[Music] mental Wellness is just as important as physical wellness and it's some cases these two categories can influence each other in this episode of being well I'll sit down with rise and Health's Dr Bill Elliott and discuss suicide and non-suicidal self-injury when Sarah Bush Linkin opened in 1977 it was with the promise to serve the community's health care needs it has grown into a two hospital system with nearly 60 clinics that provide trusted Compassionate Care for over 50 years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment to meet the everchanging needs of our community has remained the same Horizon Health 50 years strong Carl is redefining healthc care around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to optimize Healthcare Carl with Health Alliance is always at the Forefront to help you thrive [Music] thank you for joining us for this episode of being well I'm your host Lacy Spence and today we are welcoming back a friend of the show who is here just a few short years ago we are welcoming in Dr Bill Elliot from Horizon Health welcome back to being well thank you very much pleasure to be here we are so glad that we get to welcome back in such knowledgeable folks usually when they knock it out of the park the first time we have to have you back so anyways uh for our folks who maybe didn't get to meet you in our Co Special A couple of years ago can you kind of introduce yourself tell us a little bit about your background sure um I'm a licensed clinical psychologist and um have been working with Horizon Health for the last two and a half years prior to that going all the way back to 1974 I worked in the uh correctional system working primarily in state and federal prisons as a psychologist and in another management positions and I still to this day do a lot of Consulting and training throughout the country in different Correctional venues but I um devoted most of my time this last couple of years to outpatient Psychotherapy at Horizon Health is that that has to be quite the switch it is a switch and it's been very very gratifying I get to work with people who are a little bit more motivated to change and uh a great variety of mental health issues a lot of interpersonal relationship issues family issues and so forth well today we are diving into a topic um in the mental health realm very important um we'll be talking about suicide and non-suicidal self-injury um I think a a decent place to start would be how prevalent is suicide in the US well completed suicides meaning that the person has actually died um in the United States the best data we have is around 48,000 people have killed themselves um going back to 21 22 for the best information now that's an awful lot if if if of youer can think of a city um or a town that they know that has a population of 40 to 50,000 people I mean that's really like wiping that town off the face of the Earth and that's how I like to keep it in perspective um that is a bit of an increase over just a few years ago uh when it was closer to about 40,000 worldwide roughly 800,000 people kill themselves every year so this is this is a universal problem it is a problem that mankind has struggled with in since recorded history now that's for completed suicide but the the other thing that may be important for viewers to understand is when we talk about suicidal Behavior we're really talking about a spectrum a Continuum starting with just fleeting thoughts of not wanting to be here anymore which you're very transient um come and go quickly all the way up to completed suicide and in between there are two major Dimensions um one is called non-suicidal self-injury where someone doesn't really have an intent to die but yet find some comfort some purpose some reward in harming themselves and then of course attempted suicides where the person wants to die but is not successful and that that represents the most significant risk factor for a future suicide okay so definitely something to keep in mind um before we go any further as far as talking about categories of folks um what type of demographics are being impacted by this the most all right one of the things that's been standard since we've had recorded for suicide is the fact that men are three times more likely to kill themselves than women really now a lot of that has to do with access to and ownership of firearms which are by definition extremely lethal uh women rarely use Firearms when they attempt to harm themselves um interestingly one of the most robust findings for decades has been older men and by that I mean over the age of 65 represent the highest risk group and there are some pretty important reasons for that um what is alarming is that over the last quarter Century there's been an alarming increase in youth suicide and by youth I mean ages 10 to 24 that kind of 14year range usually represents what we mean by youth so with this um what are some of the the factors the personal factors that may be influencing this um I know you said means access to firearms for at least the older demographic but what are we what kind of shift are we seeing societally that is maybe making this ideation uh more of a reality well that's a great question and and again we you know as a psychologist I have to be careful to draw a distinction between causes and correlation Association okay because we really can't say with certainty what causes any individual to kill him or herself there are unique part aspects of their life that we may or may not know about there are various risk factors um there are warning signs you know there are a number of things that could clue us but we do know that for the youth group for example um you know clearly social media which carries both positive and negative influences regarding suicide there are websites that you know teach how to kill yourself how to avoid being found or caught uh glorify or normalize suicidal Behavior but then there are a number of very important sites for kids that also um talk about Alternatives talk about seeking help talk about disclosing it to a friend or a family member um during the co era clearly the social isolation was a big issue yes um within the family greater EXP exposure to family violence and family conflict um those are just to name a few of the things that may be driving this but it's important to understand that this shift in youth suicide goes back to around 2007 is that just where the data's at or that is where the data it shows a 62% increase in youth suicide between 2007 and 2021 wow um so on this topic um there's a distinction between non-suicidal self- injury um and then suicidal Behavior so can we talk about what both of those look like so that we keep them straight yeah someone who um engages in truly suicidal Behavior has made it a decision that for whatever reason or reasons life is no longer worth living now my experience has been that there are two major factors when someone makes a serious attempt the first one is loneliness a lack of sense of belonging not being loved and then the other one is and this is why we find older men at high risk lack of a sense of purpose or meaning in life and and in fact one of the great people who has written extensively about suicide um Thomas Joiner uses the term perceived burdensomeness to refer to the fact that the individual feels like he is it's typically a he is just a burden and the world would be better off if he weren't in it any longer now those two things plus some prior experience with death dying or injury which takes away the fear that many of us have of um the pain you know one of the great deterrence to people killing themselves is the fact that they're afraid of the pain involved but if that's not an issue for you let's say a police officer or a surgeon someone coming back from the military they're not really afraid of pain pain and so if the other two factors are present we have a real problem mhm and so when it comes to all of these things um it almost seems like you can never seek help you can never reach out too early um but if someone is I mean struggling to take that step you know there might be shame involved there shouldn't be you know we want to love on um our people people but if we don't know you're hurting you know you can you can definitely miss these things so what is a family member what can you maybe try to be looking out for okay to try and help them that's a good question the first thing is to legitimize normalize talking about mental health in General within the family or within the community for that matter um and then to understand that the word suicide is not going to in any way prompt someone to start thinking about killing themselves if someone has Suicidal Thoughts they're already there the best thing you can do is get it out in the open to have Frank conversations now the hardest thing for people and even people in mental health honestly is that we tend to overreact MH and Eng like threaten to hospitalize someone yeah that shuts the person down typically and this is the hard thing to do but but the most important word in all of mental health is validation that is I understand that right now you feel like life is not living I respect that let's see if you can tell me a little bit more about that and see if maybe you know there is another way that you can approach whatever problem you're having never saying I will not let you kill yourself you can't kill yourself uh threaten hospitalization although that may be necessary down the road but but that's important to make it safe to talk about because most of the time when we catch it we can intervene and rather quickly help the person come up with an alternative MH I mean validation um obviously sounds great in theory and I I don't mean to step on toes but if I have a close love one who tells me that they're having these ideations I think Panic would go through my mind so as I'm trying to provide this validation um at what point am I not qualified to continue this this conversation when should we take see what those next options are mhm well obviously one has to be conservative and safer rather than sorry so I think that when someone tells a family member that here or she is having suicidal thoughts it's time to pick up the phone and seek mental health treatment that doesn't mean the person has to go to a hospital but it means get in touch with a school counselor uh Community Mental Health Center um a place like Horizon Health where we have a fullscale behavioral health uh team and um there are places such as the living room at uh Horizon Health where someone can go in anytime and just in effect check themselves in for a period of time and receive some sort of uh counseling but yes you definitely want to act but at the same time we have to avoid communicating any punitive kind of reaction so that the person feels this is a bad thing that I shared this and I'll be darn sure I won't share it again so it seems like that line is obviously very delicate just to lay that out there um there's a national hotline number as well is it 98 8 um we'll be sure to put it on the screen yeah the last four numbers are talk TK the National Suicide helpline yes but then there's nothing wrong with dialing 911 then getting emergency services and then hopefully um work one's way into the mental health domain so pivoting over to talk about um self harm so what uh what kind of things are folks were taking in what should we be on the lookout for what age groups any all of them I mean nonsuicidal self-injury is a fairly recent term okay and it is not an official diagnosis at this point however there is a lot of support for uh uh the next time the uh psychiatric py logical Bible is revised it will probably be there because we find that it cuts across almost all mental disorders and typically uh it's found with those with borderline personality disorder one of the main characteristics of which is hurting oneself cutting um headbanging um Reckless Behavior and the purpose for the individual is not to die but it's to find some way to relieve pain for example we find that many many adolescents are uh cut on themselves see the blood flowing and it gives them a feeling of control over whatever the situation is and it also provides some relief at a neurochemical level too um it appears bizarre behavior to others but yet it's something that they have found gives them temporary Comfort now it's temporary the problem they're trying to get away from is still there so as a long-term strategy it's not effective um we do know though that it is a risk for eventual suicide um about 8 to 10% of people with borderline personality disorder sadly will go on to kill themselves sometimes it's accidental because maybe they've hadit an artery instead of a vein um but it is something that is often dismissed because it's a nuisance Behavior Uh give you an example in the prison or jail World someone an inmate might cut on himself have to go to an outside Hospital costs the taxpayers a great deal of money everybody involved even the ER nurses and doctors who treat the person get tired of them so they tend to regard them as quote manipulators unquote when in fact they're suffering pain and have chosen a pretty ineffective way of dealing with it they are at risk for eventually though killing themselves whether accidentally or or finally becoming truly suicidal so it's a it's again a fine line and I always tell people today's so-called manipulator could be tomorrow's death due to Suicide I mean that has to be so difficult to navigate because like you say I mean if if it's a repeat person you know but that doesn't mean that they're any less deserving of your attention your diagnosis moving forward with care I guess quite so and and speaking of diagnosis it's probably worth pointing out that one of the main risk factors for suicide is having a major mental disorder I mean uh interestingly enough though we think of of people being depressed as at high high risk but in fact fact actually bipolar disorder what used to be known as um manic depression is the highest risk disorder for suicide and typically it's when a person is um in the manic State and he's getting pressure to take medicine which will level him out but in fact one of the characteristics of bipolar disorder is that the Mania is fantastic you feel on top of the world you feel like Superman or Superwoman so why would you want to go back to Baseline um and then as they begin to feel less euphoric they become at very high risk so what are the evidence-based treatments for suicide for self-injury it used to be thought that suicide can be treated by treating the disorder that the person has for example if you have major depressive disorder if we treat you with Psychotherapy and medication you won't be suicidal anymore that's not true okay there is a unique private logic that people have that's that's the way they frame things to make it legitimate to kill themselves and it's very hard to get inside of that but we do know know that if we target um for example cognitive behavioral therapy which essentially means we look at thoughts and behaviors that are not working for the person and attempt to replace those for example we challenge irrational beliefs we give people other ways of looking at things and then to look at more constructive behaviors that might meet their needs that has to Target suicide specific specifically so there are a number of cognitive behavioral therapies um and then for assisted for attempted suicide there's an interesting treatment that's four sessions with follow-ups for about two years that focuses in on the attempted suicide because every time one attempts suicide the risk for future suicide goes up for up to 20 years wow every sub quent suicide attempt keeps raising the risk that they will eventually succeed because they have framed it as a legitimate option to solve their problems and then of course for some cases there is no medication that treats suicidal Behavior specifically but again to the extent that it's a product of a disorder like depression bipolar disorder schiz phrenia medication treatment for those for the disorder is very helpful too but the gold standard for treatment of mental health problems for the most part is the appropriate medication and Psychotherapy and so we're in our last few minutes here um as far as getting into those types of sessions um getting connected with a provider such as yourself how does one go about that is are they referred um like as they're in maybe an emergency room after a failed attempt or how do they make that connection from maybe I don't even have a primary care doctor to getting into a specialist well you just identified the main pathway in that is through their primary provider okay now any walk-in clinic will be more than glad to refer someone for mental health treatment if it's an adolescent if it's a youth the school system certainly has those kinds of pipelines um direct self-referral you know as I said I mentioned the living room at Horizon Health is a place where anybody can walk in off the street literally in present for health and then they would be referred from there but the M the main thing I go back to is that within that family or within that peer group getting help has to be normalized there's still although we've come light years there still is a bit of a stigma about getting treatment for mental health problems which you don't find with people getting problem for medical or physical problems right particularly for men and if I had one thing to say it would be men be willing to ask for help because that is the population that is typically at higher risk for completed suicide and other really negative outcomes very well put I don't think um there's any better way to end our episode Dr Bill Elliot thank you so much for uh shining a light on this and uh we can't say thank you enough for trying to um validate these feelings very great pleasure thank you for having me of course and we thank our viewers for joining us for this episode uh just know you are loved you are valid you are important and if you need to seek help that is a okay we thank you for joining us for this episode and we hope to see you next time Carl is redefining Health Care around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to optimize Healthcare Carl with Health Alliance is always at the Forefront to help you thrive for over 50 years Horizon Health has been been keeping you and your family healthy and although some things have changed Horizon Health's commitment to meet the Ever Changing needs of our community has remain the same Horizon Health 50 years strong when Sarah Bush Lincoln opened in 1977 it was with the promise to serve the community's health care needs it has grown into a two hospital system with nearly 60 clinics that provide trusted Compassionate Care [Music]