Tuesday, October 11, 2016

Left behind after suicide

Left behind after suicide

Originally published: July 2009

People bereaved by a suicide often get less support because it's hard for them to reach out — and because others are unsure how to help.
Every year in the United States, 33,000 people take their own lives. Every one of these deaths leaves an estimated six or more "suicide survivors" — people who've lost someone they care about deeply and are left grieving and struggling to understand.
The grief process is always difficult, but a loss through suicide is like no other, and the grieving can be especially complex and traumatic. People coping with this kind of loss often need more support than others, but may get less. There are various explanations for this. Suicide is a difficult subject to contemplate. Survivors may be reluctant to confide that the death was self-inflicted. And when others know the circumstances of the death, they may feel uncertain about how to offer help. Grief after suicide is different, but there are many resources for survivors, and many ways you can help the bereaved.

What makes suicide different

The death of a loved one is never easy to experience, whether it comes without warning or after a long struggle with illness. But several circumstances set death by suicide apart and make the process of bereavement more challenging. For example:
A traumatic aftermath. Death by suicide is sudden, sometimes violent, and usually unexpected. Depending on the situation, survivors may need to deal with the police or handle press inquiries. While you are still in shock, you may be asked whether you want to visit the death scene. Sometimes officials will discourage the visit as too upsetting; at other times, you may be told you'll be grateful that you didn't leave it to your imagination. "Either may be the right decision for an individual. But it can add to the trauma if people feel that they don't have a choice," says Jack Jordan, Ph.D., clinical psychologist and co-author ofAfter Suicide Loss: Coping with Your Grief.
You may have recurring thoughts of the death and its circumstances, replaying the final moments over and over in an effort to understand — or simply because you can't get the thoughts out of your head. Some suicide survivors develop post-traumatic stress disorder (PTSD), an anxiety disorder that can become chronic if not treated. In PTSD, the trauma is involuntarily re-lived in intrusive images that can create anxiety and a tendency to avoid anything that might trigger the memory.
Stigma, shame, and isolation. Suicide can isolate survivors from their community and even from other family members. There's still a powerful stigma attached to mental illness (a factor in most suicides), and many religions specifically condemn the act as a sin, so survivors may understandably be reluctant to acknowledge or disclose the circumstances of such a death. Family differences over how to publicly discuss the death can make it difficult even for survivors who want to speak openly to feel comfortable doing so. The decision to keep the suicide a secret from outsiders, children, or selected relatives can lead to isolation, confusion, and shame that may last for years or even generations. In addition, if relatives blame one another — thinking perhaps that particular actions or a failure to act may have contributed to events — that can greatly undermine a family's ability to provide mutual support.
Mixed emotions. After a homicide, survivors can direct their anger at the perpetrator. In a suicide, the victim is the perpetrator, so there is a bewildering clash of emotions. On one hand, a person who dies by suicide may appear to be a victim of mental illness or intolerable circumstances. On the other hand, the act may seem like an assault on or rejection of those left behind. So the feelings of anger, rejection, and abandonment that occur after many deaths are especially intense and difficult to sort out after a suicide.
Need for reason. "What if" questions may arise after any death. What if we'd gone to a doctor sooner? What if we hadn't let her drive to the basketball game? After a suicide, these questions may be extreme and self-punishing — unrealistically condemning the survivor for failing to predict the death or to intervene effectively or on time. Experts tell us that in such circumstances, survivors tend to greatly overestimate their own contributing role — and their ability to affect the outcome.
"Suicide can shatter the things you take for granted about yourself, your relationships, and your world," says Dr. Jordan. Many survivors need to conduct a psychological "autopsy," finding out as much as they can about the circumstances and factors leading to the suicide, in order to develop a narrative that makes sense to them. While doing this, they can benefit from the help of professionals or friends who are willing to listen — without attempting to supply answers — even if the same questions are asked again and again.
Sometimes a person with a disabling or terminal disease chooses suicide as a way of gaining control or hastening the end. When a suicide can be understood that way, survivors may feel relieved of much of their what-if guilt. "It doesn't mean someone didn't love their life," says Holly Prigerson, Ph.D., associate professor of psychiatry at Harvard Medical School. Adds Dr. Prigerson, "The grieving process may be very different than after other suicides."
A risk for survivors. People who've recently lost someone through suicide are at increased risk for thinking about, planning, or attempting suicide. After any loss of a loved one, it's not unusual to wish you were dead; that doesn't mean you'll act on the wish. But if these feelings persist or grow more intense, confide in someone you trust, and seek help from a mental health professional.

Support from other survivors

Research suggests that suicide survivors find individual counseling (see "Getting professional help") and suicide support groups to be particularly helpful. There are many general grief support groups, but those focused on suicide appear to be much more valuable. In a small pilot study that surveyed 63 adult suicide survivors about their needs and the resources they found helpful, 94% of those who had participated in a suicide grief support group found it moderately or very helpful, compared with only 27% of those who had attended a general grief group. The same study found that every survivor who had the opportunity to talk one-on-one with another suicide survivor found it beneficial. These results were published in the journal Suicide and Life-Threatening Behavior (July 2008).
"Some people also find it helpful to be in a group with a similar kinship relationship, so parents are talking to other parents. On the other hand, it can be helpful for parents to be in a group where they hear from people who have lost a sibling — they may learn more about what it's like for their other children," says Dr. Jordan.
Some support groups are facilitated by mental health professionals; others by laypersons. "If you go and feel comfortable and safe — [feel] that you can open up and won't be judged — that's more important than whether the group is led by a professional or a layperson," says Dr. Prigerson. Lay leaders of support groups are often themselves suicide survivors; many are trained by the American Foundation for Suicide Prevention, which has a support group locator on its Web site (see "Selected resources").
For those who don't have access to a group or feel uncomfortable meeting in person, Internet support groups are a growing resource. A 2008 study comparing parents who made use of Internet and in-person groups found that Web users liked the unlimited time and 24-hour availability of Internet support. Survivors who were depressed or felt stigmatized by the suicide were more likely to gain help from Internet support services. Interestingly, people in urban areas were just as likely to make use of the Internet as those in more isolated places.
You can join a support group at any time: soon after the death, when you feel ready to be social, or even long after the suicide if you feel you could use support, perhaps around a holiday or an anniversary of the death.
Mental Health America of Licking County has a Survivors After Suicide Loss Support Group the second Tuesday of each month from 6:30 to 7:30 pm
For more information call (740) 522-1341
Local Crisis Information:
Suicide 24-Hour Crisis Line- 2-1-1 or (740)345-HELP
Mental Health Emergency Number- (740) 522-2828

Thursday, September 22, 2016

September Quite a Month at MHA

September was quite a month at MHA. It was Mental Health Awareness Month, National Suicide Prevention Awareness Month and Recovery Month. We know that one in five – yes, I said one in five – people experience a mental health issue every year in the United States. It’s really important to bring attention and awareness to the causes, signs and symptoms of mental illness so people can get help early and on the road to recovery.

Have you read Brandon Sneed’s recent article about The Ohio State University football coach Urban Meyer’s struggle with mental health concerns? I applaud Urban and his wife Shelley for speaking up. Any time celebrities share their lived experiences with anxiety, depression, substance use or other mental health disorders, their words go viral. I consider this phenomenon a gift to the one in five who also live with such a struggle. I hope that it opens the eyes of everyone around them to the fact that mental health concerns are normal, common and treatable.

For too long, our society has considered mental health issues as taboo. It’s time for that to stop. Did you know that breast cancer used to be treated the same way? People were afraid to talk about it or to be in the same room with someone afflicted with the disease. Thank goodness Betty Ford was brave enough to speak out about the fact that it could be detected early and treated back in 1974! Today, we don’t hesitate to offer all kinds of support to breast cancer patients and we celebrate survivors with pink ribbons and fund raisers galore. I look forward to the day that we treat people with mental illness diagnoses the same way.

In Sneed’s article, Urban Meyer is quoted as saying, “It’s no different to me than, say, a hamstring injury. You don’t just ignore a hamstring injury. And you have to address it.” It’s time we all start considering mental health issues the same as physical health issues. When your hamstring is hurt, you see a doctor and do all you can to repair it. When your brain is ill, the same thing should happen.

The price of not dealing with these issues as they occur is huge. On average people wait ten years from onset of symptoms to diagnosis of a mental health disorder, often not understanding what is happening until they’ve been hospitalized or jailed and are terribly ill. Outcomes would be significantly better if they could begin working toward recovery when they first notice their symptoms.

Suicide can be a tragic result of not addressing mental health disorders. Through August 22, we lost 23 individuals to suicide in Licking County. That is 23 too many. As a member of the Local Outreach to Survivors of Suicide (LOSS) Team, I have heard the heartbreak of surviving family members who have to figure out how to carry on following such a devastating loss. We are trying very hard to get the message out to people through our Suicide Prevention program that there is help available and that treatment does work.  

I hope everyone reading this will join MHA in thinking of mental health as a critical part of overall wellness, seeking prevention services for all, early identification and intervention for those at risk, and integrated care and treatment for those who need it, with recovery as the goal. Call us at 740-522-1341 if we can be of help to you in any way.

To your mental health!

Penny Sitler

Wednesday, August 31, 2016

Welcome to the 2016-17 school year

By Penny Sitler, Mental Health America of Licking County Executive Director

Welcome to the 2016-17 school year – it’s off to a steamy start. Does the start of the new school year fill a child you know with dread and anxiety? Do the academic and social pressures of high school make you want to run and hide? You’re not alone. The start of a new school year can be difficult for a lot of young people—and many students work through those initial fears and have a great year. Starting off the school year right means taking good care of your body and mind. Doing both can make a difference in how well you do in school, how well you manage change, your productivity and overall health.

Adolescent and teen years can be tough, and many young people struggle with low self-esteem and negative body image. Unfortunately, some decide to deal with those issues through destructive—and often dangerous—means. Recent studies have found that as many as one-third to one-half of adolescents in the US have engaged in some type of non-suicidal self-injury. Self-injury often begins around the ages of 12 to 14, most commonly as the result of feelings of sadness, distress, anxiety or confusion. Self-injury is often used as a way to cope with these negative emotions. Some may find themselves constantly preoccupied with a perceived defect or flaw in his/her physical appearance which may not be observable to others. Some may focus on the numbers on the scale and develop unhealthy eating habits that can put both mind and body at risk. Others may engage in body-focused repetitive behaviors like hair pulling or skin picking, which are related to obsessive-compulsive disorder and cause shame and isolation.

If you or someone you love is dealing with low self-esteem or poor body image, and is feeling depressed or is engaging in risky behaviors like disordered eating, self-injury or body-focused repetitive behaviors, there is hope and there is help. Mental Health America of Licking County (MHA) has tools and resources to inform both students and parents about why mental health matters, and how self-esteem, self-image and the disorders that affect the way young people see and treat themselves can affect a student’s overall health. A teen support group, Circle of Hope, meets Mondays from 4-5:30 pm at 65 Messimer Drive in Newark. Visit http://mhalc.org/?page_id=4181 to learn about more resources.

Issues of low self-esteem, disordered eating, self-injury, body-focused repetitive behaviors and distorted body image are treatable and should be addressed as soon as possible—before Stage 4. Just like physical illnesses, treating mental health problems early can help to prevent more serious problems from developing. If you are concerned that you or someone you know may be experiencing a mental health problem, it is important to take action and to address the symptoms early. Remember there is nothing to be ashamed of and there is help and hope. If you or someone you know is in crisis, call 211 or 1-800-273-TALK (8255). In life threatening emergencies, go to your local emergency room or call 911.

We at MHA wish everyone a happy, healthy school year. Call us at 740-522-1341 if we can be of help.

Friday, July 1, 2016

My week at MHAC Noyes

By Cara Noyes, DKG member, Music Specialist at Cherry Valley Elementary
    As a music educator, I never realized how 5-gallon buckets and drumsticks could have an impact beyond the walls of Cherry Valley Elementary School. I also had no idea how many folks are struggling with mental health issues (at least 1 in 5!) This summer, thanks to the STEP extern program, I had the amazing opportunity to see the impact of bucket drumming on mental health.
     From June 20-24, I was an extern at Mental Health America of Licking County (MHA).  The STEP program allows area teachers to connect to Licking County business and programs to form connections that are mutually beneficial.  In my week at MHA, I saw many connections to education.  I also foresee many applications of what I learned.

     Monday afternoon I attended a Circle of Hope discussion/social group for teens. One girl recognized me immediately and shouted “Mrs. Noyes! You’re our Special Guest? Awesome!” She told how Cherry Valley was “way better” than middle school. The MHA staff empowered three of the teens to lead the group; these girls devised a lesson plan of activities for the 90-minute session. We played a dice game, illustrated our favorite quote, and talked about facing the challenges of bullying, self-mutilation, low self-image and more.

     Tuesday I spent the day at the Y.E.S. (Youth Engaged in Service) Club. In summer, the clubhouse is open from 11 a.m. to 3 p.m.  Students receive a free meal, participate in organized group activities, and have opportunities for positive social interaction. MHA executive director Penny Sitler shared at the staff meeting that I play the drums, and I raved about the success of bucket drumming thanks to a Delta Kappa Gamma classroom grant. Since I have plenty of sticks and buckets at the school, I packed a dozen sets in the car. After lunch, the teens had fun learning “We Will Rock You” and other basic rock patterns.  Using YouTube, we listened to some of their favorite tunes and practiced playing along. Incredibly, this noisy activity captured their attention for over an hour! Y.E.S. club has a set of drums and other instruments. Who knows? Perhaps bucket drumming will lead to the formation of the Y.E.S. band!
     On Wednesday, I attended the Youth Advocacy Day Camp held at E. S. Weiant. Students were learning about connecting to their emotions using the Disney/Pixar film Inside Out.  The camp administrator heard about the success of bucket drumming at Y.E.S. club and asked me to return Thursday morning with the drums. We used the instruments to convey feelings of Joy, Fear, Disgust, Anger, and Sadness. The students loved making a joyful noise, experimenting with tempo, volume/intensity, timbre, and meter to convey what was in their minds and hearts.

     Also during the week I attended the Art of Recovery, a marvelous, laid-back open studio for art held at The Main Place on N. 3rd Street. MHA also sponsors The Art of Journaling class, where participants find creative ways to outwardly express their inner challenges.  I was amazed to see how recovering addicts were able to capture their pain and confusion on canvas or on paper, and they shared how good it felt to get the feelings out.  Back at MHA in a conference room, others shared feelings in the Depression/Bipolar Support Group (which meets weekly.)

     My week culminated with a Bridges Out of Poverty class called Getting Ahead.  The 18- session course “teaches participants financial literacy, budgeting, life skills, planning, goal setting, communication between socio-economic classes, creating resumes and interviewing skills needed for employment, managing change, managing stress and standing up for themselves.”  At the Spencer House, a 90-day halfway house on Granville Street in Newark, a group of 12 men gathered around the tables with MHA staff. The men discussed their progress in searching for and attaining jobs and apartments, getting social security cards, and planning for their drug-free, jail-free future.  The gentlemen inquired about my job as a teacher, and our session leader mentioned my affinity for drumming.  The guys were excited for hands-on, healthy noise making. As we took the buckets outside, they used pot lids as cymbals, ash cans for cowbells, and tried other creative sound combinations.
     One man shared that he, too, was a musician, a rapper. For the first time since being incarcerated, he shared some of his rhythmic poetry with the group as I laid down a beat. We were all stunned and awed at the depth of his artistry. He shared that rapping never felt so good, because for the first time he was doing it sober and clear-minded. 
     To my right, I noticed a young man whose percussion skills far outshined mine. We asked him to share a drum solo for us, and his beat was incredible! He shared that he was tops in his high school drum line and invested over $15,000 in percussion gear. Then he became addicted to drugs and sold it all to support his habit. That Getting Ahead class was the first time in years that he gripped drumsticks in hand, and his outlook totally shifted. Earlier in the class he had been sullen and disinterested; now his eyes were filled with energy. He asked me, “What do I have to do to get a set of these sticks?” I replied “Stay clean and keep playing.”  I left a pair of sticks for him at the front desk; I hope he keeps drumming. J
“The Vision of Mental Health America is to live in a culture which continually:
  1. Enables mental health awareness, understanding, respect and empathy
  2. Empowers people to live health lives and achieve their full potential
  3. Is free of mental health stigma, prejudice or discrimination
The Mission of Mental Health America of Licking County is to promote and continually reinforce mental health and wellness through education, prevention and advocacy, and eliminate the stigma of mental health issues in our community.”  (www. mhalc.org)
During my week at MHA, I saw this vision in action, and do they have a powerful mission in our county! I am so thankful to have seen how MHA affects so many in need in Licking County. I feel blessed that the classroom grant I received for buckets and sticks enabled me to make a difference outside the classroom. Above all, I look forward to all the future connections MHA will have with Newark City Schools to improve the mental health of my students and their families.


Cara Noyes, DKG member, Music Specialist at Cherry Valley Elementary 

Friday, June 3, 2016

Depression and Substance Abuse: The Chicken or the Egg?

Depression and Substance Abuse

There’s a saying in the recovery movement: Alcohol and drug addiction can cause mental illness but mental illness does not cause addiction. However, some mental illnesses, especially those that are not quickly diagnosed and treated, can trigger the use of alcohol and drugs.
Depressive disorders often cause acutely uncomfortable feelings such as overwhelming sadness, hopelessness, numbness, isolation, sleep disorders, digestive and food-related disorders. It is tempting, if medications aren’t being prescribed or used properly, for people suffering from depression to self-medicate.
This can compound the depression and make it far worse. A drink or two, a line of cocaine or two, might temporarily relieve some symptoms, but the backlash when the chemical leaves the body brings the depression to new lows. This “withdrawal depression” happens each time an abused chemical leaves the body, though many people don’t experience severe symptoms at first. The withdrawal depression itself can trigger the use of more alcohol or drugs because they will help get rid of the bad feelings.
Another compounding problem is that if drugs and alcohol are being used while medication is being taken, the alcohol or drugs can actually potentiate—make stronger—or deactivate the medication. Either way, this can put the person in medical danger.
Because of their personal life-shattering experiences with substance abuse, some people in recovery are leery of using any drugs, even prescribed ones. They have faced traumatic experiences with addiction and have a difficult time coming to terms with the necessity for medication intervention. In fact, I have had patients who have quit drinking or drugging the hard way—through willpower or cold turkey—yet are willing to endure the horrible symptoms of depression rather than take medication. Very often their social sober support network advises them to refrain from taking meds. Usually, this is not within the realm of the advisor’s authority. Dually-diagnosed patients (those with both mental illness and addiction) should speak with their psychiatrist about this issue, not a friend, no matter how well-intentioned.
One question I get asked frequently from addiction-treatment patients who are diagnosed with depression after they are diagnosed with an addiction is “did my drinking or drugging cause the depression?” The initial answer is always a resounding “maybe.” A well-trained psychotherapist will often be able to tease out the source of the depression and find out if it existed before the patient came in for addiction treatment. Therapists use a psychosocial evaluation and reports from family, friends, employers, court and police records and the like to help determine which condition occurred first.
Why is it important to know when the depression first occurred? Because someone who had depression before they began to abuse substances will most likely need treatment, including medication intervention, for a longer period of time compared to someone whose depression was caused by the cycle of addiction. Someone whose depression was caused by substance abuse generally will not need the same treatment as someone whose depression preceded his or her substance abuse.
Sometimes when someone comes in for addiction treatment and has a depressive disorder that was caused by addiction, they aren’t able to accurately report what is going on for them. They may be too numb or sad or unable to focus. Or perhaps a less-than-thorough psychosocial evaluation is done. Lack of reporting or inadequate evaluation may prevent the full understanding of whether the depressive disorder preceded or was caused by the substance abuse.
If a patient whose depression was caused by chemical abuse is referred to a treatment track for those who were depressed first and chemically dependent later, within a few weeks he or she usually is asking “what am I doing here? I don’t have these kinds of problems!” In these cases this isn’t necessarily a function of denial but a valid observation due to an original lack of understanding about whether the depression or the addiction came first.