Saturday, April 2, 2016

Build the Bridge to Connect People

Build a Bridge to Connect People

Graphic used under license agreement from PresenterMedia.com


When I attended a recent training on youth in crisis, the instructor spoke about suicide. Because of my degree in counseling, I was not surprised to know that Montana ranks very high in suicide rates.  What did surprise me, though, was a statistic that in the United States in 2012, middle-aged people (45-64 years) had the highest rate of suicide, followed by the elderly (64 and older) and then the young.  Men over the age of 65 have a rate of suicide that is nearly seven times higher than that of women over age 65.  The statistics startled me and compelled me to study further.
As it turned out, the Town and Country Homemakers group in Dutton, who I’ve had the pleasure of working with several times a year for nearly two decades, were looking for an educational program for their March meeting.  I quickly volunteered to teach on the topic of seniors in crisis and suicide in the older population.  
I often find myself as much the student as the teacher with this wonderful group.  Their role call for the meeting was to tell about a time when they were struggling and someone helped them.  Years of life experiences poured out, with the critical message that each crisis passed and someone had been integral in pulling each of them through a dark point in their lives.  The group then went on to their business meeting, some of which involved purposefully considering others who might need company or correspondence.  It seemed one of the main goals of the meeting was to provide points of connection with those who might need it.  It warmed my heart, because the lesson I had prepared included statistics about suicides, signs for suicide and successful prevention of suicide. According to the Montana Strategic Suicide Prevention Plan 2015, one of the suicide risk factors in the elderly includes social isolation and loneliness.  This community-minded group was already working on their own prevention plan.  They gather each month.  During every meeting there are announcements about other community events.  They plan activities to look forward to as a group.  They make an effort to connect to others who might find themselves isolated or going through a rough transition.
Some of the other risk factors for suicide among the elderly include bereavement, perceived poor health, undiagnosed depression, major changes in social roles such as retirement or moving, and financial insecurity.  Also, physical illness, particularly uncontrolled pain, contributes.  However, very few (2-4%) elderly people who complete suicide have been diagnosed with a terminal illness at the time of their death.  
Some of the factors that protect people from suicide include social activity, established social support network, pets and restricted access to lethal means.  In Montana, 63 percent of suicides are from firearms – a particularly lethal means.  It is suggested to have firearms locked and to also have trigger locks.  I’ve heard the recommendation that ammunition and firearms be housed separately.  Anything to make it more complicated or take more time can create a preventive barrier.  Sometimes a delay of even two minutes is enough for someone to change their mind or to have their attempt interrupted.
There are often warning signs before a suicide attempt.  When someone says he should just kill himself or if she talks about ways to kill herself, it is called ideation.  Pay particular attention if a person is unusually focused on death, dying or suicide or if they are unusually seeking access to firearms or pills.  Any time someone expresses that they are considering suicide, it should be taken seriously.  Increased alcohol or substance abuse can be a warning sign.  Starting to give things away or neglecting to take care of themselves or their own hygiene are signs.  Withdrawing from friends and isolating themselves are also signs of concern.  
A way of offering hope is through QPR.  QPR is a technique to offer hope and stands for Question, Persuade and Respond.  In the same way that CPR can keep the heart beating and the blood circulating, using QPR for someone close to suicide can be lifesaving.  It is a very direct approach.  If you suspect or are worried about someone contemplating suicide, ask directly, “Are you thinking about killing yourself?”  You can provide a softer lead, if you want, acknowledging your observations, “You have seemed pretty upset and miserable lately.  Sometimes when other people get to that point, they wish they weren’t alive.  Are you feeling that way?”  Avoid anything judgmental.  It is critically important to remember, this is about them, no matter how you might be impacted.  If they are at the point they are considering suicide, you need to park your own feelings.  How they feel and what they are thinking should drive the conversation.
If they answer that they are thinking about suicide, persuade them to stay alive.  They are considering suicide as a solution.  Find out what the problems are.  Validate their feelings.  Try to really understand, and offer hope in any form.  Ask if you can get them some help.  Even your time listening to their problems is likely to be helpful and hopeful for them.  You may even persuade them to postpone any suicide decision until they have tried some other potential solutions.
Imagine the despair that a person must feel when they reach a point that they are considering ending their life.  They may feel helpless, so the next step is to refer them to help.  It is best if you can take the person directly to help, whether the emergency room, a counselor, clergy or police.  You can also get a commitment from them to accept help and start making the arrangements for a time in the very near future.  If neither of the first two options work, try to get a promise for them to schedule time with a therapist and to not attempt suicide.  
At the Golden Gate Bridge, a site of many suicides and attempts, officers are trained to spot potential jumpers.  One officer has had particular success intervening and has persuaded more than 200 people to reconsider.  His technique is much like QPR.  He asks how they are feeling, and I suspect he is particularly skilled in listening and reaffirming.  He asks them about their plans for the next day.  If they don’t have one, he helps them make a plan for tomorrow, which, in a way, is asking them for a commitment to their plan for tomorrow.  

While many of us are not specially trained to look for signs of suicide, many of us can still build the bridge to human connection.  Sometimes an act as small as a smile can be a huge acknowledgement, and a heartfelt conversation can be a lifeline.  As the women in the Town and Country Homemakers know, connection can make the difference.

Click on any of the links below to connect to more information.

 Here are some resources from MSU Extension:


Handling Challenging Times

 Understanding and Managing Stress

 Helping Friends Cope with Financial Crisis

 Depression: What You Should Know

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
After an Attempt
After a Suicide Toolkit for Schools
Let's Talk Montana
Primary Care Guidelines in Assessing Suicide Risk in Veterans
Suicide Mortality Review Team
Suicide Prevention Resources for LGBT Youth
Tools for Primary Care

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Thursday, March 31, 2016

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.  
Graphic used under license agreement from PresenterMedia.com
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
After an Attempt
After a Suicide Toolkit for Schools
Let's Talk Montana
Primary Care Guidelines in Assessing Suicide Risk in Veterans
Suicide Mortality Review Team
Suicide Prevention Resources for LGBT Youth
Tools for Primary Care

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Wednesday, March 2, 2016

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.



 

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Monday, February 22, 2016

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. 
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