My First Suicide: A Portland Experience

She helped me get into counseling and I was diagnosed with post-traumatic stress disorder PTSD and depression. The solution to my condition was quick, effective, and painless, yet I was convinced that death was my only option. The timeline of these events — from the onset of physical manifestations of PTSD to my suicide attempt — occurred over the course of two months. Time passes differently for people suffering from depression; what felt like a couple of months to my mother felt like a year to me. Months after, I was still working for the same company, but had moved to the accounting department.

I was recovering from my mental illness and on medication. Life was relatively good, if not challenging in all of the normal ways. Then, one day, I was making inventory adjustments on index cards and nodded off briefly. It reminded me that I am not the illness that is affecting me and that recovery lasts long past feeling normal again. However, what we all have in common is that, in these dark moments, we are completely and utterly alone without the strength to search for and grasp a lifeline.

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In these moments, we need you — our family, friends, and co-workers — to reach out for our sinking hand and, with your strength, pull us back to the surface. Lifesaving Points to Remember. Practical Steps for Suicide Intervention It is important to acknowledge that not everyone is fully equipped to help someone who is battling depression and suicidal thoughts. But, everyone can be a first lifeline by helping to identify there is an issue and assisting on the road to recovery.

If you are concerned that someone may be suffering from depression, suicidal thoughts, etc. If you feel unsuited to help someone who may be suffering with suicidal thoughts, let your safety manager or HR manager know and they can take over. How is life treating you? Any suicidal thoughts or thoughts about self-harm are a potential precursor to suicide completion and an indicator of the need for professional intervention. Talk Details Perhaps a co-worker who you suspected was having a hard time has just confided in you that they are having suicidal thoughts or thoughts of self-harm.

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Get as many details as they are comfortable sharing so that you can intervene more effectively. Ask how often they think about it. Ask what kind of plan plays out when they think about it. Call their partner, or if they live alone, invite them to stay with you or invite yourself over. If the plan involves a lethal means available at work, inform the safety manager or HR to prevent that employee from accessing any lethal means. Hold Space Being there for a person with severe depression requires that you abandon all judgement. We must listen, affirm, and hold space.

Holding space means to save a place in your life where that person can exist in your orbit, free of judgement, and receive whatever it is they need in that moment — whether it is reassurance, silent comradery, or intervention.

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Relate to them how important they are to you personally. Depending on your knowledge of the person, be wary of mentioning their family or the importance of family, as that may be a prime source of stress for them. Tell them you want to help because you value them and want to see them experience success and happiness. Provide Resources Put them in touch with HR or the safety manager to access mental health services.

Make sure they have the National Suicide Prevention Lifeline saved in their contacts and send the first message to the Crisis Text Line text HELLO to for them so that they have it saved, making it easier for them to start up a conversation. Ask them who else they have to talk to and write down a list with them. Help form an action plan of who to contact when things get bad. Could you imagine your gynecologist was a different doctor every time you put your legs on the stirrups?

Veterans worried that acknowledging thoughts of hopelessness or desire for death would be misinterpreted by the screener as active suicidal thoughts. For example, they often felt their future was bleak or wished they were dead but insisted they would not attempt suicide. They felt this was important to explain and clarify and to expand on in the screening process. They were also concerned that endorsing any suicidal ideation questions might lead to untoward and deleterious consequences.

They worried that the provider might misjudge their safety and overreact by hospitalizing them, perhaps involuntarily—psychiatric hospitalization seemed countertherapeutic to many Veterans. As with worries about stigma, this perception had its basis in experiences in the military. Several had vivid memories of suicidal soldiers emergently restrained and guarded in the field, or emergently evacuated for mental health reasons.

The disclosure of suicidal ideation was enhanced in the context of consistent providers who knew the patient well and were trusted. He actually sat down. He talked to me. He looked at me. Attempting to suppress and avoid thoughts of suicide was experienced as burdensome and exhausting to Veterans. While admitting suicidal ideation was often experienced as initially frightening and shocking, eventually it was followed by a sense of relief. Suicidal thoughts, once admitted, resulted in greater tolerance of the assessment process and discussion of suicidal thoughts in the future.

That day I just really got tired of it…I just wanna put it out there because my personal life was taking huge hits, I knew it was from PTSD and it was time to just access it rather than ignore it. Providers should focus on relationship building with suicide risk assessment defaulting to the provider who knows the patient best. The provider should demonstrate empathy and communicate genuine interest.

Finally, written and spoken communications should focus on understandable and direct language, which can form the basis for Veteran trust that honest disclosure about suicidal ideation will ultimately lead to improvement in their situation. Examples of potential interventions by providers or by the health system are given, though the need for more research on the effectiveness of these interventions is underscored.

This qualitative study explores the experiences of being assessed and screened for suicidal ideation during routine, non-mental health visits in VA facilities among Veterans who served in recent conflicts and were returned from deployments in Afghanistan and Iraq.

Assessment rates were higher at sites that incorporated triage nurses and medical assistants into the screening process. There are several limitations to our study. In addition, Veterans with concerns about screening, or those more open to discussing thoughts of suicide, may have been more motivated to participate in this research. Our study challenges the use of routine screening for suicidal ideation as currently implemented at some VAMCs, particularly if administered in the context of routine medical screening or by triage personnel.

Similarly, Hoge and Castro 16 summarize the current literature by pointing out the low predictive value of current tools for suicidal ideation screening in primary care, lack of information on deployment related screening, and unwillingness of many service members to truthfully report concerns, with the risk of adverse treatment effects, reduced patient satisfaction and treatment withdrawal. The domains identified may not only lead to provider and system level improvements, they may form the basis for further research in this area.

In addition, approaches found useful in eliciting socially sensitive information in other topics such as drug use should be explored. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

The authors declare that they do not have a conflict of interest. National Center for Biotechnology Information , U. J Gen Intern Med. Published online Apr Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Electronic supplementary material The online version of this article doi: Interview Guide The interviewers included a psychiatrist LG , who completed over half of the interviews, an internist, who was also director of a VA post deployment clinic DH , and a research assistant with background in social work MH.

Data Analysis Audiotapes were transcribed and de-identified.

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Acceptance and Appreciation of Suicide Ideation Screening Veterans appreciated several aspects of the suicidal ideation screening process. Criticism of Suicidal Ideation Screening At times, the suicidal ideation screens were experienced as painful and shameful reminders of previous suicide attempts. Barriers to Disclosure of Suicidal Ideation Some Veterans had pervasive difficulties admitting thoughts of killing themselves, or acknowledging the severity of their suicidal thoughts, that they needed help from others, or could not manage on their own.

Consequences of Disclosing Suicidal Thoughts Attempting to suppress and avoid thoughts of suicide was experienced as burdensome and exhausting to Veterans.

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Screening should be completed, when possible, by a provider who will complete SRA. Repetitive screens should be avoided. Providers should explore misperceptions about disclosure of suicidal thoughts. Patients should be given time to clarify thoughts of death and suicide. Questions should be couched in a personal, not medical, context.

Communication Language should be straight forward, direct and understandable. Providers should face the patient and maintain appropriate eye contact throughout screening and SRA. Providers should not fill out forms or make computer entries during the screening or SRA. Screening and SRA should be as conversational as possible. Information Providers should describe treatment options and type of treatment to expect in mental health. Patients should have information presented in plain language, including the rationale and goals of suicide screening and SRA.

Patients should be presented information explaining rationale of medications and hospitalization, right to refuse medications, and conditions under which patient might be hospitalized involuntarily. Providers should clarify whether goals of screening are triage or treatment. Patients should be warned that they are likely to be asked about suicidal thoughts at future appointments and the reasons for being asked again should be explained.

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Open in a separate window. Conflict of Interest The authors declare that they do not have a conflict of interest. Suicide mortality among patients receiving care in the veterans health administration health system. Suicide among male veterans: J Epidemiol Community Health. Suicide prevention among veterans: Accessed November 6, Department of Veterans Affairs. Accessed October 25, Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. Suicide risk assessment and content of VA health care contacts before suicide completion by veterans in Oregon.

Attitudes towards clinical services among people who self-harm: The Discovery of Grounded Theory: Strategies for Qualitative Research. Aldine de Gruyter; Strauss AL, Corbin J. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Preventing suicides in US service members and veterans: Support Center Support Center.