Get Through the Crisis and LIve

I suppose if you live long enough, you gather some of those moments that are both vivid and vague – some mixture of surreal and so real.  As I think about one such moment in my life, I could describe exactly where I was, I could sketch the room down to the furniture placement and direction I was facing.  I know the date and the day of week.  What I cannot describe is the time of day, the weather or who called me with certainty.  Even the conversation is vague, but the reason for the call is vivid.  Too vivid.  My co-worker’s son, who was a 13-year-old 4-H member, had killed himself.  He was a delightful young man.  I was new to the job, so I had only worked with him for six months, but in that time, I was with him often through summer 4-H activities and after school programs.  He was an upbeat, energetic kid with an engaging and infectious smile.  I believe he acted impulsively that day, not truly realizing the permanence of his action.  

The day for him was a bit unusual.  He had gotten into some small trouble at school.  His mother had been called in and both were visiting with the school administrator when the alarm sounded for a fire drill, which meant he walked outside with his mom and the principal in front of the whole student body. He was given the choice between in-school or out-of-school suspension.  He opted for out-of-school.  His mom took him home, lined him out with some chores and went back to work.  When his dad came home, not much later… his son was gone.

I recently attended a training for 4-H Extension where one portion addressed youth in crisis.  As a former, and still certified, school counselor and teacher, I have had experience working with youth at crisis points.  One of my Extension colleagues was also formerly a school counselor and she made a salient point during discussion – all of us are counselors.  If a youth chooses to connect with you, you have been chosen by them for a reason.  My colleague encouraged us to be aware and to recognize the fact that we can all have enormous influence.  I think what she was trying to say is keep your eyes, ears and your heart open.  

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Montana has a high rate of suicide and has been among the top five states for nearly 40 years.  We tend to focus on youth suicides, perhaps because it seems like such a tremendous waste of potential life.  Maybe youth suicide bothers us because we realize that some of the things we once thought were huge challenges in our youth, only seemed so huge because we lacked experience in dealing with them.  The more challenges we face and conquer, the more we feel empowered to keep doing so.  I think, in the case of my young friend, he had never had anything that even slightly tarnished his otherwise stellar reputation before that day and he didn’t know how to handle it.  While to the adults in his life, his trouble may have seemed trivial and insignificant (or at least out of proportion with the cost of his life), to him, in that moment, it was monumental.  Certainly, no matter what age, some of what people are dealing with seems insurmountable, torturously difficult and painful.

Graphic used under license agreement from PresenterMedia.com

During the training, the instructor talked about how misunderstood suicide can be.  He spoke of the people who have attempted suicide at the Golden Gate Bridge in San Francisco.  Of the “jumpers” who have attempted suicide at the bridge, very few have survived.  However, and this is particularly important, of those who attempted and lived, when asked what their first thought was they went over the edge, the overwhelming majority said, “I wish I hadn’t done that.”  In fact, one jumper said, “I instantly realized that everything in my life that I’d thought was unfixable was totally fixable—except for having just jumped.”

A mid-century study followed up with 515 people who were prevented from attempting suicide at the bridge during a 30+ year time span revealed that indeed more than three decades later, 94 percent were still alive or had died of natural causes.   This study reveals that suicidal behavior is often acute and crisis-oriented.  It is quite likely temporary, if the person can make it through the high-risk period, which may be just a few months.  I have often heard it said that suicide is a permanent solution for a temporary problem.  

Which brings me back to my colleague’s comment that we are all counselors.  I’m not suggesting that we absorb responsibility for anyone else’s decisions.  For instance, the day that 4-H member completed suicide, I don’t know that I could have done anything to change the outcome, as I was entirely unaware of the events of that day, until it was too late.  Nor could any of the adults surrounding him have predicted the suicide based on previous interactions with him.  I do think, however, that if anything at all might have interrupted him, the impulse would have passed and he would have made it through what he perceived as a critical crisis.  You never know when you might be able to be that needed interruption.  

If you are in crisis and want help, call the Montana Suicide Prevention Lifeline, 24/7, at 1-800-273-TALK
(1-800-273-8255).  Reach out to someone.  There are people in your life and in your community who have their hearts open and want you to live.  

Graphic used under license agreement from PresenterMedia.com

The following resources were curated by Montana Department of Health and Human Development and can also be found on their website.

2014 US Suicide Data

2015 Montana Youth Risk Behavior Survey - Suicide Report

A Manager’s Guide to Suicide Postvention in the Workplace

A Prioritized Research Agenda for Suicide Prevention

Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment (SAMHSA)

After an Attempt

• A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
• A Guide for Taking Care of Yourself After Your Treatment in the Emergency Department
• A Guide for Medical Providers in the Emergency Department Taking Care of Suicide Attempt Survivors

After a Suicide Toolkit for Schools

Altitude and Suicide

Assessment of Suicide Risk using C-SSRS (please watch training video before using scales)

Bullying and Suicide Prevention- SAMHSA Webinar

Depression Management Tool Kit

Emergency Departments:  Caring for Adult Patients with Suicide Risk

Handbook for Recovery After a Suicide Attempt

Jail Suicide Study - 20 Years Later

Let's Talk Montana

• Let's Talk Billings
• Let's Talk Miles City

Means Reduction and Suicide

Media Guidelines for the Reporting of Suicide

Montana Strategic Suicide Prevention Plan-2013

Preventing Suicide: A Toolkit for High Schools

Preventing Suicide by American Indians

Primary Care Guidelines in Assessing Suicide Risk in Veterans

SAMHSA Suicide Prevention Toolkit for Senior Living Communities

Skills and Support for Coping with Suicidal Thoughts

Social Programs that Work - Good Behavior Game

SOS Flyer

State Suicide Plan

Suicide & Bullying

Suicide in Montana Handout

Suicide Mortality Review Team

• 2014 SMRT Final Report 
• Montana Code Annotated 53-21-1107 -  Montana suicide review team
• Suicide Mortality Review Team

Suicide Prevention: A Toolkit for High Schools

Suicide Prevention Toolkit For Rural Primary Care Providers

Suicide Prevention Resources for LGBT Youth

• Leader's Guide for Suicide Prevention amo`
  
  
  
  ng LGBT Youth Workshop
• Packet of Handouts for Suicide Prevention among LGBT Youth Workshop
• Suicide Risk and Prevention for LGBT Youth
• The Trevor Project

Suicide Survivor Handbook

Talking to Children About Suicide

Tools for Primary Care

• Basic scoring guide for Clinicians
• PHQ - Questions
• SAFETY Plan Template
• Safety Planning Guide
• Safe-T Protocol with C-SSRS

Warning Signs of Suicide

Warning Signs Poster

Youth Suicide Prevention Video

Zero Suicide

Hands and Head to Save a Heart

I was at a funeral once and somebody died. Unfortunately, it wasn’t only the person for whom the funeral was being held.  At the reception, somebody sitting behind me collapsed.  Her husband was attending to her, but it seemed like those of us sitting a table away were in slow motion.  I suppose we didn’t react quickly because people close to her were with her. Sometimes you want to give people privacy and not cause a scene.  As it looked like things were not improving, I asked the people I was with, “Should I go find a nurse?”  I suppose it just a few minutes, but when I asked the question, someone from my table jumped up and said, “Oh, I’m an EMT.”

It still seems strange to me that it took so long for us to react, even someone trained.  Had it been a cardiac arrest, even seconds count.  Starting chest compressions immediately can make all the difference.  Earlier this month, I was with 4-H members who received “hands only” CPR training.  The training video showed a man collapsing in a shopping mall and no one reacting.  I watched the video thinking that it was so unrealistic.  Surely someone would come to the rescue in such a situation, and then I remembered about the funeral. 

Kevin Lauer, who was teaching the class from Gallatin HeartRescue, gave some pretty amazing statistics.  According to their Facebook page, “The Gallatin Heart Rescue is a collaborative project focused on improving bystander CPR response to out-of-hospital sudden cardiac arrests.”  They have looked at locations where bystander or hands only CPR has been taught to a high percentage of residents and the cardiac survival rates are very impressive. In the Seattle area, 70% of residents have been taught bystander CPR and the survival rates for a cardiac arrest are above 50%; whereas, the rate is closer to 8% survival where the population has been less saturated with learning hands-only CPR.  Nationally, 92% of those who suffer sudden cardiac arrest die before they reach the hospital.

Since 2012, Gallatin Heart Rescue has been on a mission to improve the concentration of people who know bystander CPR and who will react quickly and confidently when someone needs help.  This week they reached a milestone of 25,000 people trained.  The survival rates in the Gallatin area have risen as the number trained to perform hands-only/bystander CPR has risen.  The program has been so successful that there is now a Montana Heart Rescue program.

They have some pretty dramatic video footage of survivors and their families.  One young girl, Annie age 9, whose father was a fit man in his forties, said, “My father had sudden cardiac arrest right after a very hard work out.  Luckily someone at his gym knew CPR.  That man save my dad’s life. My dad lives, but without CPR he would not be at the dinner table tonight.”  She makes a plea for people to take 30-45 minutes to learn hands-only CPR, because it may give someone years of their life. 

Locally, our Emergency Medical Services department also knows the benefit of training.  

In Teton County, staff at three major employers are trained yearly, as well as all of the local guest ranches.  All school bus drivers are trained yearly, as well as several school staff members.  Heart Saver classes are offered to the public every few months.  In Teton County, to receive training in CPR and First Aid, contact Deb Coverdell, Teton County Emergency Medical Services at 466-5552.

Success begins with bystanders knowing what to do and acting quickly. It is important to know how to call 911, how to start chest compressions and how to find and use an AED, automated external defibrillator. Take a few minutes to watch these two videos.  If we all do our part, people who collapse from sudden cardiac arrest can head back to the rest of their lives, instead of to their funeral.

 

Hearts: For Loving and Living

In a recent Strong Hearts Healthy Women class, we discussed the connection between stress and heart disease.  We discussed that often we have not been taught productive ways to deal with our emotions or stress.  Coincidentally, my mom and I were recently talking with a friend about her parents and their health.  I never met my maternal grandfather, Fenton Burgess, because he died of a heart attack at age 50.  Mom said one day he told my grandma he wasn’t feeling well and thought he’d go see Dr. Buker at the clinic.  He was sitting in the waiting room when he dropped over and died from a heart attack.  The family knew of three other heart attacks that he had, but his autopsy showed enough scarring in his heart to indicate that he had perhaps had several more prior to the final one.  I know Grandpa Fenton smoked, which is a contributing factor, but while my mom was telling the story, she added a piece I had not heard before about Grandpa.   She said, “He struggled with his temper.” 

Studies have shown that people with a quick temper are at greater risk of suffering a heart attack or dying from heart disease.  Quick anger, or hostility, may increase blood pressure and contribute to the hardening of the arteries or atherosclerosis.  How emotional and physical changes in the body are linked is a fascinating area of research. Physical changes based on emotions, such as anger, can cause damage to the cardiovascular system.

Years ago, when I first moved to Teton County, I had the pleasure of attending a class in Browning, where I listened to an eloquent and wise women talk about disease in our society.  She broke down the word, “dis-ease,” and reminded us that any time your mind was not at ease, the body would find a way to manifest the situation and often it was in the form of disease.  In addition to temper, depression is found to have links to heart disease.  Depression is reported more in women. 

One of the natural ways to manage both anger and depression is through exercise.  Our Strong Hearts class participants thought of many positive mechanisms to cope with negative emotions.  The list included finding a walking partner or exercise companion, or volunteering to reduce social isolation and bring meaning to life.  Pets have long been recommended as a therapy for depression.  Yoga, Tia Chi, meditation and prayer also made the list.  Purposeful stretching and breathing can be beneficial.  There are many breathing exercises available, but one we tried in class was inhaling through the nose for a four-count beat and exhaling through the mouth for a six-count beat. 

We talked about some of the unhealthy responses such as overeating, over-consuming alcohol and smoking. Some newer negative tendencies may include binge consuming media, whether video or social media. Some concerns were raised about constant interruptions our devices and our world provide and how regaining purposeful focus can be so instrumental in reducing stress. In order to reduce stress, we may need to set boundaries as to when and where we respond and how often we take a break from social contact. Perhaps you’ve heard of FOMO, or the Fear Of Missing Out. In a March 2014 post, Forbes author Kristi Hedges put it this way, “You might have FOMO if you constantly check social media and email. This isn’t about logging into Facebook a few times a day; this is feeling antsy if you can’t be connected at all times. We like to blame our work cultures for forcing us to always be available on email, but in my experience, it’s more often a choice the person makes. After all, we train people how to treat us.” I think, in addition to exercise, meditation and breathing, we will need to learn how to disconnect to reduce stress. At the beginning of the year, I took four days to renew and refresh, and probably most importantly, to disconnect. I didn’t leave my house, didn’t answer any phones or emails and minimized my interaction with others. Sometimes, we just need to recharge for our mental and physical health.

This photo of Grandpa Fenton was on
display in our home.  It always made me
wish I had known him.  

As you think about the mind and body connection, you may want more techniques for dealing with the stress in your life.  The MontGuide, “50 Stress Busting Ideas forYour Well-being” may be a good resource for you.  I wish my Grandpa Fenton would have found some better ways to cope with his stress, so I might have been able to meet him. It is best to get a handle on your stress, not just for your heart, but for those you love, some of whom you might not have even met yet. 

Invite Yourself to Eat Healthy Foods

In anticipation of holiday treat platters inviting me to sample sugary treats all week, I decided to build a small perimeter of defense.  I spent a bit of time last Sunday evening chopping vegetables, lettuce, spinach and kale to assemble some stacked salad combos to have ready for lunches all week.  The hard-cooked eggs, garbanzo and black beans were ready to add protein to the salads to sustain us through the day.  It had been more than year since I spent a Sunday evening chopping and preparing salads for lunches.  I think at one point, I had a salad for lunch most every work day for six months.  Isn’t it strange how a disruption can throw you off of a good habit?  A year or so ago, I was preparing the salads in wide-mouth quart jars.  They looked so pretty lined up in my refrigerator.  Last week, I put the salads in glass bowls instead.  Since I layer the salads, they are not as easy to eat from a jar.  The salad fixings mix better while I’m eating them from a bowl.  I suppose I could use plastic storage containers, but somehow the opaque plastic hides all the inviting colors of the tomatoes, carrots, broccoli and beans.  It seems if the food is prepared, easily accessible and visible, it gets eaten.  I suppose knowing that simple fact is half the battle in daily health habits.

It is surprising how we unwittingly invite ourselves to make food choices.  It is no surprise that the plate of chocolate fudge, peanut butter balls, caramels and cookies that is on a glass platter sitting on the counter invites us to nibble and nosh, even when we didn’t mean to do so.  I may have just gone to the kitchen for a glass of water, but if that goodies selection is sitting there staring at me, it is unlikely that I will leave the kitchen with just my glass of water.  The good news is that we can learn to make healthier foods just as inviting.  Have you ever done a household food andnutrition assessment? 

Instead of coming home from the market and putting the produce in the vegetable drawer, prepare it in ready-to-eat packaging.  A bag of carrots can sit in the back of the vegetable drawer for a long time without anyone being “invited” to eat them, but, get them out and peel them, chop them and put them in a glass container in the front of the refrigerator and they’ll invite every person who opens the refrigerator to consider the carrots as their next snack.   There are many consumer and food psychology principles we can put to work for us.  One of my favorite consumer psychologists is Dr. Brian Wansink.  A quick web sear

ch will reveal many videos as well as a list of books he has authored.  Dr. Wansink is famous for the discreet food invitation.  From school cafeterias to business lunches, he purposefully revamps food service opportunities as part of his research.  He has spent considerable time discovering the subtle changes in where foods are placed, how they are served, what containers we use and how it all comes together to suggest and influence our choices – healthy or unhealthy.  In one school cafeteria makeover, placing fruit at the front of the line in an attractive bowl dramatically increased fruit consumption.

 

Store nutritious foods where they are easier to access than less nutritious foods.  It is easier to keep on a healthy track if the healthy choice is the easy choice.  I invite you to think about your own food and nutrition environment and how you can invite yourself to make healthy choices.  

Unwrapping the Gift of 4-H

On December 23, youth from Teton County shared in the gift we call 4-H at a project day event.  Older 4-H members had been invited through the county 4-H newsletter to teach classes for the project day planned for the afternoon of Wednesday, December 23, a time when all schools in the county were closed for holiday break.  4-H members who provided leadership included Daniel Asselstine, Delaynie Beadle, Michaela Gunderson, Ben Roeder, Watson Snyder and Annie Townsend.  Each of the older 4-H members either planned and taught or assisted an extension agent teaching a class.  The learning was also supported by 4-H alum, Katie Townsend, and MSU Extension Teton County Administrative assistants, Jamie Smith and Rhea Brutosky.

After 20 youth had sewn tote bags, sewn owl-shaped rice bags, baked and decorated cupcakes, learned about synthetic vs. natural fibers, made felted wool canning jar cozies, sheared sheep, learned jitterbug and two-step moves, made survival bands, painted chalkboard coasters and decorated gift bags, the group of 4-H members talked about the way people give their gifts to others.  One of the 4-H members learned her cake decorating skills from a volunteer 4-H leader and brought the gift forward to share with others.  Another 4-H member learned her sewing skills from her mother and with the help of evaluators/judges at sewing contests and was sharing that skill not only at 4-H project day, but also by helping younger 4-H members individually and through her club.  Another 4-H member gained dance skills from his parents and neighbors and then continued self-study using internet resources.  We talked about how important it is when someone shares the gift of their time and talent with you to wrap up that gift and present it to others.  4-H is one way to keep gifts giving well into the future.

 

To complete the project day, Extension Agents Brent Roeder and Jane Wolery discussed with youth that the 4-H members already contained the necessary gifts to excel on a local, state and national level.  However, 4-H members need to know what is available and how to unwrap a larger goal into smaller pieces.  Several 4-H members had personal experiences they shared related to opportunities, such as Rec Lab, interstate and international exchanges and National 4-H Congress.  The group discussed about 30 different 4-H opportunities and events just waiting be unwrapped by Teton County 4-H members.  

We invite you to think about the gifts you can give to others in 2016.

Here is a small sampling of opportunities available through 4-H (listed in no particular order).  To learn more, contact your local MSU Extension agent in your county.

1.  Ambassador program
2.   State officer
3.   Interstate Exchange
4.   State 4-H Congress
5.   Camp Counselor
6.   Rec Lab
7.  Winter Teen Camp
8.   State Leadership Forum
9.  State Award
10. National 4-H Congress
11. National 4-H Conference
12. Citizenship Washington Focus CWF
13. Leadership Washington Focus LWF
14. Make It with Wool MIWW
15. IFYE Program
16. Japanese Exchange
17. Natural Resources Camp
18. Nile Merit Heifer
19. Ag Youth Loan programs
20. Livestock judging and evaluation
21. Fall Ambassador training
22. Communications Contest
23. Alberta Leaders Forum
24. Citizenship Seminar
25. Horse and Livestock Leaders Forum
26. State Horse Show
27. Western Heritage Shoot
28. County Textile Show
29. Range Camp
30. Western National Round Up

That Invitation Keeps Ringing

My head finally got to the pillow at one o’clock this morning, so when I shut my alarm off just a few hours later at 5:45 a.m., it was hard to remember that I set it as an “invitation” to my morning exercise routine.  The alarm is just one part of an invitation to exercise. I also have my shoes and exercise clothes set out, making them easy to grab in the morning.  I usually have a device ready with an audio book to listen to or an old TV series to stream while I start my day on the elliptical. 

There are several strategies to use when “inviting” yourself to exercise.  One of the classes I taught, 4-Health (which was for parents of teens and preteens who were trying to establish healthy households) suggested doing an “activity inventory” of the home.  The inventory or checklist asked families to go room by room in their homes to see if equipment that would encourage activity was available and easily accessible.  Having supplies and equipment ready to use makes a considerable difference in the items getting used.  Families were encouraged to make sure that balls, jump ropes, bikes, skates, sleds, etc. were easy to find and use.  That list of “exercise equipment” makes me think that exercise sounds a whole lot like play. Sometimes it is easier to answer an invitation to play than to exercise. 

Families in the 4-Health class were encouraged to take breaks from sedentary periods for active play. For instance, if watching TV, get up and do a jump rope challenge during the commercials.  For commercial-free sedentary activities, a timer can be used as a reminder or invitation to get up and move.  Families were able to set up simple and fun activity challenges, such as obstacle and relay courses.  One group had a bucket at the bottom of their stairs that they threw ping-pong balls into and when they missed, they ran down the stairs and back up for another try.  Another group designed a foam ball and somersault activity in their hallway.  Sometimes all it takes to be active is a little creativity and an invitation.

Of course, like play, exercise is often more fun with more than one person.  Another common way to incorporate motion into your day is to make it social.  Invite a friend to join you.  You are less likely to talk yourself out of exercising, if you know someone has arranged their schedule to join you. 

Take a look around your home to see if you can find any “invitations” to be active.  If not, it is time to start delivering some invitations.  Put a basket of hand or ankle weights by your favorite chair, set out your exercise clothes and set your alarm, even if it is for a mid-afternoon stroll.  I think I’ll start working on inviting myself to put my head on my pillow a little earlier, because a good night’s sleep makes it much easier to accept the invitation to get out of bed and exercise.

An Invitation from the Stairs

I was sitting at a table with colleagues at a conference, when one of them asked me what I was enjoying most about the conference center. I didn’t even hesitate and answered, “The stairs.”  I went on to explain that I loved the large, beautiful, open staircases at the conference hotel, which had been built around 1910 and was refurbished in the late 1940's.  I said I loved the way the wide staircases were such an invitation to use the stairs.  We then discussed how none of us had even really looked for the elevators, since the staircases were such a prominent architectural feature.  Now, I have nothing against elevators, and since many of my family members have used wheelchairs, I think they are a necessary part of any public building that has more than one floor.  However, it is unfortunate that somehow, when elevators were added, stairs were hidden – no longer the open invitation they had once been. 

With the invitation these stairs offer, there is no need to look for an elevator. 

There are many invitations in life that we don’t even notice, but that create daily habits.  My colleagues agreed that they had taken way more flights of stairs than normal, simply because of the structure of the building.  A week after I returned from the conference, I was in Bozeman on the MSU campus for a few days.  While I was there, I stopped into Joel Schumacher’s office.  He is an associate specialist in Extension Economics. I told him how much I liked the way that the parking situation on campus invited me to walk everywhere.  Of course, working on campus and dealing with the parking situation daily, he thought I was crazy.  Each day I was on campus I walked from buildings on the south end to buildings on the north end of campus.  It would have been ridiculous to drive, as it would have taken more time circling to find a parking space than it would have taken to walk.  I don’t know for sure, but I suspect I could walk most of main street in Choteau in about the same time and distance as I got across campus, and yet, parking is easy here, crosswalks are not as well marked as on campus, and there aren’t bunches of other people walking; and somehow, I just do not make it a habit to walk to do my errands. 

The stairs in this hotel are so grand and indeed, this flight takes you a half-level to the grand piano and then onto the main lobby.  

4-H BioScience on MSU campus.

This has been an unusual year, as I’ve been on campus nearly once a month since last spring. I’ve been paying attention to how the built environment either invites or discourages us from daily healthy choices.  Joel and I were visiting about how the buildings on campus, built in different eras, reflect not only structural choices, but health choices.  For instance, when I stay in the Hedges dorms (built in 1965), the elevators and stairs are in the same general location, but the stairs are in stair wells.  I think there is a reason they are called wells.  They feel cold, dark and cavernous -- not exactly an invitation.  Joel mentioned that in one of the new buildings on campus (I’ve not been in yet) there is a prominent, open staircase as part of the design. Maybe we have remembered something at the turn of this century that we knew a century ago.   I worked in the courthouse in Sheridan, Wyoming, which was built in 1905. It had a gorgeous oak staircase that summoned me to use it often during the years I was there.

I invite you to start looking for and taking the stairs.   Start walking to do your errands -- just seeing you walking may be enough to encourage others. Start paying attention to your environment and listen to the ways it invites you into your habits.  If you find that the invitation isn’t in favor of your health, refuse the invitation and create a new habit.  Structure your life, so that you are invited to make healthy choices.