התמלול המלא של Substance Use Increases Suicide Risk

about one 66 00:04:36.399 --> 00:04:39.040 in twelve receiving treatment at the time of their death. 67 00:04:40.040 --> 00:04:43.879 Toxicology findings tell a similar story. Alcohol was present in 68 00:04:43.959 --> 00:04:47.480 thirteen percent of suicide deaths, cannabis in eight percent, in 69 00:04:47.600 --> 00:04:51.680 opioids in about seven percent. National data from the Violent 70 00:04:51.680 --> 00:04:55.560 Death Reporting Systems show comparable patterns and including findings that 71 00:04:55.639 --> 00:04:59.360 seventeen percent of suicide decedents in twenty twenty two had 72 00:04:59.360 --> 00:05:03.800 a history of a non alcohol substance use disorder. Suicide 73 00:05:03.839 --> 00:05:06.879 prevention is complex, but the link between substance use and 74 00:05:06.920 --> 00:05:11.240 suicide offers opportunities for action. By improving access to care, 75 00:05:11.480 --> 00:05:15.720 strengthening support systems, and responding with empathy and understanding, we 76 00:05:15.800 --> 00:05:18.160 can help protect the health and well being of people 77 00:05:18.160 --> 00:05:22.759 affected by substance use disorders. That's it for our data segment. 78 00:05:22.839 --> 00:05:25.120 Let's move on to our first interview. 79 00:05:33.319 --> 00:05:33.639 Today. 80 00:05:33.839 --> 00:05:36.040 On our episode, we're going to be talking about suicide, 81 00:05:36.120 --> 00:05:39.759 which is one, it's kind of an unfortunate topic and 82 00:05:39.800 --> 00:05:42.639 it's a sad topic or whatever, but it's a real topic, 83 00:05:43.560 --> 00:05:48.000 you know, in a real concern issue, and you know, 84 00:05:48.120 --> 00:05:53.920 the whole idea of people feeling suicidal or having suicide 85 00:05:53.959 --> 00:05:56.959 or tempts in when we're talking about substance use disorder, 86 00:05:57.160 --> 00:05:59.879 is it just happens. And so the more we know 87 00:06:00.079 --> 00:06:03.120 about it, I think the better off. So we've invited 88 00:06:03.120 --> 00:06:07.519 our first guests today here, Holly Hartman. And Holly and 89 00:06:07.519 --> 00:06:09.759 I go way back, and so we've worked together and 90 00:06:09.759 --> 00:06:13.040 we've worked together on suicide related issues in the past. 91 00:06:13.120 --> 00:06:16.120 So Holly, this will be like old Home Week, okay 92 00:06:16.160 --> 00:06:16.600 for you? 93 00:06:16.839 --> 00:06:17.319 Excellent? 94 00:06:17.399 --> 00:06:21.680 As we begin today is episode focusing on suicide. Could 95 00:06:21.720 --> 00:06:25.160 you introduce yourself to our viewers, including your background and 96 00:06:25.199 --> 00:06:27.920 your current role and maybe some of your past roles 97 00:06:27.959 --> 00:06:32.759 and how you became interested in the topic of suicide 98 00:06:33.399 --> 00:06:37.160 in particular with populations that have substance use disorder. 99 00:06:37.920 --> 00:06:38.319 Sure. 100 00:06:38.680 --> 00:06:42.879 So, I'm a director of nursing at Community Health, Behavior 101 00:06:42.920 --> 00:06:46.639 Health and Community Fairbanks right now, and my background is 102 00:06:46.879 --> 00:06:50.279 I'm a bachelor's prepared nurse. I've been doing nursing. 103 00:06:50.000 --> 00:06:51.199 For thirty four years. 104 00:06:52.160 --> 00:06:57.120 My experiences risk management and regulatory compliance, that's nursing leadership 105 00:06:57.120 --> 00:07:01.240 in there, worked in behavior health settings, cute care somes, 106 00:07:01.319 --> 00:07:05.879 use disorder settings, and I'm also a certified professional healthcare 107 00:07:05.959 --> 00:07:08.480 risk manager and a little bit of lean sic Sigma 108 00:07:08.920 --> 00:07:13.560 also certified Columbia Suicide's Ferity Rating Scale Trainer. And to 109 00:07:13.560 --> 00:07:15.399 be you know, quite honest, I think I've had a 110 00:07:15.480 --> 00:07:20.199 passion for suicide prevention before I ever got into nursing school. 111 00:07:20.720 --> 00:07:23.680 It's something that I've always thought is an important topic. 112 00:07:24.279 --> 00:07:27.360 You know, when I was doing risk and regulatory, you know, 113 00:07:27.399 --> 00:07:30.680 most of my experience of risk and regulatory was reviewing 114 00:07:30.680 --> 00:07:34.360 incident reports and reviewing things such as near misses and 115 00:07:34.439 --> 00:07:38.360 sentinel events. And I thought to myself, you know, gosh, 116 00:07:38.439 --> 00:07:40.399 you know, what can I be doing better and what 117 00:07:40.439 --> 00:07:43.279 can I be doing more of? And I kind of 118 00:07:43.319 --> 00:07:46.839 like embraced myself into you know, what conferences can I 119 00:07:46.920 --> 00:07:49.920 go to? What things can I do to learn more 120 00:07:49.920 --> 00:07:53.279 about suicide prevention and awareness? Be because, to be quite honest, 121 00:07:53.319 --> 00:07:56.639 you know, in nursing school, we hear about the subject matter. 122 00:07:57.000 --> 00:07:59.720 We don't hear the details of the subject matter. It's 123 00:07:59.720 --> 00:08:01.319 not really and depth. It's kind of just a high 124 00:08:01.439 --> 00:08:04.319 level training, and I felt, if I'm looking at risk 125 00:08:04.399 --> 00:08:06.759 and regulatory which a passion of mine is, you know, 126 00:08:06.800 --> 00:08:10.639 identifying risk in the community or wherever I'm working and 127 00:08:10.920 --> 00:08:14.160 reducing that risk while still providing a high quality care. 128 00:08:14.199 --> 00:08:16.160 And I thought, you know, I need to really take 129 00:08:16.199 --> 00:08:19.279 on this so and doing so. When I was looking 130 00:08:19.279 --> 00:08:22.879 at reviews, I had identified there were a lot of 131 00:08:23.040 --> 00:08:28.480 suicides or near missus in the Substanit use disorder community, 132 00:08:28.959 --> 00:08:32.159 and my passion just seemed to like even explode more 133 00:08:32.240 --> 00:08:36.000 when I was exposed to my first exposure of the

134 00:08:36.960 --> 00:08:40.600 Columbia Severity Rating Scale, and I thought, wow, this tool 135 00:08:40.639 --> 00:08:43.200 here is something I can really put my hands on 136 00:08:43.320 --> 00:08:46.519 and bring back to the organization and start doing some 137 00:08:46.600 --> 00:08:49.960 training with employees. That took me out not only just 138 00:08:50.000 --> 00:08:52.559 to employees, but into the community, and I started doing 139 00:08:52.679 --> 00:08:56.399 education throughout Indiana, which is a huge passion of mine. 140 00:08:56.440 --> 00:09:00.440 I ended up winning the twenty nineteen Suicide Education Award 141 00:09:00.960 --> 00:09:05.120 as well as the Champion of Children for Resiliency Award. 142 00:09:05.799 --> 00:09:08.720 So I think then it just even sparked me even 143 00:09:08.759 --> 00:09:10.519 more and I'm like, what more can we do? So 144 00:09:10.600 --> 00:09:14.399 I think we're starting to in the community really identifying 145 00:09:14.759 --> 00:09:18.480 the need for more education and prevention. We're doing better, 146 00:09:19.000 --> 00:09:20.320 we're still not doing enough. 147 00:09:20.879 --> 00:09:24.679 Well, then you are our perfect guest to be talking 148 00:09:24.720 --> 00:09:27.799 about that, So so glad you joined us today. As 149 00:09:27.840 --> 00:09:31.440 we talk today, Holly, I'd like us to focus our 150 00:09:31.519 --> 00:09:35.519 lens for our conversation really on two chunks or types 151 00:09:35.720 --> 00:09:38.159 of our listeners. And those may be people who may 152 00:09:38.159 --> 00:09:42.080 be professionals working in the field and mental health and 153 00:09:42.120 --> 00:09:45.360 substitute disorder and clinical care. And then and we also 154 00:09:45.399 --> 00:09:49.840 have the general public, including you know, families and loved ones, etc. 155 00:09:50.600 --> 00:09:54.240 Are there ways for both types of our listeners? How 156 00:09:54.279 --> 00:09:59.320 do we better understand and recognize suicide risk for people 157 00:09:59.399 --> 00:10:02.840 who have substance use disorder or or anyone in general? 158 00:10:02.960 --> 00:10:05.600 Right, Right, It's multi layered. 159 00:10:05.799 --> 00:10:06.000 You know. 160 00:10:06.639 --> 00:10:10.799 It begins you know, early age, it impacts someone throughout 161 00:10:10.840 --> 00:10:14.240 their life. 162 00:10:12.840 --> 00:10:13.000 You know. 163 00:10:13.039 --> 00:10:15.279 And I've worked in a right of settings. So I've 164 00:10:15.279 --> 00:10:21.519 worked in cute care, profit non for profit hospitals treating 165 00:10:21.600 --> 00:10:26.519 dual diagnoses as well as primary substance use disorder. And 166 00:10:26.559 --> 00:10:31.480 what I'm always so surprised by is the lack of 167 00:10:31.480 --> 00:10:34.399 awareness needed in the community. So I, you know, and 168 00:10:34.440 --> 00:10:36.279 I look at it as I think we don't just 169 00:10:36.360 --> 00:10:40.240 need to bring

awareness to the professional community or the 170 00:10:40.240 --> 00:10:45.120 general population in general. Everyone needs them. We are better 171 00:10:45.200 --> 00:10:47.399 than we ever have been in the past, and my 172 00:10:47.519 --> 00:10:52.840 career of nursing, I do see an increased awareness, but 173 00:10:53.559 --> 00:10:56.679 we have so much more to do. And when I 174 00:10:56.720 --> 00:11:01.480 look at suicide prevention awareness, to me, in my opinion, 175 00:11:02.279 --> 00:11:05.919 I think it's a specialty. I think it's a subject 176 00:11:05.960 --> 00:11:10.320 matter in itself that really deserves so much more attention, 177 00:11:13.039 --> 00:11:16.120 not just in the professional arena and in the community. 178 00:11:17.080 --> 00:11:19.840 And you know, Holly, you mentioned not as part of 179 00:11:19.879 --> 00:11:25.320 your more formal education early in your career, not necessarily 180 00:11:25.399 --> 00:11:28.320 being educated or trained in and I mean, I'm you know, 181 00:11:28.399 --> 00:11:30.799 I have a master's in social work. I'm trying to 182 00:11:30.840 --> 00:11:33.960 think back now as we talk here today, I don't 183 00:11:34.159 --> 00:11:37.600 really remember it really even being talked about. And it 184 00:11:37.720 --> 00:11:42.000 wasn't until I started working in the substance use and 185 00:11:42.080 --> 00:11:48.360 mental health field that when events had occurred, That's when 186 00:11:48.480 --> 00:11:51.679 that's when I started kind of learning about it. So 187 00:11:52.080 --> 00:11:53.679 you can kind of call that through the through the 188 00:11:53.720 --> 00:11:56.879 school of hard knocks, because each one of those events 189 00:11:57.000 --> 00:12:01.519 is so incredibly difficult for everyone involved, Okay, for the 190 00:12:01.600 --> 00:12:05.039 professional staff or the family for the individuals, for friends, 191 00:12:05.120 --> 00:12:09.600 loved ones, et cetera. It's such a difficult thing. And 192 00:12:09.679 --> 00:12:12.720 you mentioned people with substance use disorders kind of being 193 00:12:12.759 --> 00:12:16.639 at a greater risk than kind of the general population, 194 00:12:16.879 --> 00:12:21.240 and so can you help us understand what goes into 195 00:12:21.720 --> 00:12:25.000 that elevated risk? What have you seen that makes you 196 00:12:25.080 --> 00:12:26.360 think it's more risky. 197 00:12:27.320 --> 00:12:32.039 We talk about suicide prevention or someone who has experienced 198 00:12:32.240 --> 00:12:38.440 or contemplating suicide, there's so much that has happened to 199 00:12:38.519 --> 00:12:42.639 that individual prior to that day, and we look at 200 00:12:42.679 --> 00:12:46.320 someone who has a substance use disorder. To me, it's 201 00:12:46.399 --> 00:12:49.679 very similar. There's so much that has happened to that 202 00:12:49.720 --> 00:12:54.559 person prior to them seeking treatment that we really need 203 00:12:54.600 --> 00:12:59.440 to seek and discover. How did that person get here today, 204 00:13:00.279 --> 00:13:04.960 What happened, what trauma has they've experienced? What things have 205 00:13:05.080 --> 00:13:09.919 impacted their life? Are they having pain, do they have comorbidities? 206 00:13:10.600 --> 00:13:13.440 You know, what's impacting their life. It's not just as 207 00:13:13.480 --> 00:13:17.200 simple is that either someone has a substance use disorder 208 00:13:17.279 --> 00:13:22.200 or they don't. But it does complicate the picture of 209 00:13:22.240 --> 00:13:26.240 that person in their life experiences, in the trauma that 210 00:13:26.279 --> 00:13:29.960 they have experienced that led them to this day or 211 00:13:30.000 --> 00:13:33.000 whatever day we're in when we're treating them. You know, 212 00:13:33.080 --> 00:13:36.600 when we look at subsance use disorder, people are the population, 213 00:13:36.759 --> 00:13:41.000 if you will, compared to the general population, people who 214 00:13:41.120 --> 00:13:44.840 use alcohol or drugs or have subs use disorders. We 215 00:13:44.960 --> 00:13:48.039 know that are increased risk of dying by suicide. For example, 216 00:13:48.480 --> 00:13:52.399 risk of death by suicide for someone is almost six 217 00:13:52.480 --> 00:13:57.080 times more for people with alcohol use disorder. And we 218 00:13:57.120 --> 00:14:01.720 look at people with alcohol and subs use disorder, it's 219 00:14:01.919 --> 00:14:04.600 a little over eight times more. And then we look 220 00:14:04.639 --> 00:14:08.399 at that population and combine it with people who are 221 00:14:08.480 --> 00:14:14.799 using alcohol subans use disorder as well as tobacco, it's 222 00:14:14.840 --> 00:14:18.200 a little over eleven times more likely for that person 223 00:14:18.320 --> 00:14:22.000 to experience a suicide attempt. Wow, it's you know, it's 224 00:14:22.039 --> 00:14:25.440 extremely complicated when you look at it. Suicide doesn't just 225 00:14:25.519 --> 00:14:28.320 impact one person or one population of people. 226 00:14:28.799 --> 00:14:31.720 It's really kind of across the board. And yeah, you know, 227 00:14:31.759 --> 00:14:33.440 one of the things I've always thought, and you know 228 00:14:33.600 --> 00:14:36.679 you're having a career working with people with substance use disorders, 229 00:14:37.000 --> 00:14:41.080 is many times that person, as you said, has a 230 00:14:41.120 --> 00:14:48.240 culmination of traumatic experiences and significant losses and people that 231 00:14:48.440 --> 00:14:53.759 are experiencing the worst part and the and the worst 232 00:14:53.879 --> 00:14:59.799 episodes of their substance using history, find themselves many times 233 00:15:00.080 --> 00:15:03.360 in a place where they can't see the way out 234 00:15:04.279 --> 00:15:09.240 of that, and they can't see recovery is possible. And those, 235 00:15:09.279 --> 00:15:13.919 to me, are always very dangerous times

where someone is 236 00:15:14.000 --> 00:15:19.879 really at risk for potentially harming themselves. Yeah, and I 237 00:15:19.879 --> 00:15:22.960 think that's kind of common, you know with people as 238 00:15:23.000 --> 00:15:26.080 they starts losing everything and you've lost your job, and 239 00:15:26.120 --> 00:15:28.480 you've lost your family, and you've lost your money, and 240 00:15:28.559 --> 00:15:32.039 you've lost your purpose in life, the people get desperate. 241 00:15:32.559 --> 00:15:32.759 Yeah. 242 00:15:33.440 --> 00:15:36.720 When you think of that person you just described, they've 243 00:15:36.759 --> 00:15:40.840 lost hope, right, And when you lose hope, you know 244 00:15:41.519 --> 00:15:44.960 what else is it for that person? And we need 245 00:15:45.000 --> 00:15:48.600 to be able to be better practitioners. We need to 246 00:15:48.600 --> 00:15:53.039 be better aware that when we recognize somebody getting to 247 00:15:53.080 --> 00:15:56.240 that point, that we're able to reach out and help them. 248 00:15:56.720 --> 00:15:59.600 I mean, to me, when you connect a person that 249 00:15:59.679 --> 00:16:02.279 you just described as a substance someone that has experienced 250 00:16:02.279 --> 00:16:06.600 a substance use disorder is very similar to someone who 251 00:16:06.639 --> 00:16:10.720 is experiencing chronic pain. They feel that there's nothing left 252 00:16:10.759 --> 00:16:13.120 to help treat their pain and their coping. I mean, 253 00:16:13.159 --> 00:16:16.600 it is so there's so many things that are very 254 00:16:16.639 --> 00:16:22.120 familiar and or similar that that person feels they're at 255 00:16:22.120 --> 00:16:23.039 the end of the rope. 256 00:16:23.720 --> 00:16:26.200 It's interesting you bring that up, because I have it 257 00:16:26.240 --> 00:16:29.879 in my notes for us to talk about that, and 258 00:16:29.960 --> 00:16:34.159 I know in our working together in the past, that 259 00:16:34.399 --> 00:16:38.679 concept of chronic pain was kind of a common denominator, 260 00:16:39.600 --> 00:16:42.879 you know when we started looking at cases. I know 261 00:16:43.039 --> 00:16:46.960 at the time that kind of took me by surprise. Okay, 262 00:16:47.000 --> 00:16:49.000 I just remembered kind of it was like a light 263 00:16:49.000 --> 00:16:52.240 bulb went off, and it makes perfect sense with what 264 00:16:52.279 --> 00:16:55.320 you just kind of said. And it's like when you 265 00:16:55.360 --> 00:16:58.120 get hopeless and you can't see your way out, or 266 00:16:58.799 --> 00:17:02.720 the system starts backing up on you and not helping you. 267 00:17:03.519 --> 00:17:07.359 There is this significant feeling of hopelessness that we have 268 00:17:07.480 --> 00:17:11.160 to be I think, on the lookout for, and how 269 00:17:11.160 --> 00:17:15.400 do we better identify that? Can you explain ways in 270 00:17:15.440 --> 00:17:19.119 which we could better assess when we think someone's at

risk, 271 00:17:19.519 --> 00:17:22.000 how do we determine someone's at a greater risk than 272 00:17:22.000 --> 00:17:22.640 somebody else. 273 00:17:23.599 --> 00:17:26.200 So when we look at in depth, look at suicide 274 00:17:26.240 --> 00:17:30.640 awareness approach, there are a lot of risk assessments tools 275 00:17:30.640 --> 00:17:36.559 out there. There's screening tools and there's assessment tools, and 276 00:17:36.720 --> 00:17:41.640 we look at training individuals professionals and there's tools out 277 00:17:41.640 --> 00:17:44.039 there that the public and general public can be used 278 00:17:44.079 --> 00:17:47.039 as well which will help us identify people at risk. 279 00:17:47.680 --> 00:17:51.759 I do believe that, you know, we really need trained clinicians. 280 00:17:51.799 --> 00:17:54.000 And how you define a clinician, you know, could be 281 00:17:54.079 --> 00:17:58.720 a nurse, a provider, a licensed clinical social worker, someone 282 00:17:58.759 --> 00:18:01.599 who is special you knowecializes in training and assessing the 283 00:18:01.680 --> 00:18:04.079 level of risk for that person. To me, when I 284 00:18:04.079 --> 00:18:05.759 look at this and it's you know, I get on 285 00:18:05.799 --> 00:18:09.400 my soapbox with it. Training and teaching people how to 286 00:18:09.519 --> 00:18:13.640 assess someone's level of risk is not a simple E 287 00:18:13.839 --> 00:18:18.680 learning or WebEx It is a very collaborative approach to 288 00:18:18.839 --> 00:18:24.799 learning where you can have a dialogue discussion with practitioners 289 00:18:25.519 --> 00:18:28.359 to talk about what we just talked about, how chronic 290 00:18:28.440 --> 00:18:33.720 pain impacts things, how different impacts in their life impact, 291 00:18:34.160 --> 00:18:36.680 what happens to trauma, what have you. You know, people 292 00:18:36.680 --> 00:18:39.759 at risk for suicide identified and you know, refer to treatment. 293 00:18:40.920 --> 00:18:45.440 It's essential component for a comprehensive suicide prevention program. And 294 00:18:45.680 --> 00:18:50.720 understanding the difference in suicide screening for suicide assessment is essential. 295 00:18:51.720 --> 00:18:55.519 If we don't have trained practitioners understanding that, then you 296 00:18:55.599 --> 00:18:58.720 know that causes a problem for us in the community 297 00:18:58.759 --> 00:19:03.119 and or in the facility. Suicides screening can be done independently, 298 00:19:05.000 --> 00:19:07.359 it also can be a comprehensive approach. And when I 299 00:19:07.440 --> 00:19:10.799 look at and when I think about helping people understand 300 00:19:10.799 --> 00:19:15.960 the risk, it's not that just behavior health sites need 301 00:19:16.039 --> 00:19:20.680 to be experts. It's all sites need to be experts 302 00:19:20.680 --> 00:19:23.799 and identifying people at risk. And the reason why I 303 00:19:23.839 --> 00:19:27.319 say that is is if we were only to screen 304 00:19:27.720 --> 00:19:32.559 or assess someone that we think maybe at risk because 305 00:19:32.680 --> 00:19:35.480 they have a substance use disorder and or a mental 306 00:19:35.480 --> 00:19:40.279 health disorder, we are missing fifty four percent of the 307 00:19:40.319 --> 00:19:45.440 population of people coming into our facilities or in the community. 308 00:19:45.519 --> 00:19:48.359 So when I talk about that or think about that, 309 00:19:48.400 --> 00:19:51.279 there are tools to be used in the community that 310 00:19:51.319 --> 00:19:55.960 are screening tools that help people identify someone at risk 311 00:19:57.000 --> 00:19:59.960 and as well as assessment tools and a professional setting. 312 00:20:00.799 --> 00:20:04.720 But we also must always remember regardless of what tool 313 00:20:04.799 --> 00:20:08.559 we use or assessment, assessment tool or screening tool, there's 314 00:20:08.640 --> 00:20:11.160 not one tool or assessment tool out there that will 315 00:20:11.200 --> 00:20:16.119 predict suicide. There are tools to help us identify people 316 00:20:16.240 --> 00:20:21.119 at risk, so we can help them get help and to. 317 00:20:21.000 --> 00:20:24.799 Do further assessment and understand at a kind of at 318 00:20:24.839 --> 00:20:30.240 a deeper level and engage in the conversation with someone. Yeah, so, 319 00:20:30.680 --> 00:20:33.319 what are some of the myths that people have about 320 00:20:33.480 --> 00:20:37.240 suicide and suicide risk? Are there any myths that you 321 00:20:37.279 --> 00:20:39.359 can think that kind of people think this, but it's 322 00:20:39.400 --> 00:20:40.519 really not the case. 323 00:20:41.440 --> 00:20:44.319 What's really interesting, I think some of the myths that 324 00:20:45.240 --> 00:20:47.640 we used to train on or trained on years ago 325 00:20:47.680 --> 00:20:49.279 when we first starting this and you and I were 326 00:20:49.279 --> 00:20:52.119 doing this are still some of the very same myths, 327 00:20:52.839 --> 00:20:56.519 things such as, you know, if someone's suicidal, you know 328 00:20:56.680 --> 00:20:59.519 they're they're probably going to do it to themselves no 329 00:20:59.519 --> 00:20:59.960 matter what you do. 330 00:21:00.279 --> 00:21:01.039 And that's a myth. 331 00:21:01.400 --> 00:21:05.000 Yeah, and multiple studies have found that ninety percent even 332 00:21:05.039 --> 00:21:07.559 as you know that what I mentioned, when the you know, 333 00:21:07.599 --> 00:21:12.720 the public was surveyed, they believe ninety one percent are preventable. 334 00:21:13.279 --> 00:21:15.559 So it's such a controversial statement that, you know, this 335 00:21:15.640 --> 00:21:18.039 myth that people truly believe. Sometimes well, if people are 336 00:21:18.039 --> 00:21:19.359 going to do it, they're going to do it anyway. 337 00:21:20.119 --> 00:21:22.599 You know, most people are only suicidal for a very 338 00:21:22.640 --> 00:21:26.359 short

amount of time. It's a crisis, and you know, 339 00:21:26.759 --> 00:21:30.240 when we offer help. It helps them during that crisis, 340 00:21:31.200 --> 00:21:35.240 you know, so we you know suicidal lines. Safety plans 341 00:21:35.440 --> 00:21:37.000 are so important for people. 342 00:21:37.319 --> 00:21:39.359 When you say a safety plan, what what are you 343 00:21:39.400 --> 00:21:42.559 referring to with a safety plan? What does that mean? 344 00:21:43.160 --> 00:21:45.880 Yeah, a safety plan is a plan that's put in 345 00:21:45.920 --> 00:21:52.440 place that the person that is struggling. It's their plan, 346 00:21:52.559 --> 00:21:56.119 it's not the practitioner's plan. So it's a plan that 347 00:21:56.400 --> 00:22:00.119 helps a person in the middle of a crisis if 348 00:22:00.119 --> 00:22:03.839 they're feeling a certain kind of way, the steps that 349 00:22:03.880 --> 00:22:07.960 they can take. It's almost like a tear if you're 350 00:22:08.000 --> 00:22:13.359 feeling anxious, and if anxious is your trigger that I 351 00:22:13.440 --> 00:22:16.400 will go to the park, or I'll journal or watch music. 352 00:22:16.960 --> 00:22:19.039 The next step is if going to the park and 353 00:22:19.119 --> 00:22:22.680 the journaling isn't helping you, what is the next step 354 00:22:22.720 --> 00:22:25.920 you can take? Okay, then you know, and that is 355 00:22:25.960 --> 00:22:29.680 you know, reaching out to a loved one, clergy teacher, 356 00:22:30.240 --> 00:22:34.440 you know, my clinician, and if that doesn't work, what 357 00:22:34.559 --> 00:22:36.680 are your next steps? I can take myself to the 358 00:22:36.720 --> 00:22:41.000 emergency room. What I find a lot in my practice 359 00:22:41.079 --> 00:22:45.319 or when we were doing reviews with safety plans is 360 00:22:45.400 --> 00:22:50.160 really not really digging deep into that safety plan and 361 00:22:50.279 --> 00:22:54.000 talking through that with that person on those steps, like 362 00:22:54.240 --> 00:22:58.799 what if you made that phone call to that loved 363 00:22:58.799 --> 00:23:03.799 one and their phone number changed or they blocked you, 364 00:23:04.480 --> 00:23:07.279 what can you do so that we can help them 365 00:23:07.359 --> 00:23:11.759 work through that crisis, Because in a safety plan, to me, 366 00:23:12.480 --> 00:23:17.200 is really helping that person work through those triggers and 367 00:23:17.359 --> 00:23:20.839 plan for what's happening, versus you know, they're not going 368 00:23:20.920 --> 00:23:22.759 to pull the piece of paper out in their safety 369 00:23:22.759 --> 00:23:24.279 plan form or not going to pull it up on 370 00:23:24.319 --> 00:23:28.119 their phone, but it's almost something that becomes intuitive for 371 00:23:28.200 --> 00:23:31.559 them and it's a problem solving tool that helps them 372 00:23:31.640 --> 00:23:35.559 get to a place that can help them. So I 373 00:23:35.559 --> 00:23:36.680 think they're so important. 374 00:23:37.079 --> 00:23:39.960 So this would be something that you could sit down 375 00:23:40.359 --> 00:23:44.559 with your clinician or with a professional or someone and 376 00:23:44.920 --> 00:23:47.200 you kind of walk through that and the and the 377 00:23:47.240 --> 00:23:51.440 person identifies that if this, then this, If that doesn't work, 378 00:23:51.559 --> 00:23:55.880 then this, and make it several levels deep kind of 379 00:23:55.920 --> 00:23:58.799 as you said, because sometimes people don't answer their phone, 380 00:23:58.880 --> 00:23:59.920 right if this is normal? 381 00:24:00.119 --> 00:24:02.319 Yeah, and they're reviewed. I mean, as we know, in 382 00:24:02.359 --> 00:24:05.359 our life, things change in a month or six months 383 00:24:05.359 --> 00:24:08.960 in a year, and our connections and who we connect 384 00:24:09.039 --> 00:24:12.839 with change, so they have to be you know, current 385 00:24:12.880 --> 00:24:16.119 in real time, so they are working for that person 386 00:24:16.160 --> 00:24:16.799 in real time. 387 00:24:17.359 --> 00:24:21.079 How do we know which of those are accidental and 388 00:24:21.119 --> 00:24:23.400 which of those are intentional. 389 00:24:23.599 --> 00:24:25.400 It's not an exact science by any. 390 00:24:25.319 --> 00:24:28.759 Means, no, but and we may never know. So what 391 00:24:29.759 --> 00:24:33.279 should professionals and even the general public or loved ones 392 00:24:33.319 --> 00:24:37.519 of someone do if they think someone suicide all? What 393 00:24:37.559 --> 00:24:38.519 advice would you give? 394 00:24:39.400 --> 00:24:39.720 Well? 395 00:24:39.759 --> 00:24:42.799 I think we need to work on changing our culture 396 00:24:42.839 --> 00:24:46.519 to not be afraid to ask the questions, changing that 397 00:24:46.759 --> 00:24:50.359 some of those myths of you know, if I ask someone, 398 00:24:50.960 --> 00:24:55.880 I'll stimulate a thought of suicide. It actually is quite 399 00:24:55.880 --> 00:25:01.079 the opposite. If someone is thinking of suicide or struggling, 400 00:25:01.680 --> 00:25:04.559 someone reaching out to them and asking them, are you 401 00:25:04.599 --> 00:25:08.960 feeling suicidal? Actually brings relief to that person. So I 402 00:25:09.000 --> 00:25:12.079 mean we need to really start really understanding that we 403 00:25:12.119 --> 00:25:16.160 need to ask those questions. It's maybe uncomfortable. 404 00:25:15.559 --> 00:25:17.680 And don't be shy right asking directly? 405 00:25:18.160 --> 00:25:19.759 Right, We always say, you know, it's better to ask 406 00:25:19.799 --> 00:25:22.480 than not ask, be safe than sorry. But we do 407 00:25:22.599 --> 00:25:26.759 know in interviewing people that have attempted that when someone 408 00:25:26.839 --> 00:25:31.440 has asked them genuinely, now that's the key. Genuinely ask 409 00:25:31.519 --> 00:25:35.319 them are you feeling suicidal? Are you having thoughts of harm? 410

00:25:36.160 --> 00:25:40.079 You know, those questions. It brings relief to them that 411 00:25:40.119 --> 00:25:44.440 they feel they can speak on it, that someone cares. 412 00:25:45.039 --> 00:25:48.480 When we ask people like such a question as you're 413 00:25:48.519 --> 00:25:52.440 not feeling suicidal? Are you, we are giving the impression 414 00:25:52.880 --> 00:25:56.319 to the person that it's not a genuine question. We 415 00:25:56.400 --> 00:25:59.519 really want them to answer no. The other thing, you know, 416 00:25:59.680 --> 00:26:03.599 is be there for them, listen without judgment. It's key 417 00:26:03.640 --> 00:26:07.039 to them, don't you know, thinking and feeling. You know, 418 00:26:07.119 --> 00:26:12.279 research suggests that talking about suicide may reduce the suicidal 419 00:26:12.319 --> 00:26:17.160 thoughts and or risk. It helps decrease stigma in the community. 420 00:26:18.200 --> 00:26:21.880 It's okay to talk about it. Helping them be safe, 421 00:26:22.119 --> 00:26:24.759 keep them in a safe place, reducing you know, the 422 00:26:24.920 --> 00:26:29.519 access to lethal means, and then you know, help them 423 00:26:29.559 --> 00:26:35.480 contact someone, connecting to to someone, asking them if they 424 00:26:35.480 --> 00:26:39.359 have a safety plan, call nine one one, call those 425 00:26:39.440 --> 00:26:41.880 you know areas and then follow up, you know, stay 426 00:26:41.880 --> 00:26:45.920 in touch with that person if you can reach out 427 00:26:45.920 --> 00:26:48.599 to them. We also know that in community mental health 428 00:26:48.599 --> 00:26:52.319 centers and behavior health centers that you know that connect, 429 00:26:52.400 --> 00:26:56.400 that caregiver connect. When we reach out to someone after 430 00:26:56.440 --> 00:27:01.640 a visit is really important and helps them feel that 431 00:27:02.000 --> 00:27:04.720 someone they just saw really cares about them. 432 00:27:05.480 --> 00:27:08.079 And so a couple of things that you touched on 433 00:27:08.200 --> 00:27:11.880 that lit a spark for me was that concept of 434 00:27:13.000 --> 00:27:17.359 eliminate the lethal means and so that that can mean, 435 00:27:18.039 --> 00:27:20.960 is the person safe in their environment? Are there guns 436 00:27:20.960 --> 00:27:23.960 in the house, maybe you should take the guns to 437 00:27:24.039 --> 00:27:28.000 another location, you know, are there poisons in the house? 438 00:27:28.200 --> 00:27:31.640 Are there other means by which someone in a panic 439 00:27:32.319 --> 00:27:35.200 could grab? So we want to kind of in a 440 00:27:35.240 --> 00:27:39.279 protective stance remove some of those things, but also not 441 00:27:39.519 --> 00:27:42.279 being afraid to talk about it. Yeah, until you get 442 00:27:42.319 --> 00:27:45.920 it out in the open and ask very directly, and 443 00:27:46.000 --> 00:27:48.839 so thank you, thank you for that. Is there anything 444 00:27:48.880 --> 00:27:51.960 in particular that you think we should absolutely avoid doing. 445 00:27:52.519 --> 00:27:55.799 Take it seriously, don't minimize it what you're saying, don't 446 00:27:55.799 --> 00:27:56.400 blow it off. 447 00:27:56.480 --> 00:27:57.559 Don't blow it off right. 448 00:27:57.799 --> 00:28:02.200 Yeah, we need to remember that someone trauma is their trauma, 449 00:28:02.559 --> 00:28:07.359 and just because you may have experienced something similar doesn't 450 00:28:07.400 --> 00:28:10.279 mean that person is experiencing it the same way you 451 00:28:10.359 --> 00:28:13.920 are experiencing it. And we need to not say things 452 00:28:13.960 --> 00:28:17.119 such as, oh, I've been there, I've done that, You'll 453 00:28:17.119 --> 00:28:20.920 get through it. Kick rocks, you know, put some you know, 454 00:28:20.960 --> 00:28:23.000 all those sayings we hear, rub some dirt on it, 455 00:28:23.000 --> 00:28:25.519 and all those things that is not helpful to someone 456 00:28:25.559 --> 00:28:27.920 in a crisis. We need to be non judgmental, and 457 00:28:27.960 --> 00:28:30.559 we need to empathetic. We need to listen and be helpful, 458 00:28:30.759 --> 00:28:33.440 and don't lay blame. Don't make them feel that they 459 00:28:33.519 --> 00:28:37.319 are not a good person, don't blame them for maybe 460 00:28:37.359 --> 00:28:41.480 the choices they've made, don't point out fault and help 461 00:28:41.559 --> 00:28:42.480 them connect. 462 00:28:42.440 --> 00:28:43.920 And always take it seriously. 463 00:28:44.200 --> 00:28:48.960 Don't promise them something such as you can tell me 464 00:28:49.000 --> 00:28:51.640 and I won't tell anyone, well, I'll keep it a secret. 465 00:28:52.200 --> 00:28:54.960 We need to understand that there's a level of trust 466 00:28:55.799 --> 00:29:00.880 when someone who is feeling that way or suicidal, they 467 00:29:00.920 --> 00:29:04.480 are entrusting in you to share their information. And we 468 00:29:04.599 --> 00:29:07.680 also need to be very upfront and transparent with that 469 00:29:07.759 --> 00:29:13.359 person and say I'm here for you, I'm listening, and 470 00:29:13.440 --> 00:29:15.440 I'm going to help you get help. 471 00:29:16.319 --> 00:29:18.720 And you know, Holly, there also was another myth out there. 472 00:29:18.759 --> 00:29:20.839 I wanted to at least touch base on. What I've 473 00:29:20.880 --> 00:29:24.240 heard many times is that people in the helping profession, 474 00:29:24.960 --> 00:29:29.680 when someone endorses shall we say either some sort of 475 00:29:29.759 --> 00:29:33.960 suicidal ideation or what have you, sometimes ready to hear 476 00:29:34.000 --> 00:29:38.559 people say, is well, yes they endorse, you know, feeling 477 00:29:38.640 --> 00:29:41.839 kind of having thoughts of suicide, but they told me 478 00:29:41.880 --> 00:29:44.480 they weren't going to do it. How should we take that? 479 00:29:45.319 --> 00:29:48.839 Yeah, I think there's a lot

to that question. When 480 00:29:48.920 --> 00:29:53.400 someone tells you I'm feeling suicidal, but I'm not going 481 00:29:53.440 --> 00:29:56.559 to act on it. There's more questions that need to 482 00:29:56.559 --> 00:30:01.079 be asked. What are your protective facts? What are your 483 00:30:01.160 --> 00:30:04.759 risk factors? And we need to also know that, you know, 484 00:30:04.920 --> 00:30:08.000 just because someone has twenty protective factors and two risk 485 00:30:08.039 --> 00:30:12.400 factors doesn't mean that they're more protected. We need to 486 00:30:13.400 --> 00:30:17.480 those conversations, which to me is key with someone promise 487 00:30:17.559 --> 00:30:19.559 me you're not going to act on it now. And 488 00:30:19.599 --> 00:30:22.079 there was something I learned one time at a conference 489 00:30:22.119 --> 00:30:25.880 that I thought was absolutely brilliant. When are all the 490 00:30:25.920 --> 00:30:28.720 cards off the table for you right now? You're not 491 00:30:28.920 --> 00:30:31.839 feeling that way, But what is the trigger that would 492 00:30:31.880 --> 00:30:35.400 take you back to that point and having those questions? 493 00:30:35.440 --> 00:30:38.039 You know, I call it the sixth question on the Columbia. 494 00:30:38.119 --> 00:30:41.960 Have you ever started to do something you changed your 495 00:30:42.000 --> 00:30:45.319 mind and or someone interrupted you. It's such an important 496 00:30:45.319 --> 00:30:50.400 piece of that conversation with that particular person experiencing that. 497 00:30:50.400 --> 00:30:52.359 That's just not a question we ask and we leave 498 00:30:52.400 --> 00:30:54.920 it there on the table. There's more detailed questions we 499 00:30:55.039 --> 00:30:58.680 need to ask that person to really evaluate their risk 500 00:30:58.839 --> 00:30:59.960 at that moment in time. 501 00:31:00.519 --> 00:31:03.079 It's not a yes or no question. And it doesn't 502 00:31:03.079 --> 00:31:05.599 mean you checked the box and moved on, is what 503 00:31:05.640 --> 00:31:06.480 I hear you saying. 504 00:31:07.000 --> 00:31:07.880 Well, absolutely not. 505 00:31:08.119 --> 00:31:10.920 So you've mentioned the Columbia several times. If someone was 506 00:31:10.960 --> 00:31:14.480 interested in finding more about the Columbia screening, where would 507 00:31:14.480 --> 00:31:15.039 they find it. 508 00:31:15.799 --> 00:31:19.359 They can go to the Lighthouse Project. The Columbia Tool, 509 00:31:19.400 --> 00:31:23.559 which is amazing, is free. There are several tools at 510 00:31:23.559 --> 00:31:28.559 the Lighthouse Project for the Columbia that are specific for caregivers, 511 00:31:28.839 --> 00:31:34.079 for police officers, for emergency workers there and you know 512 00:31:34.119 --> 00:31:38.960 it's very detailed. For teachers that can you know, you 513 00:31:38.960 --> 00:31:40.880 can put it in your pocket. It can help you 514 00:31:41.759 --> 00:31:45.279 help identify

people at risk. And there's there's also tools 515 00:31:45.480 --> 00:31:50.680 that are also free for clinicians and or people then 516 00:31:50.720 --> 00:31:53.079 the profession or in the medical field that are screeners 517 00:31:53.079 --> 00:31:56.079 and or the Assessment Tool. There are other tools out there. 518 00:31:56.160 --> 00:32:02.079 The QPR question, persuade and refer which is really highly 519 00:32:02.160 --> 00:32:06.559 used in environments outside of the hospital like schools where 520 00:32:06.880 --> 00:32:09.359 it helps you identify and ask those questions and then 521 00:32:09.400 --> 00:32:11.480 you refer the person to help, and you know, you 522 00:32:11.519 --> 00:32:13.200 stay with them until you get them help. There's a 523 00:32:13.240 --> 00:32:15.240 lot of tools out there, but the Columbia I mean, 524 00:32:15.240 --> 00:32:19.160 it's just my particular favorite one that is free and 525 00:32:19.279 --> 00:32:22.839 actually has the most research done, evidence based tool out there. 526 00:32:23.359 --> 00:32:28.519 Great, and so they could just google Columbia Suicide Screening 527 00:32:29.119 --> 00:32:32.400 then they would find it, okay, perfect that it's always 528 00:32:32.400 --> 00:32:36.359 helpful for when people are listening to beyond substance, that 529 00:32:36.680 --> 00:32:40.279 they get something they can go do and make really happen, 530 00:32:40.319 --> 00:32:43.079 as opposed to just talking about it. So Holly, as 531 00:32:43.119 --> 00:32:46.119 we as we wrap up our time here, we always 532 00:32:46.200 --> 00:32:49.039 ask every guest if they have any kind of a 533 00:32:49.079 --> 00:32:52.920 special message or a special thought that they want to 534 00:32:52.920 --> 00:32:57.160 make sure that our listeners here and so what would 535 00:32:57.160 --> 00:32:58.960 that be special message be from you? 536 00:32:59.680 --> 00:33:06.079 It's pretty simple, ask the question, just ask people how 537 00:33:06.160 --> 00:33:10.759 they are? You know, if you go back to some 538 00:33:10.920 --> 00:33:16.000 of the studies of people that were interviewed who had 539 00:33:16.000 --> 00:33:20.960 made suicide attempts, that the turning point was when someone 540 00:33:21.119 --> 00:33:25.960 asked them, can I help you? How are you? It 541 00:33:26.079 --> 00:33:29.920 is such a powerful question to ask and it takes 542 00:33:30.000 --> 00:33:31.839 you and that person to the next step. 543 00:33:46.640 --> 00:33:50.880 Most of the time, day tend to like isolate themselves. 544 00:33:51.640 --> 00:33:54.240 I knew that I did that he loves especially when 545 00:33:54.279 --> 00:33:58.759 I'm kind of like depressed. Sometimes I would want tottend 546 00:33:58.799 --> 00:34:02.720 like evains dies just because I feel like I feel 547 00:34:02.720 --> 00:34:08.199 like intimidated to be amongst those people. Also, I'm only 548 00:34:08.320 --> 00:34:15.039 talking about wanting to die. 549 00:34:17.519 --> 00:34:20.199 Sometimes the hardest pain to name is the pain people 550 00:34:20.280 --> 00:34:23.679 carry in silence, the kind that hides behind a smile, 551 00:34:24.079 --> 00:34:28.480 a joke, or a simple I'm fine and our story Today, 552 00:34:29.000 --> 00:34:31.159 Zanab shares with us what it's like to live with 553 00:34:31.199 --> 00:34:34.559 suicidal thoughts and to use substances as a way to 554 00:34:34.639 --> 00:34:37.800 numb emotional pain, and to carry all of that in 555 00:34:37.880 --> 00:34:43.360 a culture where mental health is often ignored, dismissed, or misunderstood. 556 00:34:45.159 --> 00:34:50.360 For zaneb, substance use did not begin as recklessness. It 557 00:34:50.440 --> 00:34:53.920 became a way to cope, a way to quiet thoughts 558 00:34:53.960 --> 00:34:58.119 that felt too loud, too painful, too constant when the 559 00:34:58.159 --> 00:35:03.360 emotional weight became overwhelming. Smoking, drinking, and self harm all 560 00:35:03.400 --> 00:35:07.800 became part of the same struggle, different expressions of the 561 00:35:07.880 --> 00:35:08.920 same pain. 562 00:35:12.599 --> 00:35:18.519 My name is Zigna. Previously back in Nigeria. The law 563 00:35:18.639 --> 00:35:20.840 is not like really like you don't really have to 564 00:35:20.920 --> 00:35:23.800 abide by the law like that like that, so it's 565 00:35:23.840 --> 00:35:28.239 easy to get like cigarette alcohol and like whenever I'm 566 00:35:28.280 --> 00:35:32.639 thinking or anything with like any slight inconvenience and back 567 00:35:32.679 --> 00:35:35.880 on it, I'm back on smoking and other stuff and 568 00:35:35.920 --> 00:35:39.239 i'malays just isolated or it's just being in my room 569 00:35:39.760 --> 00:35:44.360 from school to just my room. And sometimes I would 570 00:35:44.400 --> 00:35:49.559 take stuff weapons sharp knives to like cut myself because 571 00:35:49.599 --> 00:35:51.679 the pend just makes it feel good for me. 572 00:35:52.960 --> 00:35:55.880 What she describes is not a neat line between addiction 573 00:35:55.960 --> 00:36:02.280 and suicidal thinking. It's an overlap interconnection. And the substances 574 00:36:02.480 --> 00:36:05.960 helped numb the pain for a while, but when they 575 00:36:06.000 --> 00:36:11.079 were gone, the thoughts were still there waiting, and when 576 00:36:11.199 --> 00:36:15.920 really felt out of reach, the desperation deepened. 577 00:36:17.480 --> 00:36:21.079 With me personally, none of the others seem to like 578 00:36:21.280 --> 00:36:24.960 intesify each other really, they just kind of like correlad 579 00:36:25.480 --> 00:36:30.159 It's something that is like interconnected together because substance use 580 00:36:30.239 --> 00:36:33.519 is just like I'm just like you know, using it. 581 00:36:33.519 --> 00:36:35.679 It's kind of like a coping mechanism for me, I 582 00:36:35.719 --> 00:36:40.320 would say, helps me like to norm the emotional pain 583

00:36:40.400 --> 00:36:42.639 that I have that way. I'm not like, my thought 584 00:36:42.760 --> 00:36:46.719 is not all over the place. And if I'm like 585 00:36:47.039 --> 00:36:51.079 shots of money to get some then it gets really 586 00:36:51.079 --> 00:36:55.320 really difficult. I'm stressing out. I'm thinking, Oh, there's something 587 00:36:55.360 --> 00:37:00.559 I can do, So just because I feel deeping, I 588 00:37:00.639 --> 00:37:03.639 need something to like take my mind from it. So 589 00:37:05.280 --> 00:37:10.239 rya creeping my body, my hands with knives and blade 590 00:37:11.239 --> 00:37:14.159 sees us just because I get a type of feeling 591 00:37:14.199 --> 00:37:19.000 with using substances and without the substanceals the society tota 592 00:37:19.159 --> 00:37:22.239 just like right there, like my total holl over the place. 593 00:37:23.719 --> 00:37:28.360 Part of Zayingep's story is also about culture and education 594 00:37:29.360 --> 00:37:33.079 about what happens when someone is suffering in an environment 595 00:37:33.119 --> 00:37:36.800 where mental health is not seen as real and asking 596 00:37:36.880 --> 00:37:42.159 for help is treated like weakness or shame. In Nigeria, 597 00:37:42.519 --> 00:37:47.119 she says, therapy was not something people talked about. Struggle 598 00:37:47.239 --> 00:37:49.000 was judged not supported. 599 00:37:50.320 --> 00:37:54.280 With Nigeria, we have like this culture that like mental 600 00:37:54.280 --> 00:37:59.360 health thing is not a thing. You can't be emotionally dreamed. 601 00:37:59.360 --> 00:38:02.760 They don't. They see it does like it's nothing, like 602 00:38:03.239 --> 00:38:05.440 you don't even know what you're talking about. They see 603 00:38:05.519 --> 00:38:10.360 it does it doesn't exist, so which makes it really 604 00:38:10.400 --> 00:38:15.719 difficult and hard to even ask for help if you're 605 00:38:15.800 --> 00:38:18.119 using substances. They don't want to know if you're using 606 00:38:18.159 --> 00:38:20.719 it to know your pain or anything. They just think 607 00:38:20.840 --> 00:38:24.280 you're just a bad person, like you're gonna get judged. 608 00:38:24.679 --> 00:38:29.039 They're like very judgmental, bad stuff. And they will never 609 00:38:29.159 --> 00:38:31.920 like take it upon themselves to offer your therapy, like 610 00:38:32.320 --> 00:38:35.920 they don't even think. They don't even think therapy is 611 00:38:35.960 --> 00:38:39.360 a world that like you, oh, you gotta just like 612 00:38:39.400 --> 00:38:43.079 whenever you make mention the name or the world of therapy, 613 00:38:43.119 --> 00:38:47.519 they're like, no, like why you need therapy for but yeah, 614 00:38:47.719 --> 00:38:50.199 so that is why it's kind of like difficult to 615 00:38:50.320 --> 00:38:51.079 ask for help. 616 00:38:52.039 --> 00:38:55.119 That same silence also shaped what happened in her family. 617 00:38:56.039 --> 00:38:59.760 They have watched an uncle's alcoholism take over his life, 618 00:39:00.840 --> 00:39:04.840 cost him his job, and leave him without support and 619 00:39:04.960 --> 00:39:09.719 a system that offered little compassion and even less help. 620 00:39:11.039 --> 00:39:14.440 His story echoes her own in a different form, showing 621 00:39:14.519 --> 00:39:18.519 how untreated pain can ripple through an entire family. 622 00:39:19.800 --> 00:39:23.760 It's still drinking, like he drinks so much that it 623 00:39:23.800 --> 00:39:27.519 works at the pots where like they see and containers. 624 00:39:28.079 --> 00:39:32.039 And then he later got fired because he drunk so 625 00:39:32.199 --> 00:39:36.039 much that he almost jumped into the sea. Which is like, 626 00:39:36.159 --> 00:39:38.920 ah know, it's like very deep, Like he would have 627 00:39:39.039 --> 00:39:41.760 died because most of the African people or black people 628 00:39:41.760 --> 00:39:44.039 that I know, most of us don't even really know 629 00:39:44.119 --> 00:39:48.519 how to swim, so he would have like died. But 630 00:39:48.639 --> 00:39:51.480 he got fired because of that, or he doesn't have 631 00:39:51.519 --> 00:39:55.039 a job because he keeps drinking even at his workplace 632 00:39:55.039 --> 00:39:57.760 where he's not supposed to be drinking. Nobody is helping 633 00:39:57.840 --> 00:40:01.320 him because it's Nigeria. They don't care about stuff like that, 634 00:40:02.519 --> 00:40:04.960 and they're like very judgmental and even for him to 635 00:40:05.000 --> 00:40:07.880 even ask for help because he knows how the culture is, 636 00:40:07.960 --> 00:40:10.320 like they're gonna judge him and other stuff, so he 637 00:40:10.360 --> 00:40:11.599 wouldn't even ask for help. 638 00:40:13.000 --> 00:40:17.119 But Zadab's story did not end there. After moving to 639 00:40:17.199 --> 00:40:20.599 the United States, friends in her school noticed the weight 640 00:40:20.719 --> 00:40:24.760 of what she was caring. She found support and resources 641 00:40:24.760 --> 00:40:32.159 were available. Group sessions, encouragement therapy, and non judgmental care 642 00:40:32.880 --> 00:40:36.639 helped her begin to see something different, that healing was 643 00:40:36.719 --> 00:40:40.400 possible and that she was not alone. 644 00:40:40.760 --> 00:40:42.199 At first, when I was in school and I started 645 00:40:42.239 --> 00:40:43.639 talking about mental health, I was. 646 00:40:43.719 --> 00:40:47.920 Like, whoa you guys believe like in helping and giving 647 00:40:48.039 --> 00:40:52.519 support to people that are delivered that are mentally challenged 648 00:40:52.639 --> 00:40:57.480 or just having depression and anxiety, And to. 649 00:40:57.400 --> 00:41:00.440 Be honest, that was what made me switch my major 650 00:41:01.239 --> 00:41:05.559 is kind of like really being an eye opener for me. 651 00:41:05.960 --> 00:41:10.840 The way they they all come together to help and 652

00:41:10.920 --> 00:41:14.079 give resources, Like if they don't know something, they're gonna 653 00:41:14.119 --> 00:41:17.599 find someone else. That's like that is their thing, Like 654 00:41:17.639 --> 00:41:21.079 they will help you. So I've really seen a big 655 00:41:21.119 --> 00:41:25.320 difference with them. Now I'm currently out of therapy, I'm 656 00:41:25.320 --> 00:41:31.320 doing good. I don't like the self AM has reduced 657 00:41:31.719 --> 00:41:34.519 tremendously as well, but like I feel like without the 658 00:41:34.559 --> 00:41:38.320 help that I've gotten, it could have really like lead 659 00:41:38.360 --> 00:41:41.039 to losing me, my parents, losing me. 660 00:41:42.199 --> 00:41:45.239 What changed for saying that was not one perfect solution. 661 00:41:45.960 --> 00:41:49.000 It was a community of people who made her feel 662 00:41:49.400 --> 00:41:52.199 that she was supported and loved. 663 00:41:54.159 --> 00:42:00.400 Me personally, it was causin helly like in high school, 664 00:42:00.519 --> 00:42:03.760 so I have like a mental not really like a 665 00:42:03.800 --> 00:42:09.599 mental but the person WORKSI while I was in high school. 666 00:42:10.000 --> 00:42:12.639 So the person comes to her UI and we have 667 00:42:12.760 --> 00:42:15.480 like this group session that I was just like, I'm 668 00:42:15.480 --> 00:42:17.440 gonna try that just to be able to like you know, 669 00:42:18.760 --> 00:42:21.480 get my mind of things and other stuff. So I 670 00:42:21.480 --> 00:42:24.039 would say, the person that's really helped understand up to 671 00:42:24.079 --> 00:42:30.480 me was Miss Anthony my high school. She wasn't like 672 00:42:30.519 --> 00:42:33.079 a teacher, but she was the person that organizes this 673 00:42:34.679 --> 00:42:39.840 event and clubs and organization where we share our experiences 674 00:42:40.159 --> 00:42:43.280 and other stuff. And even after sharing, she will like 675 00:42:43.760 --> 00:42:48.840 have some doctors, some partitioners come in and some other 676 00:42:48.920 --> 00:42:52.719 people to come in to come share like their own 677 00:42:52.760 --> 00:42:58.599 lived experience and she provides resources support even with Eskinazi, 678 00:42:59.599 --> 00:43:01.519 just being able to know that, oh, I'm not alone 679 00:43:01.599 --> 00:43:05.760 doing this, uh, you know is always going to get better. 680 00:43:07.239 --> 00:43:12.199 Now. Zanab is using what she's lived through to help others. 681 00:43:12.239 --> 00:43:15.679 Through her work with the IU Echo program. She's seeing 682 00:43:15.679 --> 00:43:21.800 how support, education and connection can open doors. She knows 683 00:43:21.840 --> 00:43:25.639 recovery is not about forcing someone to change overnight. It's 684 00:43:25.639 --> 00:43:31.039 about meeting them where they're at, walking with them, encouraging them, 685 00:43:31.320 --> 00:43:35.639 and helping them believe there is a bright future ahead. 686 00:43:36.960 --> 00:43:40.760 Most cases, something that you already dig that to you 687 00:43:40.800 --> 00:43:43.599 can just stop all of all of a sudden. It's 688 00:43:43.599 --> 00:43:47.360 got to be like beats by beats and also which 689 00:43:47.480 --> 00:43:51.280 I know it's gonna be like a very difficult tax, 690 00:43:51.599 --> 00:43:55.039 you know, just help them walk the paths with them 691 00:43:55.679 --> 00:44:02.079 or be encouraging, give them some like positive formations, and 692 00:44:02.159 --> 00:44:05.639 also just let them know they you know, support these 693 00:44:05.679 --> 00:44:10.079 help these resources, and also that there is always light 694 00:44:10.280 --> 00:44:12.679 at the end of its ownel just kind of like 695 00:44:12.800 --> 00:44:17.400 reward them positively so that they know they're not like 696 00:44:17.800 --> 00:44:21.559 alone and stuff like that. Also, I would just suggest 697 00:44:21.719 --> 00:44:24.559 we all be humble and kind to anyone because we 698 00:44:24.679 --> 00:44:28.639 don't know what they're dealing with in their own lives. 699 00:44:28.920 --> 00:44:34.039 Zayingab's message is clear, it's okay to not be okay, 700 00:44:35.400 --> 00:44:39.679 and sometimes the simple act of believing someone's pain is 701 00:44:39.800 --> 00:44:43.840 real can be the very thing that helps them keep going. 702 00:44:50.079 --> 00:44:54.000 Just being intentional with whatever you're doing and having friends 703 00:44:54.119 --> 00:44:57.920 or family or not partitional just having someone who you 704 00:44:57.960 --> 00:45:01.239 really trust that can also hold you account and you know, 705 00:45:01.519 --> 00:45:06.360 just exploring activities to do such as like singing me personally, 706 00:45:06.440 --> 00:45:09.480 I sing, listen to music, and then journal like if 707 00:45:09.519 --> 00:45:12.320 I'm having like if I'm in a bad space, and 708 00:45:12.480 --> 00:45:16.440 generally lot. So I just wanted to know that you 709 00:45:16.480 --> 00:45:21.079 are not alone right now, and also it's okay not 710 00:45:21.480 --> 00:45:25.159 to be okay, and it also shows that it's a 711 00:45:25.199 --> 00:45:29.559 sign of strength and not weakness. Also try to reach 712 00:45:29.559 --> 00:45:33.440 out for support, and one last thing. The feelings of 713 00:45:33.639 --> 00:45:37.880 hopelessness can be like a dig for that eights the lights, 714 00:45:38.800 --> 00:45:42.559 but therefore can always be lifted if you're able to 715 00:45:42.599 --> 00:45:45.840 find support and resources and just reach out to the 716 00:45:45.880 --> 00:45:49.440 people that you know they have these resources available for 717 00:45:49.519 --> 00:45:53.920 you to use. De pain is always temporary, even though 718 00:45:53.960 --> 00:45:56.880 if it does feels like it's eternal. 719 00:46:13.599 --> 00:46:16.119 You know, Jody, I'm so glad that we're having this 720 00:46:16.159 --> 00:46:20.599

conversation about suicide and substance use disorder today. It is 721 00:46:20.679 --> 00:46:24.000 something that is so common and I think many times 722 00:46:24.039 --> 00:46:27.719 just kind of really kind of overlooked, and people don't 723 00:46:27.760 --> 00:46:31.760 necessarily put the connection between those two things. But I 724 00:46:31.800 --> 00:46:35.599 know in my clinical practice this has been something that 725 00:46:35.679 --> 00:46:39.599 was kind of pretty common and that sometimes people don't 726 00:46:39.639 --> 00:46:43.079 pay as close attention to as they might. 727 00:46:43.920 --> 00:46:47.480 I totally agree this was a very hard interview for me, 728 00:46:47.679 --> 00:46:51.400 I know, just talking about this in general, especially with 729 00:46:51.480 --> 00:46:55.199 someone that has had that lived experience, And like you said, 730 00:46:55.320 --> 00:46:58.639 we don't talk about this as much as we probably 731 00:46:58.679 --> 00:47:01.880 should because it is uncomfortable and there is such a 732 00:47:01.920 --> 00:47:07.079 connection with substance use and suicide unfortunately, and so I 733 00:47:07.119 --> 00:47:11.440 think it's it's important to listen to stories and to 734 00:47:11.559 --> 00:47:14.920 know how to connect people to resources and ask the 735 00:47:14.960 --> 00:47:19.159 hard questions, especially for us that you know, who've been 736 00:47:19.199 --> 00:47:22.719 trained in this area, it's hard. It's a really tough 737 00:47:22.760 --> 00:47:25.559 subject to talk about. So I'm glad we've you know, 738 00:47:25.760 --> 00:47:26.639 been able to do that. 739 00:47:27.079 --> 00:47:30.199 And it is I think more common than we think about. 740 00:47:30.239 --> 00:47:32.800 And when I think back over, I'm not sure how 741 00:47:32.800 --> 00:47:35.119 to say this. It's not usually my involvement, but my 742 00:47:35.280 --> 00:47:41.440 knowledge of suicide with clients or with friends or you know, 743 00:47:41.559 --> 00:47:44.639 in family and that type of thing. And many times 744 00:47:44.679 --> 00:47:47.480 it's hard for people to talk about, just like you know, 745 00:47:47.599 --> 00:47:50.760 in previous episodes, you know, we have talked about people 746 00:47:50.880 --> 00:47:54.480 finding a reluctance to talk about people who may have 747 00:47:54.519 --> 00:47:57.639 suffered an overdose and have passed away from an overdose, 748 00:47:57.719 --> 00:48:00.480 and so sometimes we just don't talk about about that. 749 00:48:00.559 --> 00:48:05.480 And it's so important to one find the support to 750 00:48:05.559 --> 00:48:10.079 help prevent suicide from taking place. And also, you know, 751 00:48:10.159 --> 00:48:14.239 even in the unfortunate incident where a suicide may have occurred, 752 00:48:14.679 --> 00:48:17.559 how important it is to seek the support, to find 753 00:48:17.599 --> 00:48:20.039 help to kind of work through that. Right. 754 00:48:20.159 --> 00:48:24.559 And with Zanab who I spoke with, she really shared 755 00:48:24.599 --> 00:48:29.400 a lot about just her own experience and the country 756 00:48:29.440 --> 00:48:32.480 of origin where she's from, and how it is completely 757 00:48:34.000 --> 00:48:39.440 looked at differently, and so it was very interesting and 758 00:48:39.440 --> 00:48:42.880 insightful to really talk to her to see, you know, 759 00:48:42.960 --> 00:48:46.119 kind of the difference and how things have changed by 760 00:48:46.159 --> 00:48:49.480 living here and being involved in a community and being 761 00:48:49.599 --> 00:48:53.960 able to get connected to resources. It was good and 762 00:48:54.000 --> 00:48:56.480 you know a lot of good information I learned from her. 763 00:48:56.679 --> 00:49:00.960 So but yeah, I think, you know, getting connected into resources, 764 00:49:01.000 --> 00:49:05.079 and you know, if things get overwhelming for someone, if 765 00:49:05.119 --> 00:49:08.119 there's there's a number that you can reach out to anytime, 766 00:49:08.239 --> 00:49:12.800 then the nine eight eight. You don't have to be suicidal. 767 00:49:12.920 --> 00:49:16.000 You can call, text or just chat just to talk. 768 00:49:16.800 --> 00:49:20.559 There's a real person there that will listen. So so 769 00:49:20.679 --> 00:49:24.960 reach out. If you or anyone you know needs help, 770 00:49:25.480 --> 00:49:28.519 you can. You can call the nine eight eight number 771 00:49:28.679 --> 00:49:30.599 and get some help. You're not alone. 772 00:49:31.639 --> 00:49:34.039 I want to thank our guests today and thanks for 773 00:49:34.119 --> 00:49:36.000 everyone for joining us. 774 00:49:36.440 --> 00:49:39.400 We'll see you next time on the Beyond Substance podcast. 775 00:49:44.599 --> 00:49:47.039 If you feel you need assistance, please reach out to 776 00:49:47.079 --> 00:49:50.559 a counselor or other healthcare provider, a supportive loved one, 777 00:49:51.119 --> 00:49:53.960 or contact resources in the community such as two one 778 00:49:54.039 --> 00:49:57.400 one where you can be connected to assistance or talk 779 00:49:57.480 --> 00:50:03.280 with a peer or counselor Beyond Substances hosted by Dean 780 00:50:03.360 --> 00:50:07.239 Babcock and Jody Miller. A Look at the Number segment 781 00:50:07.320 --> 00:50:11.679 is hosted by Ali Martin. The executive producer for Beyond 782 00:50:11.679 --> 00:50:15.760 Substance is Sean Penel, and it is mixed at Studio 783 00:50:15.800 --> 00:50:43.719 two thirty six at Advocast