It gets better: Facing the symptom of suicidal thoughts

Run to Remember 5K 2013

A 40 year old woman finds a lump in her breast.  "It's cancer" she thinks to herself.  She tries to ignore the thought, but it rips through the lining of her thoughts all day.  She can't sleep at night.  She considers her life, family, friends. "How can this be happening to me?" She has responsibilities, people depend on her.  She thinks of the women she knows who have had cancer, some have lived, some have died.  She goes over and over these thoughts for several days before she says the words aloud "I need help."

A 15 year old girl begins to have suicidal thoughts.  "I'm crazy" she thinks to herself.  She tries to ignore the thoughts, but they are unstoppable.  Suicidal thoughts follow her down the halls at school and into her bedroom at night.  She considers her life, family, friends. "Why do bad things always happen to me?"  Her family is mad  because of her dropping grades and "attitude." Her friends have all been ignoring her since the bad break up with her boyfriend, who won't even look at her in class.  What's the point she wonders.  She goes over and over these thoughts for several weeks before she says the words aloud "I need help."

Both women are dealing with symptoms.  Ignoring a symptom doesn't make the problem go away, in both of these cases ignoring a symptom can be fatal. 

The 40 year old has had enough life experience to know that sometimes bad things happen, but she has hope that good things are still possible.  She realizes that she cannot evaluate the symptom without the helped of a trained person. The 40 year old has an idea about what will happen next.  She will consult with a trained physician who will diagnose the symptom and recommend treatment.  Knowing what the symptom means will relieve a lot of stress, even if her worst fears are true.  It gets better.

The 15 year old doesn't know anyone who has suicidal thoughts, because no one talks about it.  She doesn't realize that her parents are worried about her, not angry, and her friends are too busy thinking about their own problems to show her how special she is to them.  The boyfriend, well, he doesn't wish her harm.  She believes that she is weak and broken to even have the thoughts but she can't stand the pressure anymore and is compelled to ask someone for help.

This is what happens AFTER the 15 year old asks for help. 

Assuming she asks the right person, she will be referred to a qualified evaluator.  This could be the family care physician who has known her all of her life, or a licensed counselor.  If she asks for help at 2 am, it will be the Emergency Room doctor.

The physician, psychologist, or counselor will explore other symptoms and get a context for how the 15 year old is functioning, aside from the thoughts.  The evaluator will then assess risk, what is the availability of lethal means for self harm? What is the 15 year old's support system? What has triggered the suicidal thoughts?

The 15 year old does not know that the mental health of a person is based on many factors besides the presence or absence of suicidal thoughts. a lot of adults don't know that either. Suicidal thoughts can be fleeting, or obsessional.  They can be passive "I wish I wasn't here anymore" or active "I have a clear plan about how to kill myself and I am considering when I will do it."  All suicidal thoughts are disturbing and stressful when they cannot be easily dismissed. 

If the 15 year old is at low risk- the treatment plan will include counseling and the education of family members and may include medication. (Medication alone will not improve coping, but it will relieve symptoms)

Finding the "right fit" with a mental health person is important.  Changing behavior is difficult, especially when a teenager is anxious and/or depressed. The 15 year old will be encouraged to increase involvement in meaningful activities and be assisted to improve support systems.  A form of monitoring will be put in place to help the teen return to improved coping that is maintained over time.  It gets better.

If the 15 year old is at high risk for suicide- hospitalization or intensive outpatient counseling and medication will be considered.  Hospitalization is sometimes used to stabilize a young person and remove the risk by providing safety in a controlled setting.  It is a last resort but has its place when needed to save a life.  Intensive outpatient counseling could include day treatment (removal from school with structured activities throughout the day which include academic credit, the teen returns home at night), or multiple sessions per week at a counseling center.  Once the 15 year old is feeling more "like herself" with less symptoms she will be transitioned to a low risk treatment plan. It gets better.

September is Suicide Awareness Month.  Get informed.  Get Better.

Please forward this to someone you know who needs the information. 

Crisis Numbers:

• Heartline: 405-848-CARE (Oklahoma)
• National Hot line: 1-800-273-TALK