Notes on Resilience

89: Understanding Suicide: The Connection Between Trauma and Suicide Prevention, with Dr. Anita Everett

• Manya Chylinski • Season 2 • Episode 37

Share episode

Send us a text

What if understanding trauma could save lives?

Join us for the second in our four-part series for suicide prevention awareness month, for an enlightening conversation with Dr. Anita Everett, director of the Center for Mental Health Services at SAMHSA.

She sheds light on the profound connection between trauma and suicide risk. We explore the impact of trauma and discuss the vital strategies for offering support to those affected. You will learn about creating safe spaces for open dialogue, the significance of validating experiences without judgment, and the importance of upstream approaches to addressing suicide prevention at its roots.

Dr. Everett also shares valuable insights into how community engagement can act as protective factors against suicide, recognizing changes in language as potential distress signals, and the importance of postvention to support those grieving after a suicide.

Resources

Dr. Everett is the Director of the Center for Mental Health Services within the Substance Abuse and Mental Health Services Administration (SAMHSA). Serving in this role since 2018, she provides executive leadership for federal efforts to improve the nation’s mental health service systems.

Prior to SAMHSA, Dr. Everett served as the Section Chief of The Johns Hopkins Bayview Community and General Psychiatry in Baltimore, Maryland. She was on the faculty of the Johns Hopkins School of Medicine and the Bloomberg School of Public Health. Earlier in her career, Dr. Everett also served as the Senior Medical Advisor to SAMHSA. From 1999 to 2003, she served as the Inspector General to the Office of the Governor in the Department of Mental Health in Virginia. 

Dr. Everett is a past president of the American Psychiatric Association, Maryland Psychiatric Society and the American Association of Community Psychiatry. She has served on the National Institute on Drug Abuse National Advisory Council, is currently an ex-officio member of the National Institute of Mental Health National Advisory Council and is active in several professional organizations. She has been engaged in a number of international projects, including with the Global Leadership Exchange, and has provided consultation to the Ministries of Health, Department of Mental Health in Iraq and Afghanistan on the implementation of mental health services in these countries.

Learn more about Dr. Everett. Learn more about SAMHSA on their website, LinkedIn, Instagram, or Facebook.

Go to https://betterhelp.com/resilience or click Notes on Resilience during sign up for 10% off your first month of therapy with my sponsor BetterHelp.

Support the show


Producer / Editor: Neel Panji

Invite Manya to inspire and empower your teams + position your organization as a forward-thinking leader in fostering resilience and trauma sensitivity.

#trauma #resilience #MentalHealth #leadership #survivor

Dr. Anita Everett:

Protective factors are one of those things, you know, strengthening the social fabric of a community. Some of the things that individuals used to engage in are not as prominent in society these days. I'm thinking of participation in faith-based communities as one example of something that's really dropped off recently and is very protective for certain individuals.

Manya Chylinski:

Hello and welcome to Notes on Resilience. I'm your host, manya Chylinski. My guest today is Dr Anita Everett. She is the director of the Center for Mental Health Services within the Substance Abuse and Mental Health Services Administration and she provides executive leadership for federal efforts to improve the nation's mental health service systems. She and I talked about the subject of suicide and suicide prevention, and we talked about the relationship between trauma and suicide and what are some protective factors and what are some things we can do if we ourselves or our friends or family are thinking about suicide. I think you're going to find some really valuable information in this episode. Dr Everett, thank you so much for being here today. I really am excited to chat with you.

Dr. Anita Everett:

Thank you. Thank you for having myself as a staff from the Center for Mental Health Services within SAMHSA. Yeah, thank you, thank you. Thank you for having myself as a staff from the Center for Mental Health Services within SAMHSA.

Manya Chylinski:

Yeah, thank you. And before we start talking about this very important subject, I have a question I ask everybody, which is if you could have dinner with any historical figure, who would it be and why?

Dr. Anita Everett:

I thought hard about this question, having known in advance that you were going to ask this, and I was trying to think of a mental health figure that I would feel comfortable and interested in talking with. But really what I came up with the person I would most enjoy sitting with at the table with is Thomas Jefferson, and he's known as one of our founding fathers familiar to many, I think. But why I'm thinking about Thomas Jefferson is that he was quite a Renaissance man and he's known as one of our founding fathers familiar to many, I think. But why I'm thinking about Thomas Jefferson is that he was quite a Renaissance man and so he was key author of many of our founding documents and was involved in some of the thinking that formed our nation. But he also was an inventor and would love, I think it would be fun to talk with him about what's happened in the 200 years or so since he's been on the face of the earth, and I think he'd be amazed and surprised by computers and cell phones and all of the technology that we have. I think he would just be amazed in a very positive way, and I even think he'd be amazed.

Dr. Anita Everett:

One of the problems, so to speak with Thomas Jefferson these days is that he was in fact a slave owner. But I think he'd be amazed. You know, one of the problems, so to speak with Thomas Jefferson these days is that he was in fact a slave owner. But I think he'd be surprised and very pleased with the advancements we've made, so many ways to go with regards to inclusivity socially. But I think he would be very pleased that we addressed even those issues that you know he's often accused of being somewhat hypocritical and I just think he would be really fun to talk with and he'd be delighted to see all the new things that have happened.

Manya Chylinski:

Yes, that's a great one and I say this to everybody, but I so wish I could make it happen and either get the notes or be a fly on the wall while you were talking, because I think he would be. He could have some. Really. I think he'd have some amazing insights. So thank you for sharing that. So we are here today to talk about the subject of suicide, and trauma can be a major risk factor for suicide. So what would you say is the connection between different types of trauma and suicidal thoughts?

Dr. Anita Everett:

Yeah, so we know that there is a connection. You're right when we think about suicide, of course we can't predict with accuracy who's going to die by suicide, but there are a lot of what we think of as risk factors that increase the chances of someone thinking about planning, actually planning out and attempting and actually dying by suicide all of those things that are often part of the process. And we do know that trauma, the exposure to trauma, experience of trauma, all types of trauma, but in particular trauma that's advanced by another human being, is a particular risk factor. So as many as 14% of individuals who attempted suicide have trauma in their background and I we all mostly think that's an underestimate. Trauma again comes in many ways Perpetrated. Examples of trauma perpetrated by other people would include sexual assault, those kinds of things, but also car accident where another human was involved, so some human error was involved, or something like that.

Manya Chylinski:

And what is that connection? What makes it more traumatic or more difficult to deal with when it's human caused or when there's a human involved?

Dr. Anita Everett:

But one of the ways that we think is key thinking there is that it is. How could another human being do that? It's emotionally a little bit more complex than something that's completely random. If it's your father, for instance, that was engaged in serial sexual assaults, or a close family member, it's a twist on your emotions that make it harder to understand and sort of move on from.

Manya Chylinski:

Yes, I can see that when you explain that. How can we better support individuals who have experienced a trauma so that they can process it in a healthy way and, ideally, not think of suicide as an answer to their challenges.

Dr. Anita Everett:

Yeah, so that's really important. And one of the things that we've learned about trauma and I know this question is centered on suicide, but I'm going to just sort of do a little deviation about trauma Trauma turns out to be really important. One of the major studies that's spearheaded by the Centers for Disease Control is the ACEs or the Adverse Childhood Event series of studies that look at the effect of trauma, which can take all sorts of forms, but trauma or adverse events in childhood and we know that has lingering effects across adulthood in their mental health and associated mental health risk factors. But also more recently we've learned it also impairs physical health. So that really gives hard data, so to speak, to the idea that trauma is really important.

Dr. Anita Everett:

And trauma can be known by people who you know our friends, family, those things and trauma can be unknown and a lot of times trauma is hidden and the victim of trauma or the person who was traumatized doesn't always feel comfortable talking about it.

Dr. Anita Everett:

So one step to answer your question is creating environments where individuals feel comfortable, safe spaces where individuals feel comfortable talking about what's happened to them in their lives, taking the time to listen. That's sort of part of what I'm saying. It's a really important thing, some way of sort of verbally or non-verbally validating the experience of someone. Not judgmental questions like why did that happen or how could a person do that it doesn't really help the individual but validating their own experience so they know you're with them. Some people have specific triggers that can be problematic. So in Baltimore, where I used to practice, there was a person who was assaulted at a particular bus stop and so passing that street was a particular trigger for that person, and so part of what we worked on was actually wanted it to be and that was helping for her at least for the short term to avoid that particular corner street.

Manya Chylinski:

Yes, I particularly appreciate you mentioning validating someone's experience and refraining from asking judgment or asking judgmental questions. In my own experience after the Boston Marathon bombing, I had people who said to me essentially, why is anything wrong with you? You still have both your legs and I remember just being so crushed by the utter lack of support that that showed that there could be other impacts to people who were there that day.

Dr. Anita Everett:

Yeah, I mean you could read the meta message there as being you know you should be grateful that you weren't physically harmed, and that's in the mental health space. That's something we really bristle about because, you know mental harms can be every bit as debilitating and sometimes even more, because they're not outwardly apparent work and physically at work but be very distracted by unwelcomed thoughts and recurring, you know, associated features of PTSD-like features.

Manya Chylinski:

Right, absolutely yeah, thank you for that.

Dr. Anita Everett:

That scenario that you just explained also has kind of a phenomenon that we see a lot and that is the survivor sort of thinking about what it's like to survive the same thing and not have the kind of external injury that another person has. We see that a lot in car wrecks the kind of trauma that car wrecks have, where one person lives through the accident and other people do not, and the complex emotions involved in living through an accident where you might have friends in the car that were killed by the accident.

Manya Chylinski:

Well, I can tell you, it messes with your head. It really does.

Dr. Anita Everett:

And you don't. It's like you know, you can't predict ahead of time. There are certain risk factors that go along with the development of those longer term trauma symptoms, but we don't know ahead of time and we learned a lot about that from the. You know, the Defense Department and our armed services have tried for a long time to try and identify individuals who would be more at risk for combat-related PTSD. And you really, there's some factors that can lean a little bit in that direction, but it's not a reason to not take someone in the military or to anyway. It's a challenge.

Manya Chylinski:

Oh, absolutely Absolutely so. When we're thinking about suicide prevention, I feel like it often is thinking about the crisis, the moment of crisis, and it's a crisis intervention. But what about upstream approaches that are addressing the root causes of suicide risk? I mean, I think that's a larger issue. How can we, as a society, kind of foster well-being and resilience before a crisis occurs, since if we do that, then we won't know that a crisis was going to occur?

Dr. Anita Everett:

Right, and that is really challenging and also challenging really to measure, and I'll also say it's gotten more challenging in our current world, particularly post-pandemic.

Dr. Anita Everett:

So we know one thing, for instance that one among several things that's protective with regards to actually acting on suicidal thoughts is a sense of community, a sense of a person you could outreach to, a sense of belonging, so to speak, and know how y'all were barely isolated for a pretty prolonged period of time during COVID. Some of us are just sort of working our way out of the COVID isolation, and so that is. Protective factors are one of those things strengthening the social fabric of a community. Some of the things that individuals used to engage in are not as prominent in society these days. There I'm thinking of participation in faith-based communities is one example of something that's really dropped off recently and is very protective for certain individuals. There was a book written several years ago called Bowling Alone that sort of talks a lot about the whole sort of thing, about the social engagements that were across, or many you know were civil organizations that were present that are much less present now in our environment.

Manya Chylinski:

And a question that just occurred to me as we were talking how common is it for people to have a suicidal thought or suicidal ideation, and it doesn't really mean that they're going to go through with it?

Dr. Anita Everett:

I'm going to. I'm paused a little bit on that question because I want to answer it in a slightly different way. We know there are a lot more people that think about suicide than actually make a plan and or actually attempt suicide. So there, by frequency or by a number of people we know there's a lot more. I don't think it's fair to say, just because someone thinks about it, they think about it and they don't have the thought that they could or would go through with it. So there are a lot of people that are in that category of don't quite have the energy or do something that's painful.

Dr. Anita Everett:

But that might be an explanation, for instance, why we see overdose is a very common reason for actual attempts at suicide, which luckily aren't that often lethal Some things you could take that are pretty lethal and some things not. So I don't think it's really fair to say they're thinking about it but they don't attempt. It also sort of gets at the idea of feigning suicide or what do they call it in some emergency rooms I'm blanking on the term but attention seeking just only for the purpose of attention seeking rather than a genuine attempt. I always I discourage anybody calling it taking this an overdose or something, any kind of time you do anything like that, you're taking a risk, and when you think about things like that, you're taking a risk.

Manya Chylinski:

So I think I was thinking more. Is it normal to occasionally just have a thought like that and it's not something, and should one be concerned about it? Or is it more that one starts to have those kind of ideas and it's indicative of something more deep or more difficult that's going on?

Dr. Anita Everett:

It's pretty common for people to answer a question like in your life, have you ever thought about suicide, to have thought about it, and that may or may not be problematic. So let's say, you get a new diagnosis of some illness that you didn't want to have and you might think, well, one way out would be just to kill myself or whatever. But sometimes people do have sort of transient thoughts. Most people that have those kinds of thoughts don't go on later to make a detailed plan about exactly how they would do it and follow through with it and make an actual attempt. Okay, some, but some do, yeah, okay, so, yes, it can be. It doesn't always mean there's a deep, dark problem that needs to be rooted out. Just because someone has a transient thought, it's when they become what you might call obsessive or they become sort of dominant in the thinking every day, multiple times a day, that kind of thing that becomes much more a risk.

Manya Chylinski:

Right, that makes sense when you describe it that way. We're thinking about how do we identify or support individuals who may be struggling. It may be trauma, it may be something else, but they're having that suicidal ideation. I don't know. How do we identify, Can we identify them and how can we help?

Dr. Anita Everett:

Not 100%. There's no way to 100% identify, and that's really important because that is the thought process that a lot of family members go through when they have a family member if only I'd known, or if only I'd done something different. So there's no 100% way to do it, but one thing that we can be aware of, and we sense a series of grants called mental health awareness training. One of the elements that we teach people is to listen for language that could be potentially problematic. Parents listen for children that might be saying things that are kind of a change in the way they talk about, things that talk about being here or I don't know if I'll see you tomorrow, or there's. Sometimes there's things that get dropped in sentences that are sort of like clues that might need some follow-up on the part of someone in the environment, a friend, a family member, someone like that that could sort of follow up and listen Again sort of back to that key thing of listening to.

Manya Chylinski:

Right, and you mentioned family members, and losing someone to suicide is a trauma beyond merely the death of someone. So how can we create support systems for the folks who are left behind and maybe break a cycle of that trauma?

Dr. Anita Everett:

Yep. So that's very important as well because it's very complicated emotionally for family members or friends in the environment of someone who does wind up dying by suicide. And one of the techniques or strategies that we promote at SAMHSA and CMHS as an entity is the thing we call postvention, which means afterward sort of having time to get together, sort of having time to get together, Think about ways to think through what happened, who was where, and sort of. Usually this is helpful if a professional's involved but doesn't have to be, could be a trained person. That sort of helps to guide pathway forward for the emotional complexity of being in the environment of someone who has died by suicide. So the term there is postvention, like intervention, only postvention, and many of our grants that focus on suicide prevention include that as an element.

Manya Chylinski:

Absolutely. I can imagine that would be very needed at a place like this. I would imagine that people have a lot of unanswered questions dealing with a family member or a friend who dies by suicide.

Dr. Anita Everett:

And some that may never get the answer to because the person's gone. It's a very complex thing. Sometimes in families that have had that it actually works as a protective factor. Work with family members who will say, no, I'm not doing that to my family. I saw what my uncle's suicide did to their family and I would never do that. For that reason I don't want to live. But I would not do that because of what I saw with the impact that it had on someone else. That is known so way that you might not expect sometimes that itself can be protect, a reason for living that a person has.

Manya Chylinski:

Right, I never thought of that. Well as you say, person has Right. I never thought of that. Well, as you say, it's so complex and there's so many complex feelings and often we often focus on the risk factors. But can you discuss how to build an individual strength and resilience after trauma and if they're dealing with systemic challenges that we can think of in society that are impacting people? You know, how do we give people agency to maybe deal with this and move past the ideation stage?

Dr. Anita Everett:

Yeah, so one of the things that we recommend is a tool that's called the Suicide Safety Plan or the Stanley Brown Suicide Safety Plan, they being some of the primary researchers that have sort of validated this tool, and what the tool has in it is a series of steps that ask the person to think through what they would do themselves should they become suicidal again, and so it asks them to think through, starting sort of with broadly who would you call? What's their phone number? This would be something that you could imagine being even posted on a refrigerator or you know handy or wallet size thing.

Dr. Anita Everett:

Here's the phone number. Who would you call? It goes through. You know, friends, therapists, if there's a therapist involved in the mix. Nine at eight if that's. You know part of the answer.

Dr. Anita Everett:

So there's a sort of a sequence of things you could do. It has a component, for we call them skills, but for things that a person can do that might help to get their mind off if they're in a period where they're sort of stuck thinking about suicide, it asks them to specifically select a handful of things, at least three or so, that they could do. Sometimes it's take a walk, Sometimes it's call a friend, sometimes it's watch a comedy on TV. I mean, they're distracting things that not. They're distracting things that no one, they're not going to cure the thoughts, but they, they provide space between the thinking and the acting, and so those can be really helpful and at best, if this is tailored to the individual. So if they hate walking or they can't walk, that's not going to be not a one size fits all kind of thing. It's sometimes it's find your dog and pet your dog, or it's different things for different people, but that's those tools, really kind of help.

Dr. Anita Everett:

And then we you know that also includes literal sort of what we call means restriction. Or you know some ideas about if people have a plan or if the plan should be something like a shooting, making sure there's space between guns are put away or there's space between where the guns are and where the ammunition is, so they're not loaded, or guns are given to a friend. So means for suicide is less. Sometimes you'll see people who will hoard hundreds of pills, thinking that just in case they want to take a bunch of pills, they can do that. So this means restriction component is a part of this suicide safety plan. So all those things are kind of like a way to sort of individually work with that.

Dr. Anita Everett:

And I would submit to you that a friend could do that, or a parent could do that, or a sister who had another sibling that they were worried about, brother could do that with someone that they're worried about and kind of work it through. And then should they call and reach out, coach them through that. Hey, jo, did you call? You said on your list here that I've got a copy of on my refrigerator that you know you were going to call such and such. Or I see here it says you know, you worked out. You like to walk down to the mailbox to check the mail, did you? Anyway, things like that can be really sounds very elementary, but they can be very helpful. Therapy is something else that we recommend for people, particularly when they get to a spot where they're really just stuck thinking about suicide or it's worrying them in some way. So you know, mental health professionals are very important there.

Manya Chylinski:

It sounds like one of the things that's very important is kind of stopping the thought process and thinking about something else, so that you're just not going over and over again in your head and then it somehow amplifies that way.

Dr. Anita Everett:

That's right, and talking about it with another person really helps. There's a lot of times, individuals. It's interesting when you talk with people who've survived suicide attempts. They think they're alone, they think nobody's there, and it's interesting. I've, you know, myself, worked many times with people in hospital settings where they've come in with an overdose and they're overwhelmed with how many people come to visit them in the hospital because they didn't have that sense of people caring about them or they'd lost that perspective.

Manya Chylinski:

Yes, absolutely. Now you mentioned 988. So can you tell us what, what is that resource and how can people use it?

Dr. Anita Everett:

Sure. So 988 is a new version of a telephone line support that was called the National Suicide Prevention Lifeline. It's actually been around for quite a while, but now, for the last two years, what was previously a 1-800 number is now available through calling 988. And uh, what it's? The suicide and mental health crisis line. It's not only for suicide, but it is it is for suicide and other mental health crises as well. People who are experiencing the crises themselves and are concerned family members can call that number and it's available on any landline or phone line. Right now you could pick up your cell phone and Don988, and you would be connected to a trained counselor, the network of over 200 crisis call centers that take these calls. We try to associate it with the closest geographic call center Not always, but for the most part we're working on having it more located where the person is. So right now it goes by area code, so that's a little bit of a hangover.

Dr. Anita Everett:

You've got a California area code but you're calling from New York, You'll be routed to California and we're trying to get that fixed to the nearest cell tower. But that's on the horizon. In many communities there also are emerging other components to a crisis response system. Ultimately, we'd like to have a completely built-out system that would include three aspects which we say are similar to the kinds of aspects you have when you think about 911 type responses there's someone to talk with, which would be the 988 line. Someone to respond, which would be these mobile crisis teams that include trained counselors. Someone to respond, which would be these mobile crisis teams that include trained counselors. An IDL team has a trained counselor together with a peer, and right now, many times it's law enforcement. But we'd really prefer that this alternative model be used to law enforcement. And then the third element is a place to go, a safe place to be, and we prefer you know you can always go to an emergency room.

Dr. Anita Everett:

In America now, because of the built-out, you know, emergency system that we have I would argue we didn't have about 40 or 50 years ago we now have that Many emergency departments across the country don't feel comfortable with or well-equipped to address mental health concerns, and so communities are starting to build alternative walk-in style clinics, urgent care clinics, receiving centers that are trained mental health professionals, Anyway. So those three elements are what we're aiming for, and many communities have built those out, but it's not universally accessible just now. Right, Okay, One thing about 988 that we've learned also just a small note that your listeners might be interested in is the number. 988 is also available through text or chat, and we've learned from our experience over the last two years that younger folks prefer the text and chat modality rather than talking.

Manya Chylinski:

So we've had to kind of beef up our responsiveness in those two domains up our responsiveness in those two domains Right, absolutely Well, dr Everett, we are getting towards the end of our time and thank you so much for sharing. Do you have any final thoughts or what's giving you hope this Suicide Prevention Awareness Month, as we deal with this very difficult issue?

Dr. Anita Everett:

Well, I'll say we work from a strong belief that suicide is preventable. Those of us who work in the field have seen so much positive impact on both interventions that happen across the community public health style interventions, as well as upskilling or training, behavioral health and just general health providers. We know suicide's preventable. It's just a matter of getting the word out and helping people, equipping people with some of these tools that we talked about. So I want to thank you for your interest in this area.

Manya Chylinski:

Oh, yes, I'm happy to be able to help people learn more about this really important topic. And, before we go, how can people learn more about you and your work or get some resources from SAMHSA on this subject?

Dr. Anita Everett:

Yeah, so we do have a number of resources. One of them would be just Googling 988, if that's an issue, and know that 988 is available. We have a center, the Suicide Prevention Resource Center, which has many resources, some of which are intended for the general public, some of which are intended. All of the information there is available and downloadable. We have a findsupportgov that can be used for a broad variety, not only just suicide, and then we also have a treatment locator. So for individuals trying to sort of get into treatment, you can put in things like your zip code and area that you live in, indicators of that, and then come up with a list of treatment resources, and so those are sort of some of the main things we refer people to. I don't know, kim, if you have other resources that you want to make sure we cover.

Manya Chylinski:

Okay, sounds great, and I will put links to all of these resources in the show notes so it'll be easier for folks to access them. And, Dr Everett, thank you so much for chatting with me today and helping us explore this really important topic. Again, thank you for your interest. Thank you for listening. I hope you got as much out of this conversation as I did. So if you'd like to learn more about me, Manya Chylinski, I work with organizations to help understand how to create environments where people can thrive after difficult life experiences, and I do this through talks and consulting. I'm a survivor of mass violence and I use my experience to help leaders learn of resiliency, compassion and trauma-sensitive leadership to build strategies to enable teams to thrive and be engaged amidst difficulty and turmoil. If this is something you want to learn more about, visit my website, www. ManyaChylinski. com, or email me at manya@ manyachylinski. com, or stop by my social media on LinkedIn and Twitter. Thanks so much.

People on this episode

Head Shot

Manya Chylinski

Host