancing, isolation, quarantine – all these words flooded our minds as news and social media began reporting on the COVID-19 epidemic. Unemployment, homeschooling children, fear of contracting the virus and the newfound chaos wreaking havoc on our lives created the perfect storm for an imminent mental health crisis,” Kinney explains. Therefore, staff and volunteers at the National Alliance on Mental Illness (NAMI) – Hernando, Florida knew that when their doors closed on March 16th due to physical distancing protocols, they had to act fast to get ahead of the impending uncertainty.

“We must be the one unwavering constant in our peers’ lives…[therefore]…we immediately came together to find a platform to offer our support groups virtually. Once a platform had been selected, we moved to format a PowerPoint presentation to mirror the NAMI Connections Recovery Support Group model,” says Kinney. Peers received a crash course in facilitating an online support group and designing a flyer to share meeting information. “The best way to describe the process is that we were flying the plane as we were building it. Everything happened so fast that we didn’t even know what we created. Our first group came together just four days after the Beautiful Mind (Drop-In) Center in Spring Hill closed – it was a huge success,” adds Kinney.

In fact, it was so well implemented that NAMI Hernando began training other Florida affiliates on how to expand the program statewide. They shared their PowerPoint designs, offered Zoom trainings virtually and hosted mock groups so others could see how the model was facilitated in a virtual setting. They also added their Family Support Group, LGBTQ+ Support Group, Book Club, Yoga and Saturday Night Social to the “virtual” calendar.

They supplemented their CARE Line with a Google Voice line to increase the hours and availability of assistance and began offering ‘Care Calls’ to check in daily with peers. They designed questions during those calls that would engage conversation while offering peers a tool ensuring the mental and physical needs of participants were being met. One example: “Have you tried a new recipe this week?” would not only be a conversation starter but may uncover if the peer was experiencing any food insecurities.

NAMI Hernando’s mission is to provide mental wellness in the community through education, support, advocacy, empowerment and outreach. While COVID-19 may have placed obstacles in the way, through resiliency they have found a way to turn adversity into an opportunity to expand and enhance programs. Kinney says, “Through this endeavor we have overcome both transportation issues in our rural community as well as stigma and plan to continue to offer the virtual platform even after we return to in-person meetings.”

Wraparound Best Practice Finds a Champion in LSF Director

LSF Health Systems Director of Training and Development Samantha Lawson was recently recognized during a statewide Wraparound gathering as leading the state in teaching the most wraparound trainings. Lawson received awards on behalf of the Statewide Wraparound Initiative, including the Visionary Leadership Award for her involvement in the statewide Wraparound work group, a regional Champion Award for being the LSF Wraparound Champion, and the statewide “Super Trainer” award. She is a certified trainer in Wraparound and has been a tremendous asset to the statewide implementation of high-fidelity Wraparound.

Director of Training and Development Samantha Lawson

The Statewide Wraparound Initiative was developed alongside a SAMHSA grant awarded to the Florida Department of Children and Families’ Substance Abuse and Mental Health Office. The initiative provides statewide support for the implementation and scaling of high-fidelity Wraparound, which is a process designed to assist children with behavioral health conditions and their families navigate the challenges of working within various behavioral health services and systems. The process involves bringing together a team of traditional and natural supports to help families create a better life.

The state has contracted with The Ronik-Radlauer Group to facilitate Wraparound training, coaching and technical assistance to Managing Entity regions and providers in those regions. Julie Radlauer-Doerfler, Principal at The Ronik-Radlauer Group, says of Lawson: “Her duties towards this effort have included working with providers to ensure that they have access to training, coaching and technical assistance. She has done an amazing job of organizing the training process in the LSF region.” Many sites contract out for training. Lawson has created a hybrid model where she provides some training while contracting with others for training.

LSF, Officers and Mental Health Staff Partner to De-escalate

LSF Health Systems (LSF), Mental Health Resource Center (MHRC) and the Jacksonville Sheriff’s Office (JSO) recently implemented a co-responder program to help police provide timely assistance to individuals in crisis and deescalate challenging situations. A full-time mental health clinician from MHRC, funded by LSF and the Florida Department of Children and Families (DCF), accompanies a JSO officer in a marked patrol car to respond to calls involving individuals who may be experiencing a mental health or substance use crisis in the community. The Jacksonville co-responder team, the third of its kind in Florida, is modeled after the successful program implemented by Meridian Behavioral Healthcare and the Gainesville Police Department, which was showcased at LSF’s inaugural Behavioral Health Innovation Summit.

“Having someone respond who understands the mental health challenges people face helps quell situations that may otherwise become tense. A key component of the program involves a warm hand-off from the Co-Responders to the MHRC Comprehensive Services Centers and outreach care coordination services, thereby diverting individuals from potential incarceration or Baker Act when appropriate,” says Dr. Christine Cauffield, CEO of LSF Health Systems.

The Jacksonville program was featured in a recent Florida Times-Union article and has already demonstrated positive results in the short time since it began. In addition to responding to calls, the team conducts follow-up visits to individuals they have previously encountered to ensure they have connected to behavioral health services. The co-responder team is currently focusing its efforts in areas of the city with the highest number of mental health-related calls. Additional efforts are under way to expand the program throughout the county with two additional teams pending approval of a federal grant request to the Bureau of Justice Assistance’s Justice and Mental Health Collaboration Program (JMHCP).

LSF Employee Elected to Key Position on Task Force

LSF Health Systems’ Community Engagement Specialist Lesley Hersey

Lesley Hersey, LSF Health Systems’ Community Engagement Specialist in Circuits 3, 5 and 8, was recently elected vice chair of the North Central Florida Human Trafficking Task Force. The task force’s reach covers the counties of Alachua, Bradford, Baker, Union, Gilchrist and Levy. The task force began in 2013 as a coalition with a mission to build a safety network of partnerships that work together to identify, rescue, and restore the lives of human trafficking victims. The task force is governed by an executive board and officers of the board: two co-chairs, a vice chair, a secretary and treasurer.

“The task force works within the communities to raise awareness through training and education. It also works alongside law enforcement, the State Attorney’s Office, and others to arrest and prosecute traffickers,” says Hersey, “We work with service providers and child welfare to ensure services and resources are connected to trafficked survivors.”

About 25 million people are trafficked worldwide, according to the Polaris Project. In 2018, 1,771 victims were identified in the state of Florida. According to Human Trafficking Search, Florida ranks 3rd in the nation for human trafficking incidents. “We do not know the exact number of people trafficked, and we may never know. However, we know that rates of trafficking are higher around interstates, tourism regions and rural and farming communities,” Hersey explains.

Task force meetings are held monthly and some are open to the public. Meeting information and a schedule can be found on the web at www.accaht.org or on Facebook at the Alachua County Coalition Against Human Trafficking.

CRISIS FATIGUE: On the Forefront of Behavioral Health Issues

Dr. Christine Cauffield CEO, LSF Health Systems

The COVID-19 pandemic, paired with the systemic issues of racism as well as economic distress in our country, have compounded to result in unprecedented levels of stress for Americans who are now experiencing what psychologists are coining “crisis fatigue.” This phenomenon presents when our bodies become overwhelmed by the cortisol and adrenaline associated with our natural response to stress, commonly known as the “fight or flight” response. While our bodies are well adapted to handle temporary stressors, they become overwhelmed by constant and unrelenting pressures like those many are experiencing this year.

If one sustains a chronic elevated level of stress, problems can result that may include anxiety, depression, insomnia, weight gain, high blood pressure and bone loss. For those who are managing mental illness, repeated high stress levels can interfere with treatment and stability and increase the need for therapy and medication to help combat new difficulties. It is normal to be feeling a mixture of exhaustion, rage, despair, desperation, hypervigilance, anxiety and grief right now. Acknowledging all of these feelings, however they are presenting themselves, is important. Additional tips to manage crisis fatigue include:

  • Be intentional about how you are spending your energy: Prioritize things you can control or influence and spend less energy on things that induce negative feelings, no matter how small.
  • Choose your battles and how you will fight them: While you can’t control how others react to the situations around you, you can control your response. Decide how you’ll approach adversity and be sure you understand when to disengage from conversations or situations that are mentally and emotionally draining and/or unproductive.
  • Focus on the things that bring you joy: Try making gratitude lists and noting the things that you are thankful for. This carves out moments for you to escape your negative thoughts in a productive way.
  • Make time for self-care: Give yourself permission to take breaks from the stress you are feeling. Aim to engage in healthy distractions and soothing activities to allow your body and mind to rest.
  • Reach out for support: It is a sign of strength to ask for help. Whether you connect with a trusted friend or seek help from mental health professionals, don’t be afraid to address problems head on.

At LSF Health Systems, we are proud to work with our 60 Behavioral Health Network Provider Organizations that provide care and resources for people with mental health and/or substance use issues. Our Access to Care Line, open 24/7, is available to connect you to community resources. Call us at 1-877-229-9098.

Sincerely,

Dr. Christine Cauffield, CEO

 

 

The Managing Entity Packs Compassion With Personal Protective Equipment

Meridian employee Amanda Craig, Director of Facilities, unloads a box of face shields.

LSF employees met at The Centers in Ocala on May 7 and 8 to distribute Personal Protective Equipment (PPE), including masks, hand sanitizer and gowns to providers throughout the LSF region. The Centers in Ocala was chosen as the distribution point because of its central location in the region. Those who did not make it to the distribution point that day arranged to have their items dropped off and picked up later.

LSF Housing Resource Specialist Paul Tarnowski (left) alongside Andrew Harding, Director of Vincent House Hernando.

The PPE was ordered by LSF through a partnership with the Florida Association of Managing Entities (FAME), the Florida Coalition for Children, and DCF, who worked hand in hand to ensure these critical supplies were made available to the Managing Entities (ME) and Community Based Care (CBC) lead agencies for distribution to local providers in their respective networks. David Doylak, Michael Blessing, Paul Tarnowski, Dusty Pye, and Dr. Christine Cauffield helped organize and deliver these items throughout the LSF region beginning in late April.

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