Small Differences Add UP

My last couple blogs have been about the large impact small differences can have. Over time, these small differences can grow to become significant differences. I have 2 examples for you to consider.

“Make your bed.” This could be something you remember hearing when you were a child, but as a commencement speech at the University of Texas?  Not a topic you might expect.

This, however, was the title and theme of Admiral William McRaven’s (US Navy Retired) address to the 2014 graduating class at the University of Texas. He then expanded his address into an excellent book by the same title. You can watch the video of his commencement address here.

Admiral McRaven’s point is that the act of making your bed every day, and doing it well, can give you the lift you need to get started. “If you want to change your life and maybe the world – start off by making your bed (p. 8).”

The second example is a short video by Stephen Morris of a domino chain reaction. We’ve probably all stood up a line of dominos then delighted in knocking them over, right? Stephen’s dominos, however, begin at a tiny 5mmX1mm domino and grow to the largest at over 3 feet tall and weighing 100 pounds. Each of the 13 dominos is successively 1.5 times larger than the prior domino in the chain.

Stephen’s point is that the energy in standing up and tipping the tiniest domino over into the next largest can eventually lead to knocking over the large 100 pound domino at the end of his chain reaction.

Small differences can grow to become significant differences much like the pace of a camel walking across the horizon significantly altered the course a colleague and I took while driving in the desert during the First Gulf War (see Camels, Compasses & 1% Better).

Your smile, your encouraging word, your small act of kindness may have a significant positive impact in someone else’s life. Just try it.

If you are interested in my upcoming trainings or my online suicide prevention training, please visit my website at criticalconcepts.org.

I recently read a post by someone quoting Navy Seal Commander Mark Divine: “Be 1% better than yesterday.”

I often tell this story on myself in my trainings to illustrate a similar philosophy when it comes to suicide intervention: by helping someone considering ending their own life make a very small shift in thought or perspective, we can make a significant difference in that person’s life.

My camel example: During the 1st Gulf War, I was assigned to the 1st Armored Division as the division psychologist. CPT S. was the psychiatrist of our team, and she and I daily drove around the desert, visiting troops and command staff prior to the start of the ground war.

This was before the commonality of GPS, so to drive from one unit to another, we needed a compass heading to the next unit, say 97 degrees, and a distance between the two points, say 14 kilometers.  To advance, we picked a point on the horizon in a straight line with 97 degrees and drove to that spot, then picked another point on the horizon, and drove to that spot, until we accumulated the distance and, hopefully, arrived at the next unit we were visiting.

And, we always hoped that the person giving directions did not utter those fateful words – “You cannot miss it…”

One day, CPT S. was driving our HMMWV and she suddenly stopped.  Since we were nowhere near any visible units or vehicles, I was first puzzled, then worried.  After asking her why she stopped multiple times, she finally responded in an apprehensive voice, “We are in deep trouble. The last point we picked on the horizon are camels walking across the desert!”

This meant we had drifted off of our planned course, and were somewhere unknown in a combat zone! Fortunately, our story ends happily. Two soldiers driving a water truck knew their exact location and were quite happy to help two ‘lost’ medical officers find their way to safety.

The point? All it took was the pace of a camel walking across the horizon to significantly alter our course.

If you have changes you’d like to make in life, remember “Be 1% better than yesterday.” Small changes add up over time.

https://pixabay.com/en/alone-sad-f-depression-loneliness-2666433/

Feeling alone?

Especially during the holiday season, people may feel alone, left out, or isolated.  Maybe you’ve recently moved, are deployed military, or are emotionally or geographically separated from loved ones.

Whatever your life circumstances, please remember you are NOT alone. There are people willing to help you all around you.

Who can you talk to?

Family, friends, neighbors

Mental Health Professional – psychologist, social worker, psychiatrist, counselor

Faith based person – Chaplain, Father, Rabbi, Deacon, Priest, Imam, etc.

Your company EAP (Employee Assistance Program)

Coworkers, supervisor

Healthcare provider

In many states, dialing “211” provides a shortcut through what can be a maze of health and human service agency phone numbers.  By dialing 211, those in need of assistance can be referred, and sometimes connected, to appropriate agencies and community organizations.

Text 741741 from anywhere in the USA to text with a trained Crisis Counselor. Every texter is connected with a Crisis Counselor, a real-life human being trained to bring texters from a hot moment to a cool calm through active listening and collaborative problem solving.

If you are feeling suicidal, call the National Suicide Prevention Helpline at 1-800-273-TALK.  Or you can text or use their chat room to talk with someone.  They also have Spanish speakers available plus you can contact the Lifeline via TTY by dialing 800-799-4889 if you are hard of hearing.

If you are a veteran and feeling suicidal, call the above number (1-800-273-TALK), then press “1” and you will directed to someone who understands the military.

If you are a first responder, call Safe Call Now at 1-206-459-3020 or the Code 9 Project at 1-(929) 244-9911 to speak with someone who has first responder experience.

This is just a sampling of resources.

What other resources would you recommend?

We’ve reached the end of my series on the Safety Plan as a brief suicide intervention. The Safety Plan has a distinct advantage over the no-harm/no-suicide contract because the Safety Plan helps patients develop a plan for how to care for themselves while the no-harm/no-suicide contract is a “promise” not to try to end their life.

The Safety Plan is often a collaborative effort between the healthcare professional and the patient or client, developing the lists of options for each step.  One of the aspects of SPI that I really like is that the plan is developed when the patient is not in acute crisis and is available to use when they are in crisis.

The Safety Plan consists of 6 steps:

Recognition of warning signs

Internal coping strategies

Socialization strategies for distraction and support

Social contacts for assistance in resolving suicidal crises

Professional and agency contacts to help resolve suicidal crises

Means restriction

For a copy of the Safety Plan form or for the manual, go to suicidesafetyplan.com and request access.  The Safety Plan form is also included in the manual, along with ‘brief instructions’ which are very helpful.  The manual is for the VA, but can be used in any setting.

Remember that the Safety Plan can be completed either on paper, as referenced above, or there are at least 2 apps available for smartphones or tablets.  The 2 apps are named MY3 and Safety Plan.  Both are free and available from the Apple app store or Google Play.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.

Two massive hurricanes.

A large earthquake in Mexico.

The horrific mass shooting event in Las Vegas on Sunday.

If you feel overwhelmed with recent events in our world, you are not alone.

Many resources exist to help us deal with these critical incidents.  Allow me to share just a few.

The American Psychological Association has many resources on their site, www.apa.org.  They also just posted an article, “APA Resources for Coping with Mass Shootings, Understanding Gun Violence” which details several resources, including a guide for talking with children.

SAMHSA (Substance Abuse and Mental Health Services Administration) offers a Disaster Distress Helpline providing 24/7, 365-day-a-year crisis counseling and support to people experiencing distress related to natural or human-caused disasters.  More information is available at the Disaster Distress Helpline. Call 1-800-985-5990 or Text TalkWithUs to 66746.  For the deaf/hard of hearing, use your preferred relay service to call the Disaster Distress Helpline at 1-800-985-5990.  Information is also available in Spanish.

The National Center for PTSD also offers information on “Coping with Traumatic Stress Reactions.” Active coping, defined as taking direct action to cope with your normal stress reactions, means accepting the impact of potential trauma on your life and taking direct action to improve things.  Recommended steps include talking to others for support, distracting yourself with positive activities, learning about trauma, and engaging in relaxing activities such as muscle relaxation exercises, breathing exercises, meditation, swimming, stretching, yoga, and/or spending time in nature.

If you are caring for others, please remember to take care of yourself as well.  For helpful tips, review the recommendations at the National Center for PTSD on Self-Care After Disasters.

If you are interested in my upcoming trainings or my new online suicide prevention training format, or want to review my CV, please visit my website at criticalconcepts.org.

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are returning to the final step, Reducing the Potential for Use of Lethal Means, to review some practical steps, especially for firearm use.

Remember that I mentioned in my last post that means restriction is not fool proof or guaranteed, but it is a useful intervention step, especially in the short term.  Once people select a method to end their life, they are unlikely to switch to another method.  Please note I did not say they will not switch – I said they are unlikely to switch.

Firearms are used in half of completed suicides.  If the person considering suicide is planning to use a firearm to complete their suicide, how can we provide means restriction?  See if there is someone who can temporarily store any firearms for that individual.  Sometimes, local law enforcement can assist with this.  If the individual owns a firearm safe, consider placing the firearms in the safe and having them give you the key or change the combination.  Another option, which requires some knowledge of firearm mechanics, is to remove the firing pin.

If medications are the selected method, consider having a family member or friend control the medications, ensuring the individual receives their daily dose but restricting access to large amounts of the medication.  Also consider working with the individual to speak to their prescribing physician about changing the medication (especially opioids and benzodiazepines) to a less lethal option.

The key to means restriction is determining the method the individual is planning on using, and restricting that access.  You cannot eliminate access to lethal means but you can restrict access to lethal means. For more information, see the Means Matter website.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are ready to explore the final step, Reducing the Potential for Use of Lethal Means.

This final step in the Safety Plan is particularly important when someone considering suicide has developed a plan.  Once someone has selected a method – gunshot, hanging, cutting, etc. – the probability of suicide increases the more they refine their plan – when, where, how, etc.

Thus an important follow-up question to “Have you been thinking of hurting or killing yourself?” is “Have you developed a plan for how you will end your life?”  A broader question would be, “Which means to end your life are available to you and would you consider using during a suicidal crisis?”

We ask the question as part of the ongoing assessment process (Is their plan available, lethal, and accessible?), but we also ask it as an intervention tool as well.  Namely, can we eliminate or limit their access to those named lethal means for a temporary time?

This is based on the belief that once people select a method to end their life, they are unlikely to switch to another method.  Please note I did not say they will not switch – I said they are unlikely to switch.  Means restriction is not fool proof or guaranteed, but it is a useful intervention step, especially in the short term.

Barber & Miller (2014), in their article on reducing access to lethal means, suggest several potential avenues of approach: 1) physically impeding access (e.g., gun locks, bridge barriers, restricting access to car keys); 2) reducing the lethality or toxicity of a given method (e.g., reducing carbon monoxide content of motor vehicle exhaust); or 3) reducing “cognitive access,” that is, reducing a particular method’s appeal (e.g., discouraging media coverage of an emerging suicide method).

In my next post, we’ll look at practical ways to implement reducing access to lethal means.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are ready to explore the fifth step, Professional and Agency Contacts to Help Resolve Suicidal Crises.

If the prior four steps are ineffective in resolving the suicidal crisis, the person in crisis is encouraged to contact a mental health professional (MHP) or helping agency.  Thus, the fifth step consists of identifying MHPs, helping agencies, or hotlines to assist the person in crisis.  List their contact information, their telephone numbers, and locations.

The list of MHPs or helping agencies can be prioritized. If the person is actively engaged in mental health treatment, the Safety Plan should include the name and phone number of this provider. However, the Safety Plan should also include other professionals or agencies who may be reached especially during non-business hours.

I strongly recommend the plan include the National Suicide Prevention Lifeline: 1-800-273-8255 (TALK).  If the person in crisis is a veteran, recommend they press 1 after they dial the other numbers.  This will take them to a person who understands veteran’s needs.

The person in crisis may be reluctant to contact MHPs and disclose their suicidal thoughts for fear of being hospitalized or rescued. The clinician should discuss the person in crisis’ expectations when they contact MHPs and helping agencies for assistance, then discuss any challenges in doing so. Are there any concerns or other obstacles that may hinder the person from contacting an MHP or helping agency? Only those MHPs whom the person is willing to contact during a crisis should be included in the Safety Plan.

In my next blog, we’ll cover the last step, Reducing the Potential for Use of Lethal Means.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are moving on to the fourth step, Social Contacts for Assistance in Resolving Suicidal Crises.

The first three steps are Recognition of Warning SignsInternal Coping Strategies, and Socialization Strategies for Distraction and Support.  If these three strategies are not effective in reducing the suicidal crisis, the next step in this process is encouraging the individual to ask for assistance from family members or friends.  This is the first time the individual may be revealing they are in crisis.

If the individual is working with a therapist or Chaplain, this is a great time to discuss with whom they might feel comfortable discussing their thoughts about suicide.  This could be a spouse/SO, close friend/buddy, Chaplain/faith leader, parent, sibling, or AA (or equivalent) sponsor.  Ask, “Among family or friends, who could you talk to during a crisis or when you are under a lot of stress?”

Two follow-up questions for this step are important. First, how likely is the individual to actually contact the person they have named?  Second, what are potential obstacles in contacting this person?  For example, perhaps the suicidal individual isn’t sure how to bring up the topic or fears the response they might receive.  Brainstorming or role playing possible words to use and potential responses may address these concerns.

It is a good idea to help the individual develop a short list of people they are willing to contact, in case their first choice is unavailable during the crisis.

In my next blog, we’ll cover the fifth step, Professional and Agency Contacts to Help Resolve Suicidal Crises.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are moving on to the third step, Socialization Strategies for Distraction and Support.

The first two steps are Recognition of warning signs and Internal coping strategies such as internal distractions – favorite music or movies, exercise, walking, hobbies, etc..  If these strategies are not effective in reducing suicidal ideation, Socialization Strategies encourage the individual to spend time in social settings as a way to distract themselves from their suicidal thoughts.  Being in social settings may also help the individual stop ruminating or worrying excessively about their current problems or challenges, and focus on something more positive.

What are some healthy options for socialization?  Spending time with friends and/or family is one option.  Other social settings might include places where people naturally gather, such as malls, coffee shops, libraries, book stores, parks, or at a public performance.  Also, attending self-help meetings such as a 12-step group or similar gatherings may be a positive distraction.

Places where alcohol or other substances are present would be locations to avoid in favor of healthier social settings.

In this step, the person with suicidal thoughts does not need to share these thoughts with the people with whom they are socializing.  Nor is this intended to be a way to seek help.  The purpose of this step is distracting the individual from their suicidal thoughts and life problems.  As a corollary, socialization may help individuals feel more connected with others or increase their sense of belongingness.

In my next blog, we’ll cover the fourth step, Social Contacts for Assistance.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.