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