Suicide Prevention: Know the Signs and Where to Get Help

Author: David Fein, MD, Medical Director of  Behavioral Health Emergency Room Services

Suicide rates have been on the rise, now standing as the 10th leading cause of death in the U.S. and the 2nd leading cause of death in teens. Now more than ever, it’s critical to know the signs that might indicate a person is considering suicide, where to go for help, and how to provide appropriate support and interventions.

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Risk Factors

While there are known risk factors for suicide, such as being older, male, or single, there are additional risk factors to be mindful of as well. These include dramatic changes in behavior, such as getting one’s affairs in order, giving away possessions, increasing substance use, and expressing feelings of being trapped, a sense of hopelessness, or the belief that there is no purpose or meaning to life.

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Many suicides occur during moments of extreme anxiety and hopelessness about the future. In fact, interviews of people who attempted suicide reveal that, oftentimes, they experienced profound regret about their decision almost immediately.

We should strive to never let temporary feelings of hopelessness drive us or a loved one to a permanent act like suicide. If you feel you are trapped with no way out and think the only solution is death, know that many resources are available to help you through the crisis.

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Where to Find Help

Each parish has a community mental health center and a mobile crisis unit that are available 24/7 to provide support for people in a behavioral health crisis. Calling the crisis unit does not necessarily mean you will be brought to the E.R. They are there to provide support to you – sometimes over the phone, sometimes in person.

Metropolitan Human Services District serves Orleans, St Bernard, and Plaquemines parishes. Call (504) 568-3130 for their clinic, and (504) 826-2675 for their mobile crisis unit. Jefferson Parish Human Services Authority serves Jefferson Parish. Call (504) 838-5257 for their clinic and (504) 832-5123 for their mobile crisis unit.

If a friend or loved one is in crisis and unwilling to seek help, another option is an Order of Protective Custody, which is signed off by the parish’s coroner and gives the police legal authority to bring the person to the hospital for an evaluation. To  request for an Order of Protective Custody in Orleans Parish,  call (504) 658-9660; in Jefferson Parish, call (504) 365-9100; in St. Tammany Parish, call (985) 781-1150.  

There are also national services such as the Suicide Hotline (1-800-273-8255) and the National Alliance on Mental Illness (NAMI) (1-800-950-6264) which also has a Crisis Text Line (just text NAMI to 741-741). As always, emergency rooms and 911 are available 24/7 in case of an emergency.

Dr. Fein is an Assistant Professor of Psychiatry and Associate Director of the LSU-Ochsner Psychiatry Residency Training Program, LSU Health New Orleans School of Medicine.

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Am I Experiencing Vicarious Trauma?

Authors: Jennifer Hughes, PhD, and Alisha Bowker, LCSW, UMC Trauma Recovery Clinic Team

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At times it can feel nearly impossible to find the motivation to keep showing up to work, week after week, especially after working long hours or dealing with crises and looming deadlines. Working in the medical and helping fields, especially, we are often overwhelmed with horrific stories of violence, pain and trauma, which can dramatically alter the way in which we understand the world, ourselves and others.

The clinical term for this phenomena is Vicarious Trauma (VT).

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What is Vicarious Trauma (VT)?

Vicarious Trauma can be defined as a change in a helper’s inner experiences after working with people who have experienced traumatic events. Trauma can be defined as a deeply or distressing event that one directly witnesses or hears about. This can include natural disasters, interpersonal violence, war, divorce, childhood abuse and so on.

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Does Everyone Experience VT?

VT is a natural consequence of being an empathetic human, and being exposed to a population who has experienced trauma. Those often impacted by VT are social workers, case managers, doctors, nurses, first responders, etc. It is an inevitable hazard in these lines of work and, unfortunately, cannot be avoided, but definitely can be addressed and managed.

VT can also extend not only to helping professionals who work with this population, but also to the caregivers or loved ones of a survivor.

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How Does VT Impact My Life?

Vicarious Trauma is an ongoing process that slowly builds over time the longer we are exposed to the stories of trauma survivors. It generally begins to impact us in three different realms:

  1. Identity: It begins to impact our identity, which changes the way we see and define ourselves.
  2. Worldview: It impacts our worldview by skewing the ways in which we understand others or understand how to interact with those around us.
  3. Spirituality: It can impact our spirituality, and replace feelings of hope with feelings of cynicism and despair.

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VT Versus Burnout

Vicarious Trauma is different than burnout, as it truly only develops after being exposed to traumatic stories. Burnout is a state of chronic stress, particularly in a work environment, that leads to physical and emotional exhaustion, cynicism, detachment and feelings of worthlessness.

While the symptoms are similar, burnout is generally not rooted in trauma exposure.

Signs and Symptoms of VT

Some of the most common signs and symptoms of VT fall under these 5 areas:

  1. Cognitive: Intrusive thoughts, sounds or images about the traumas an individual has been exposed to, difficulty concentrating, constantly thinking about survivors outside of work, becoming more cynical or negative in one’s thinking patterns.
  2. Physiological: Ulcers, headaches, chronic pain, stomach aches, sweating or heart racing when reminded of a trauma
  3. Spiritual: Lose hope, see others as bad or evil and lose sight of the good in humanity, difficulty trusting our own beliefs
  4. Behavioral: Hair trigger temper, isolating, using unhelpful coping to manage big feelings (drinking, drugging, gambling), need to control everything and everyone
  5. Emotional: Lose touch with one’s own self-worth, isolate from loved ones, feeling overwhelmed or emotionally restricted

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So now that we have the language to define the symptoms we are experiencing, what can we do about it?

Thankfully there is an answer for this and it can be broken down into three phases:

Anticipate and Protect, Address and Transform

  1. Anticipate and Protect: Arrange things ahead of time to anticipate the stress of your work and its impact on you.
    • Become aware of VT and start to look out for signs and symptoms. Intentionally plan for a healthy balance between your work life and personal life.
    • Find a support system, particularly amongst colleagues who share this language and can support you as needed.
  2. Address: How you take care of yourself in and out of work
    • Engage in Self-care: Attending to yourself physically, spiritually, emotionally and psychologically
    • Self-nurture: Engaging in activities or things that provide comfort, relaxation and play
    • Escape: Getting away (whether literally or mentally)
  3. Transform: Transform the negative aspects of this work into positive connection and meaning
    • Create Meaning: Find ways to hold onto your values and identify even in the face of trauma
    • Infuse current activities with new meaning: Mindfulness, Connection to others
    • Challenge negative beliefs: Actively challenge negative thoughts or cynicism/ Re-frame your thinking

While vicarious trauma is a very common and inevitable consequence to the work that we do, the exciting news is that we have the tools to fight back. This is an ongoing process that will continue to look different at different stages of our careers, so it is a process we must continuously be engaging with.

Both individually and collaboratively, begin to identify the signs of VT in your own life and use the template above to make a plan for how to begin addressing and counteracting these symptoms.

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Remember, you are not alone with your vicarious trauma, and do not have to manage it alone either.