This program is funded in part by the following.

Addiction, anxiety, mental health.

How do we address our traumas and how do we begin to move forward?

The path to healing and understanding is through candid conversation.

I'm Aisha Sultan and this is Things We Don't Talk About.

What do you do when your own mind becomes the most dangerous place you know?

For millions of people, that's not a hypothetical question.

Suicidal thoughts, also known as ideation, affects people across every age, background, and walk of life.

That includes people we love, people we work alongside, people sitting right next to us.

And yet, most of us never have a real conversation about it.

Someone in the United States dies by suicide every 11 minutes.

That means by the time this episode is over, nearly three people will be gone.

And yet, we barely talk about it.

Maybe because we're afraid of saying the wrong thing.

Maybe because the silence feels safer.

But silence has a cost, and it's one that falls hardest on the people already feeling like they're struggling alone.

Today, our guest will open up about what suicidal thoughts actually feel like from the inside.

Then we'll hear from two experts who will share what helps, what doesn't, and how to be the kind of support that actually makes a difference.

I'm joined by Melissa Brickey, who experienced a major depressive episode that led to dangerous thoughts of suicide.

Hi, Melissa.

- Hi.

- Thank you so much for coming on and sharing this really personal story.

Can you tell me a little bit about what led up to the situation in which you found yourself in a crisis?

- Sure.

In 2021, early, the early part of 2021, when I was almost 50, (laughs) I started feeling some physical symptoms that included things like poor digestion, stomach aches.

I started feeling like it was very difficult to breathe.

My heart rate was elevated.

Eventually I started to find it really hard to sleep.

And that kind of episodic insomnia snowballed into chronic insomnia, which very, very quickly led to this major depression and feelings of not wanting to continue my life.

- So when you talk about physical symptoms, did you just think maybe you had a cold or a flu or something?

Like, did you go to the doctor?

What did you do at first?

- At first, that's what I thought it was.

I just thought, okay, this is, you know, I'll just power through this like we do with all kinds of physical symptoms.

And after it lasted for, you know, several weeks, we did go to, I went to my primary care doctor.

Then we were sent to specialists.

I did several visits to urgent care, all kinds of testing, and we couldn't figure out what was going on with me physically.

And especially the insomnia, we went to a sleep doctor.

I did a sleep test, and there was just a big question about why this was all happening, and I was really frustrated about it.

And then prior to that, you'd never had a diagnosis for any kind of mental health issue.

Is that right?

No, nothing before that.

Not at all, no.

And you're part of a large family.

Right.

You have a big support network around you.

Yes.

Yeah, and that was part of the challenge is that it made no sense to me.

Yeah, I have a great family.

I have an incredible husband.

I had a great job.

You know, I have a little house in South City.

I just had a wonderful life.

And there was that kind of, "Well, this makes no sense.

Why would I want to be... First of all, why do I have all of these physical things happening to me?

Because I swim every day.

I really look at my physical health as something that's important.

I recognize how important it is.

But yeah, it made no sense to me.

And then especially when I started feeling suicidal, it really made no sense to me because there was kind of that cognitive dissonance of, I have all this great stuff in my life, yet I feel like I don't want to continue living.

- So I think all of us had times when we can't sleep or it's hard to fall asleep.

Can you describe what the difference of not being able to sleep once in a while or having one bad night of sleep feels like versus not being able to sleep night after night after night?

Take us in your experience for that.

- It's really, really hard to describe, but it is a dark, dark place, very, very dark.

Every night, night after night, not being able to sleep, even having medication for sleep, doing all the things that people say, make sure your room is quiet and all you do in your room is sleep, don't look on your phone, all the things, yet I kept not being able to sleep.

It was very frustrating and it was just damaging, not only my physical health, obviously, but it really led to, like I said, the mental health breakdown that I had.

- Well, and sleep deprivation, we know, is a form of torture.

- Right, yes.

- It's a form of torture because it changes all the chemistry of your brain, you know, in addition to all the physical symptoms that it can cause.

- Yeah, that's a good description of it, torture, for sure.

- Were you able to function in the rest of your life, or were you so tired and so groggy and out of it that you just couldn't work?

I functioned in the rest of my life, which is what is so hard to understand, but I did.

I was still working.

I was still swimming.

I was doing everything, which part of me thought, "Well, I need to just keep doing everything because eventually this will certainly get better."

And then it didn't get better and it kept not getting better, which led to a lot of frustration and also a lot of sort of self-reflection that there must be something really, really wrong with me at my core, that I'm not able to overcome this.

- And tell me when you finally said something to someone and then what happened.

I finally said something to somebody probably mid-summer that I was thinking about ending my life.

By that time, it was constant.

So I had had some intrusive thoughts about ending my life earlier, but by mid-summer of that year, I was -- that's all I was thinking about was, okay, I'm going to the pool.

How can I drown myself?

Things that made no sense to me, right?

And I'm driving in my car and I'm thinking, okay, if I just hit the wall, all of these things.

And it was so scary.

It was so scary because again, I really didn't want to die, but I was having these intrusive thoughts and I was feeling very, very hopeless.

So midsummer, I talked to my husband and I talked to a couple of my sisters and I just said I really need help because this is so scary to me and I don't want to die but I feel like I'm going to I think I'm going to do something.

And then what what happened?

At that point my sister moved in with us.

We did talk to a psychiatrist and started some medication, trying a bunch of different things.

My husband and my sister came up with a safety plan for me which included somebody with me almost all the time because that was my biggest fear was if I am alone I know I'm going to do something and I just didn't want to.

We hid all the knives.

My sister and husband took all of the medication that we had in the house and hid it or took it out of the house and we were, my entire family was essentially on suicide watch for me.

I think one thing that you said in a speech that you gave about this later is that one you wish you had said something earlier to somebody and two that you're trying all these medications and none of them are really helping and you took an unconventional treatment.

Quickly explain to us what it was that worked and eventually got you feeling better.

Yeah, the thing I wouldn't say that this was the only thing that worked because a lot of things go into that healing journey for sure.

But the thing that I think finally changed something was what's called ECT.

And that is essentially it's just to explain it, I'm not a scientist or a doctor, but to explain it, it's basically causing a seizure in your brain.

And so it's a shock therapy.

Yes, exactly.

Shock therapy is the is the way that it's kind of described.

But then that's what are kind of layman's terms or whatever.

So I did that.

My doctor and psychiatrist, after being hospitalized for several days, suggested that that might be an option for me.

I was desperate.

I mean, I was desperate.

My family was desperate.

And so I chose to do it.

It was a hard choice, though, because of the stigma around ECT and just the stigma around mental health in general.

But particularly, I hesitated to do it because I was afraid it would it would change my life for the worse.

And and I is because of that stigma, really, because I didn't want people to think that I had gone through this very kind of dramatic treatment.

They might have a judgment about me.

And at the time, I decided not to worry about that.

I decided not to worry about that because it was more important for me to be able to continue my life.

So I decided to do it knowing that there is a stigma around it.

So over several months, you had about 11 treatments.

That's right, 11 ECT treatments.

- And eventually you felt better.

- I start, yes.

- Can you just tell us, like, are you able to sleep normally?

Do you still have to take medication?

Just sort of let us know where you're at right now.

- Yeah, I did start to feel better after ECT.

It was not instantaneous, but I did certainly feel some joy.

It wasn't constant joy, but I started to see some light.

I am medicated.

I sleep fine, but I protect my sleep, and I protect my mental health more than anything, more than I ever have.

I protect my mental health and I protect my sleep because I know it's such a slippery slope.

And I talk about it, and I talk about it, and I appreciate you giving me an opportunity to talk about it because I think it's part of my own healing to be able to understand it and talk about it and and it's also part of sort of creating this community where people understand what this is and and that there there is a reality that people can go through it and it can be horrible but there is hope and healing and that's what I believe in.

And you're a testament to that.

Thank you so much for coming and sharing this incredible story with us.

♪♪ - Welcome back.

Now we're joined by Tom Duff, Chief Executive Officer at the CHADS Coalition for Mental Health.

Thank you for being here.

What do you do if someone that you love or someone that you know says something like, "I don't think I should wanna live anymore."

- I think first and foremost, knowing that 988 exists, right?

So we all heard of 911, but 988 is for a mental health emergency.

Also, even if you're not sure if you should call or if that person should call, the beautiful thing about 988 is go ahead and call because they can help you.

There are trained professionals you can call, text, video in.

It's an amazing resource.

So right off the bat, know that.

And sometimes sitting with that person and making that call is so valuable.

So let's say that someone says that to you.

Tell me exactly like what you might say to them in response.

- So first and foremost, acknowledge, right?

Acknowledge what they're saying is real.

Take it seriously.

But right off the bat, you want that person to know they have value, all right?

So anything that they're sharing with you means they trust you.

So be a listener, be nonjudgmental, and be present for them.

And let them know they are valued, right?

They are a person that brings value to this world.

- So if you hear something like that, what would you say?

- I would say, first of all, wow, thank you so much for trusting me with sharing this with me.

So can you tell me a little bit more, right?

So I have an open-ended question.

And let them know that I'm here to listen to you then.

- Okay, and what should you not say?

- You know, you don't wanna come across like authoritarian, you know, and to say things like, don't do it.

You know, don't try to take control away from them because you wanna have that open door with them.

So you wanna use phrases that keep the relationship open.

So first and foremost, don't tell them not to do it.

Don't tell them that, you know, there's a better way.

There's all these things where you're trying to control the situation.

Open the door.

- What do you wish people knew about suicide and suicidal thoughts or suicidal ideation that you think a lot of people don't know?

- So I think there's, you know, we heard from Alyssa earlier that stigma, stigma is there, right?

And so a lot of people think about if you, there's this myth, if you talk about suicide, it'll make people want to engage in suicide.

And that's a myth.

Ultimately, the world of prevention is so valuable.

We want to put knowledge in the hands of others, as young as possible, about mental health in general.

Just talking about suicide doesn't make an individual engage in suicide.

There is a myriad of factors.

First and foremost, providing the knowledge around what is healthy mental health, and also knowing that we all have mental health.

Just as we have physical health, we all have mental health.

- Right, I think that's a really good point, because sometimes people are afraid that if they say something, they might get taken to a hospital.

It might close up opportunities to them or their career.

How do you respond to that?

- So, you know, I think we're in a much better place than we ever have been in regards to stigma.

But the way I would respond to that is, you know, letting people know there's many different channels to a mental health crisis.

And there's a lot of things that we can do, we can improve within ourselves, like from sleep, nutrition, exercise to start with, right?

And then from a safety plan perspective as well too, there are things that you can do at home with the right care network that will help create more safety.

- Now, your organization offers prevention programs.

So if someone wants to reach out and say, "Hey, train my organization, come talk to my school."

They can reach out to CHADS and get resources for that.

Is that right?

- Definitely, yeah, definitely.

We work with individuals 25 and under, and then as well as how we look at as corporate St.

Louis, right, the business world, getting inside of the normal practices of our society and helping people understand mental health 101.

So prevention is the key.

- That is such a valuable service.

So if anybody's watching and would like to learn more about prevention and what to do, if you do face a tough conversation like that, please do reach out.

Thanks for sharing that with us.

- Thank you so much.

♪♪ - Now we'll hear from Dr.

Laura Hennefield, Assistant Professor of Psychiatry at Washington University School of Medicine, who studies suicidal thoughts and behaviors in children and preteens.

Laura, what can you tell me about what the trends are and the data show in terms of suicide and suicidal thoughts?

Sure.

So in preteens, we've seen an increase over the past 15 or so years in deaths by suicide.

These are children as young as 8 to 10.

And also emergency room visits for suicidal behaviors have been increasing quite a bit over the last few years.

- Why is that?

- We don't have a great, you know, there's many reasons potentially for that.

Part of it is awareness, but also children are really having these struggles these days.

- And so what should parents look out for and what should they do if they fear something might be going on with their kid?

- Yeah, so I think the first thing is to take children seriously.

So if they're expressing thoughts about wanting to die, if they're talking about not wanting to exist anymore, to really listen to them.

This goes back to what Tom was saying, you know, really think about what kids are saying and take them seriously.

I think there's often a reaction to either be very dismissive of what children say.

They can't possibly be having these thoughts.

What do they know?

Or shut them down.

We don't talk about this.

I think really, really listening to what kids say and also keeping an eye out for other warning signs besides just talking about suicide.

So children who are talking about feeling worthless, feeling like maybe they don't belong in their family, they can't do anything right, really paying attention to that.

- So who do you bring that up with?

Do you call your pediatrician?

Do you talk to the school counselor?

I don't know if parents even know what the next step is.

- Right, right, and that's very tricky and it can be really hard to get the right care.

I think there's a huge range of things parents can do, but in general, yes, a school counselor is great.

Pediatricians are always a wonderful resource.

If parents have a therapist for themselves or another child, that can also be a resource.

And of course, 988, you can always call and they can help direct you.

They're also really great at figuring out or helping you sort of gauge how seriously do we take this?

When does this become, you know, are we at the point of a crisis or is this something that we can manage?

- And do you actually do research with children and preteens?

Can you tell us a little bit about what your research shows?

- Sure, yes, I do.

So I bring children into my lab who are as young as four and we ask children questions about their own experiences with suicide and with younger kids, the kids about four to seven, we're also really interested in knowing what they understand about the concept of suicide.

So one of the things we hear a lot with kids this age is, oh, they just, they don't know what they're talking about, right?

And so how much, what do you need to know about suicide in order to be able to have suicidal thoughts or to be able to, you know, even die by suicide?

And kids this age know a lot more than we give them credit for.

And so that's one sort of part of my research is really figuring out what these youngest kids know.

I've also done a lot of work looking at older kids.

Older kids in my line are preteens and suicide risk screening in this group.

So there's also this big question out there and another sort of place where often people go to extremes.

Either you, of course, it's perfectly safe to ask kids about suicide or no, we absolutely can't ask.

Oh my gosh, we're gonna put thoughts in their head.

This is not something we can be doing.

And the literature and what's coming out of my lab and other labs really shows pretty strongly that there is no risk to asking children about suicide.

So in kids who have never experienced suicidal thoughts, asking them about them does not lead them to have these thoughts.

- And does it mean if a child is having thoughts that they're actually gonna do something, they're gonna act on that?

Like how do we know whether a thought is gonna lead to action?

- Absolutely, and this is a huge question in the field.

Most of the time it does not, but that does not mean we should take them any less seriously.

Right?

And so these are, again, this goes back to keeping the conversation going, opening up that conversation with children and having, you know, at times professionals come in to assess, you know, is my child, you know, are they having thoughts?

Are they having, you know, are they expressing a suicide plan?

Do they have anything else going on?

- Do you think social media plays a role in all of this?

- So in the youngest kids I study, I don't, mainly because most of them are not on social media.

So this is a question that comes up a lot.

In preteens, possibly, one of the things we're looking at in our current work, we have a study going on, actually, with preteen girls right now, and we're interested in questions about rejection, for example, and we know that being rejected and rejection sensitivity is something that's highly linked to suicidal thoughts.

And is social media just one more place this can happen very frequently?

- So you're saying that people who are more sensitive to rejection or experience rejection more might have a vulnerability because social media is a place where teens can reject other teens or mock them or taunt them or leave them out or give you feelings of that.

- Exactly, so this vulnerability may already be in place and social media may be able, may be exemplifying this.

- Right, exactly.

Do you know what makes somebody more at risk to die of suicide or to have suicidal thoughts?

- Sure, so we know some risk factors, and of course it's very tricky to use risk factors to predict any individual's risk, right?

But broad things, having experienced trauma is a risk factor, having comorbid psychopathology, so having depressive symptoms, for example, depression, having, we're learning more about having ADHD, anxiety, a lot of other mental health conditions are also related to suicidal thoughts and suicide behaviors, including at the youngest ages.

And what have you seen in the research as the most effective interventions that help children and preteens?

So children in particular, parent-child psychotherapy tends to be one of the most effective ways that we can treat children.

- So finding a therapist that you and your child can speak to together.

- Yes, and yes, where parents and children participate together, and also where a lot of the focus is on parents, is on how parents are interacting with their child, how they're setting up the dynamic within the family.

- Oh, okay, that's really great.

And what if it's something happening at school?

Like, are there ways to intervene if something's happening in a friend group, or social media, or with bullying, or something like that, that might be causing the child to feel really depressed.

- Yeah, I think this is another place we're bringing in a school counselor, reaching out to people, letting people know that something is happening with your child, it would be, is really effective.

- So what is one thing that you wish more educators and parents knew about suicide and suicidal thoughts in young kids?

- Right, I think the main thing is really understanding that children as young as preschool age can have suicidal thoughts, and they can also engage in suicide behaviors, and that we need to be taking these seriously from the earliest ages.

Is that a new phenomenon?

No, in that there are some studies dating back to about the 1970s looking at children who had suicide behaviors who were in psychiatric hospitals.

So overall, this is not something completely new that we're only seeing now, but it really has not been studied before.

So we don't have a great sense of how common this is, how potentially normative having, you know, occasional suicidal thoughts might be in children.

We don't know how that is yet.

Do we know what causes some children to feel this way and others are much more resilient and never have that kind of thought?

Do we know?

Not to a great degree of certainty.

I think certainly having good coping skills, good socio-emotional coping skills, help children go to more proactive responses if they're experiencing a stressor, whereas something like suicidal thoughts and ideation might not be the most proactive approach.

Right, but it sounds like we don't really have a clear answer.

We don't really clearly know yet that this is still just an area of research that's going on.

It is.

It's a very new area and certainly a place where we need a lot more focus and funding.

I think a lot of people would be shocked to hear that, you know, someone who is preschool age or kindergarten age could actually die of suicide.

That seems jarring and shocking for a lot of people.

In that case, could it just, could it be a question of impulsivity with children and not really realizing the finality of what happens in a case like that?

Right.

I think there's a few things to unpack here.

Certainly, children's abilities to adequately assess risk are not the best.

We certainly have had children who talk about wanting to die by suicide, and they present plans that may not actually have a high degree of lethality.

That happens fairly frequently.

But it's kind of like a signal that something really wrong is going on in that child's life or in their emotional life, if that's something they're talking about.

Well, this is a really difficult thing to think about and talk about, but I really appreciate the research that you're doing and then coming and helping us get a better understanding of this.

Thank you.

♪♪ - This program is funded in part by the following.

- This program is funded in part by the following.