13th September 2018 is R U OK? DAY, a national day of action dedicated to remind everyone to ask family and friends “Are you ok?” and to start conversations that could help change a life. R U OK? DAY aims to support those who are coping with grief, dealing with stress, and struggling in life.
In this episode, Amanda Gordon, Director of Armchair Psychology, talks about the prevalence of suicide in today’s society, how to approach a friend, a family member, or a work colleague who may not be okay, encourage them to open up and help them manage the load.
Amanda Gordon is experienced in helping people deal with the full range of life crises. She works with individuals, couples and families, helping them enrich their lifestyle and their effectiveness in the world. She is an endorsed specialist Health and Clinical Psychologist, and a member of each of those specialist Colleges of the Australian Psychological Society.
Join the movement. Visit www.ruok.org.au.
Toby Longhurst: Hello and welcome to Health Professional Radio. My name’s Toby Longhurst and joining me in conversation today is Associate Professor Amanda Gordon. Amanda is the director of Armchair Psychology and leading up to R U OK Day, she’s going to speak to us today about suicide prevention. Amanda welcome to the program.
Amanda Gordon: Thanks Toby.
Toby: Now listeners in Australia will be familiar with R U OKAY Day, it’s been running for many years and it’s a great initiative that helps to facilitate people starting some of those awkward conversations in the aid of suicide prevention. That’s coming up tomorrow, how important are these conversations, Amanda?
Amanda: Look, they’re really important conversations because any conversation will be connecting with the other can be the one that makes the difference. We know from all the research, forensic research, working with people who were going to commit suicide, in fact had written notes and were really ready to commit suicide then didn’t, we know that those people will say that the reason they didn’t in the end kill themselves was because of some connection, someone rang or someone knocked on the doors, or spoke to them connected with them let them know that they were caring about them and that they really were concerned that they were okay. So we know that we can really intervene and make a difference.
Toby: ‘Are you okay?’ is a such a simple question but I get the feeling if somebody came and asked you, “Are you okay?” – almost on autopilot, we’d just say “Yeah, I’m fine. No worries, it’s not a problem.”
Amanda: That’s right.
Toby: What is a better way to be bringing up a conversation that could potentially be quite an awkward one to bring up?
Amanda: Look, for health professionals is in a way easier because you’ve got someone captive in your office I guess and you’re going to say “How are you feeling today?” It’s really important that health professionals who are working mainly with the body make it clear that they’re also willing to hear how the mind is functioning. So ‘How are you feeling today?’ opens up the possibility of that conversation that could be lost if it was just ‘How are you?’ “Are you okay?” is still better than saying nothing just in generally but for health professionals, we have the opportunity to go much further.
Toby: For health professionals, I’d imagine most doctors and obviously psychologists and psychiatrists have the appropriate training. For allied health and other doctors and other health professionals, if they are seeing signs and they are concerned – what specifically can they do to help people to take the next step?
Amanda: I think the most important thing is connection. So by reaching out and letting the person know that you’re aware that sometimes life is tough, sometimes things are tough but there’s always hope. There’s always an opportunity to make things better, there’s always an opportunity to make things right. We can be just lifting the veil perhaps, just enough that that person can see that there might be a way through because people suicide when they lose hope, when they can’t see any way through whatever is going on or if they believe that nothing will ever be better than it is now. “If this all that life is, if this is the way I’m going to feel, then maybe life isn’t worth living.” And when we talk to them, when we reach out, when we connect, when we say “There are ways through this. There are possibilities of making a different place for ourselves in the world.” That can be enough to help people take the chance, perhaps grab back some hope if only briefly to try to make a difference.
Toby: Now I know sadly from my own personal experiences, I’ve known people who have taken their own lives, like most of us will at some point in our lives. And there’s this awful feeling you get after, aside from the loss it’s “If only I’d known.” Are there things that that we can look out for that are give away signs that perhaps ones that might not be so obvious?
Amanda: When people talk about life not being worth living, listen to them. Listen to the fact that they might feel that they’re worthless or that they contribute nothing to society and support them in seeing the importance that they have in your life. One of the key things that we know people do is they can give things away. If they start giving gifts especially of treasured items, be aware that that’s often very predictive of an attempt on their own life. Say I was speaking to some parents recently of a 14 year old boy who killed himself. In the night before, he went back to his dad and he just said to him “Oh Dad you gave me this $50 earlier in the day and I didn’t need it after all” and gave it back. His dad laughed and said “You know you didn’t have to give it back. You could have gotten away with keeping that.” “No, no I want to give it back to you Dad.” And if only that had been the tell-tale sign but in hindsight, it was. Not that we don’t want our kids to be honest and to give things back to us but be aware that if people are handing things over as if they have no use for these possessions, then that could be because they really believe they have no use for these possessions.
Toby: Now we know that rates of suicide vary among ethnicity, amongst age, geographic location, culture. Do the signs that people give off change across those different variants as well?
Amanda: They probably do and I’m not going to pretend expertise across all cultures. There is no doubt that a change in activity level, either becoming frenetic and excitable or becoming withdrawn is the thing to be aware of. It’s the change rather than whether they are always withdrawn. So someone’s who’s always withdrawn isn’t necessarily suicidal but if they’ve always been very excited and engaged and warm and then they withdraw and seem sad and reluctant to engage, that would be a danger sign. So within cultures, it’s still the shift in behavior that would worry a professional person rather than the specifics of the event.
Toby: While we’re talking about demographic, is there any current information that you know of that you can share with us about who is most at risk?
Amanda: We know during this time of terrible drought that farmers, the people living in rural communities especially men in their middle age seem to be particularly vulnerable right now added back to this idea of they have no value, they can’t provide for their family and there’s no sign of things improving in the future. And again, it’s a matter of working on this idea of hope was on this idea of you, yourself being of value to me now even though right now you can’t provide in the way you did previously. That we can all work together as a team and share roles and make things better, that’s going to make a difference. We’ve always known that young people are particularly vulnerable and I think the reason that is so is that as adults we tend to see the possibilities in our future most of the time but poor adolescents, the world is pretty black or white. It’s either fabulous and engaging and engaged and there’s so much going to happen or it’s black and terrible and there’s nothing. And when kids get stuck in the black and terrible and nothing for too long and too long unfortunately, it doesn’t have to be a very long time, that can lead to suicidal behavior because they don’t have that history of coming through a bad time and seeing that the world can become colorful again. We have to get them through the hard time and let them see that feeling badly and having life crash down on us isn’t a constant state but is something that varies and moves and the world is like that to some extent and it will become joyful again. And if they can experience that once or twice or three times, they can then become more resilient and survive the hard times.
Toby: For teenagers in particular, a lot of adults find it difficult to speak with teenagers at the best of times. How can we bring up this type of conversations with people who often don’t want to talk and express their emotions to you?
Amanda: Yeah. Look, there are a number of things. For health professionals, often teenagers are sort of dragged in to see you by their parent or another caring person and they really are reluctant to speak so you sometimes have to do a bit of the speaking for them. And the peaking for them is about sometimes things can be pretty hard but there are people who are here to listen and there are plenty of people who care and giving those messages, giving them things that they can take away with them that are reminders that there is help available and that life gets better than this. It’s not always this hard and not always this bad and that’s the key. Sometimes though, teenagers are ready to talk and it takes very little. I remember this sixteen-year-old who was brought in me by his mother and she thought that he was struggling at school because of school work but the minute she left the room he told me about his concerns and his struggles were really about his concerns for his sexuality which in fact resolved over the months and years that I knew him but there was a suicide attempt in the middle of the work that I did with him when he felt hopeless and he felt like he couldn’t talk to anyone else. And so it’s really important that the lines of communication are kept open, that you urge parents not to try and cajole words out of their kids but continue to show their kids constantly that they’re available and open if they do want to talk and the kids don’t have to talk about the specifics that are worrying them but together, there are strategies and solutions we can help them find for their future. And always talk about futures, that things get better rather than “Oh these are the best days of your life” or “School days are the great days.” Well they’re not, often for kids they’re a great struggle, very hard to get through.
Toby: When we have these conversations, just listening is such an important step. What’s the next step? Where can people go to get the help that they need?
Amanda: Look, there are a number of things and doctors who are listening, GPs would know that they can write a mental health care plan and send people, kids and adults, to a psychologist as appropriate. If it’s more urgent and they can’t get into a psychologist immediately, although generally people like me keep one or two sessions available so that we can see someone in a crisis, there’s LifeLine, there’s BeyondBlue, there lots of helplines. There’s the local mental health crisis team that is available and accessible for mental health professionals to call if they’re concerned. There’s the emergency department of your local hospital. We’re not alone. We as health professionals can ring each other and talk to each other and say “I’m concerned, what shall I do?” No GP will turn a physio away of the physio rings and says “I’m concerned about the patient of yours. Is there anything that I can do to help?” We’ll work together as a team to make sure we support people through the difficult crisis time.
Toby: No just finally, are there any piece of advice that you would give people who are concerned? Suicide amongst doctors is really quite high, alarmingly high – what advice can you give to doctors that might think that, maybe I will say, so sometimes that the ego might get in the way, that they feel like they can’t reach out to help because of their position?
Amanda: I think doctors need to know that we all understand that medicine is a very stressful profession. Holding people’s lives in your hands, having to deal with difficult people, having to deal with people when you’re sorting out emotional from psychological from physical problems can leave you exhausted and drained. Psychologists have ongoing peer supervision throughout their professional lives. We know that it’s vital to prevent burnout and to protect us, that we actually have the support of our colleagues. I think often doctors are left pretty alone in the work that they do and just a joke in a lunchroom or sharing lunch isn’t enough and you need to be able to talk about the impact on you of the work that you’re doing. There are psychologists like me who work very closely with the medical profession and have a lot of médicos who come to see us to protect themselves in to build resilience and to work out whether it’s time even for a break, even for a week or so just as what yourself out so it’s ready to go back refreshed and enriched and ready to move forward. So don’t be shy, understand that psychologists understand how stressful medicine is and we respect absolutely the privacy needs and the particular needs of health professionals working with their patient so that you can go back and do the best job you can do.
Toby: That’s great advice. Amanda, thank you so much for joining us. We’re quickly running out of time but it’s been a pleasure talking to you today.
Amanda: Good to talk with you Toby. I hope it’s been helpful.
Toby: Very much so. If you’ve just joined us on Health Professional Radio, you’ve just missed my conversation with the director of Armchair Psychology Amanda Gordon who’s been discussing suicide prevention strategies by having more conversations and seeking help. The good news however is that you can find this full interview on our website along with all of our other interviews on our website hpr.fm. You can also find us on Facebook, Twitter, SoundCloud, Instagram, LinkedIn and Pinterest. My name is Toby Longhurst and you’ve been listening to
Health Professional Radio.