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Transcript for September 2014 Brown Bag

>> Desperately important because 1 in 4 people has a diagnosable mental illness and, so, for example, if you take all of San Diegans that is enough to fill Qualcomm seven times. That's a lot of people. And so -- actually, it might be eleven times. Anyway, it's a lot of people. And so it's something that affects all of us. And one of the most frequently diagnosed of mental illnesses is depression. And for that reason, suicide, which is frequently discussed by people who have severe depression and the people who experience other disorders as well. And, so, for that reason, it can touch everyone's life. They say that in the world a person commits suicide every 40 seconds, which means that every 41 seconds, there's a family member or loved one, someone who is affected by that person's suicide. So, here we are. We're going to learn the 12 flares of suicide prevention. That way, perhaps if you see these in a friend, a neighbor, a loved one, you will be able to recognize it in time to act on it. Okay, what do I do [Inaudible] -- Okay, so just a little bit about me. I work for the National Alliance on Mental Illness. I am not here on their behalf. I am here on my own volition. I lecture frequently at universities. I've lectured at many of the universities in the area, and more than 30 times. I am also an employee here at [Inaudible] I teach that best practices and psychiatric rehab with Marge, and we have an absolute blast doing this. I am a certified rehabilitation counselor. I love making jewelry. I also write a column, moving through [Inaudible] with mental illness. I, myself, am diagnosed with seasonal affective effective disorder, bi-polar type. And let's see. I graduated from San Diego State, 2013.

 

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[ Inaudible ]

I'm an alumni of BYU and also the college Napoleon Dynamite made famous. He's wearing this little Rick's College t-shirt there. I love to write. These are all my journals so far, and this is my family. I've got my bookend twin boys, Joshua and Jonathan, my dear, sweet -- these are my step-children because I married my man of my life, man of my dreams, almost three years ago. Next month it will be three years. And I [Inaudible] him for amazing two neighbors in the process. Okay. [Inaudible] So, basically There we are. Basically, what we're going to go through is we're going to understand how suicide can affect everyone. We're going to talk about some of the myths. We're going to identify how to recognize suicidal thoughts or suicidal ideations. If you ever read S.I. on case notes, it means suicidal ideations, and ways that we can intervene. Can I please get a volunteer to read this quote for me?

>> U.S. health officials said nearly 100 people every day commit suicide, and many more attempt it. It is the tenth leading cause of death in the U.S., with rates doubling those of lives taken by homicide.

 

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>> It's an outrageous statistic. And this is what it looks like here, let's see, in San Diego County. This is pretty frightening. Yellow indicates suicides. So the numbers, you know, it's really small, but if you look, these are the age groups. Okay? So, suicide is the second leading cause for children ages 10 to 14. Second leading cause. This is on a couple. It's the third leading cause of teenagers 15 to 19. This is motor vehicle, second is suicide. This is homicide. And it's the second leading cause of death for people in San Diego from the ages of 20 to over 85. This is a serious problem and I'm so grateful because you are the people who are taking this seriously. You're coming here to learn about it so that you can prevent this, because suicide is 100% preventable if you're paying attention, if you are asking. However, there are times when you recognize the signs, you try to do whatever it is that you possibly can to do, but the person is just too determined. But the earlier you can intervene, the less likely they will be that determined. My little -- So, this was basically San Diego County Suicide Rate categories -- where it happens the most. As you can see, we had a really high incident, more than 20 from 2002 to 2012 way out in East County. Those are a lot of underserved people that we really need to be able to reach out to. And you can't see these numbers, but, for example, from 2002 to 2012 there was two people who committed suicide and these are the colors over here. If you would like a copy of this slide, we can get that to you. That way you can read it better. So here's a look at myths. Can I have a volunteer read a myth? Go ahead.

>> Those talking about suicide just want attention.

 

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>> Now, I will tell you, I have been suicidal. From about 2002 to 2008-9, I had a voice in my head telling me how and when to kill myself. Sometimes my doctor told my family I was just looking for attention. But I'm grateful my family always took me seriously, because in my discussing suicide, I was always asking for help. I was trying to be proactive so that something didn't happen, because those voices weren't going away. Okay, myths. Myths. Myths. Can somebody --

>> There are never warning signs.

>> There are never warning signs. But, I promise you, there are always warning signs. Myth. Bobby, can you read myth. [Inaudible]

>> Sure. Talking about suicide encourages someone to commit suicide.

>> In actuality, the fact is, if you reach out to someone and you're willing to use the S-word, willing -- you know, you seem really down. I am just curious, you know, how's it going? What's going on? Let's talk about this. What that really is showing the person is that you care and that they make a difference in your life and you want to make sure that they're still here tomorrow so that they can keep making that difference. This is interesting. This is a quote from an article by Aaron Beck. [Inaudible] I like this picture. The quote says, "Hopelessness is the key variable linking depression to suicidal behavior." How many of you are familiar with the recovery model? And what's the first pillar of the recovery model?

 

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>> Hope.

>> Hope. So, as we work to help people keep that hope, find that hope, or as we work as providers, holding that hope for them or family members, holding that hope for them, encouraging them, letting them know that you are hopeful for them -- that will take away the major ingredient right there. So, we have a very happy looking person with a red flare. And we're going to go through 12 red flares of suicide. The first red flare is talking about wanting to die. Have you heard comments like this? I wish I were dead. Everyone would be better without me. I'm tired of my life. Those are all people reaching out. Take my hand, please. Next, feeling -- what's that? Hopeless. Feeling hopeless. Big plan. My life is never going to change. I'll never get enough money to pay off my creditors. Knowing these signs of hopelessness. Think -- what are some other comments that might be a sign of hopelessness?

 

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>> How will I ever be able to work?

>> How will I ever be able to work?

>> Support myself.

>> How am I going to support myself.

>> My family would be better off without me.

>> Mm-hmm. I actually -- that was a reoccurring voice in my head. One of the people was always telling me that you're a burden to your family. Your family would be so much better without you. That is a hopeless comment, and when someone starts believing that, bad things can happen. Giving away possessions. Here we have an elderly lady giving her grandson his grandpa's favorite book. Go ahead.

 

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>> Any -- for your last slide, that is another example of hopelessness: I'll never be in a relationship.

>> I will never be in a relationship. I thought that for many years. People told me that for many years. [Inaudible] I have totally [Inaudible]. That right there --

[ Inaudible ]

Putting affairs in order. I have a friend who recently got a haircut and when asked about it he said oh, I'm getting ready for the coffin. I know of -- I mean, we've heard of people who are in such deep debt; they know that they're worth more as a dead person because of their life insurance policy than they are as a live person. And to help their family members, that, in their unbalanced, chemically-imbalanced brain, that's the thing that makes the most sense to them. [Inaudible] Mm-hmm.

>> Wow.

>> Getting your hair cut for your coffin -- when I discussed this with him, he said, oh, I'm just joking. You know me. I'm just joking.

>> Mm-hmm.

 

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>> But he said so many red flare things, [Inaudible] kind of. I don't think he realizes he's not joking.

>> Yeah. Well, not only that, but sometimes people will say they're joking. I'll give Chuck an article to send out, but I saw a friend -- I have an online support group, and one of my friends who is in the support group, actually posted something that was likened to this and it was oh, this is September -- September is suicide prevention week. And I work in a mental -- I worked in a mental health clinic at the time, and so I told my boss that, you know, it was lunch time. I looked on Facebook. My friend said this. And she said go. And gratefully, she was in town. She lives up in Alpine. I drove up to Alpine, and she just slapped on this smile. She was so happy to see me. But I stayed and I talked to her and I brought up the comment on Facebook and then we started talking. And she was serious. She had fully researched everything. She had saved all her meds. She had enough now and she was just seeing this from one [Inaudible]. She actually is an acquaintance of mine. I only knew her through Facebook. But I was the one that noticed, because I've experienced this and I'm aware of the 12 flares. And now you will be, too. Reckless behavior. Yeah. That's a big one. Can I access YouTube from --

 

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[ Inaudible ]

Okay. So we're going to show -- this is a YouTube video. [Inaudible] Okay. Thank you.

[ Inaudible ]

Sorry. I should have checked these beforehand.

>> Hey, Sarah.

>> Yeah?

>> [Inaudible] somebody has a question from Andy.

>> Okay.

 

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>> It says they are referencing a previous slide, I believe a client's sense of helplessness perceived and [Inaudible] hopelessness, and too often this helplessness is learned. Your experience with learned helplessness? With a question mark.

>> Learned helplessness is a wonderful topic. It's a theory that was created or recognized, I guess, I should say, [Inaudible] Okay. It was recognized by a man named Martin Seligman. And he was doing a study seeing whether or not there are actually dogs -- I think they were dogs. It was back in the seventies when they allowed testing on animals like this. But, basically, they put these dogs in a cage where the cage was electrified and the dog was not able to leave the cage, and so, soon, the dog just laid down. Then they removed the wall on the side of the cage so that the dog could move to the other side, and he stayed there. And this happened over and over again because the dog had learned that regardless of what he did, nothing would change and so, even though he was being electrocuted, he laid down and just took it. And the learned helplessness happens all the time. People in low socioeconomic groups, poverty. We see it in mental health as well. You know, regardless of the medication I take, nothing changes. Things like that. And it's something that we have to work on overcoming. And part of that is, as providers, holding that hope for people. You are right. It hasn't worked until now. And sometimes, that's something we even need to say to our --

 

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[ No Audio ]

-- which creates a very agitated person. And that's what I struggled with, with mixed mania. Changes in sleep patterns, like Joe mentioned, not being able to sleep. It's important to recognize that this isn't them saying that they want to commit suicide. It's the illness. It's the illness. And so, being able to recognize that, as an illness, helps them recognize, oh, okay, you know, there is hope. It's biological. Something can be done to help it. That -- for me, when I finally recognized it was biological and that it wasn't just well, Sarah, just think positive, just work harder, just -- you can do this. You can do this. You can do this. I was spinning my wheels trying and trying to do it, but it wasn't working. So, biologically, changing in sleep patterns, oh, my goodness. You can get your days and nights mixed up like no one's business. Suddenly, you're walking around wondering why everyone is sleeping and you're calling everyone because you want somebody to talk to and it's three in the morning. And everyone's like, I'm going to work tomorrow. Why are you calling? It's because my sleep pattern was changed and I didn't have the insight to recognize that theirs hadn't.

 

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Sudden changes in mood. This picture is a little misguiding. When I'm talking about sudden changes in mood, I'm actually talking about someone who has seemed very depressed for a long period of time and is suddenly happy or kind of at peace. They are, you know, care free [Inaudible], because the decision has been made and they're at peace with it. So it's important to recognize sudden changes in mood. No sense of purpose. You know, the last pillar of the recovery model is finding meaning and purpose. It is kind of linked with spirituality. You look at the successful addiction treatment programs, AA, NA, everyone is acknowledging that there is a higher power and that helps. That helps people with mental illness. It's one of the pillars of a recovery model, helping people find that meaning and purpose. Okay, so now you know. And as my brother's favorite cartoon in the eighties said at the end of every single one, now you know, and knowing is half the battle. [In Sing-Song Voice] G.I. Joe. [End Sing-Song Voice]. Well [Inaudible] what can we do about it? You know, that begs the question, now that we know, oh, okay. They're obviously showing signs, but -- We need to take it seriously, you know? Even if the person afterwards, oh, I was just joking. If they have shown enough signs, you either need to sit down and talk to them or just call the police, and when the police come and the person slaps the smile back on their face, you can say, you know what? They've done this.

 

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They've done this. They've said this. They've said this, this, this and this. We've got 9 of the 12 flares of suicide. Why aren't you taking this person for help? Fifty to 75% of people contemplating suicide actually mention it to someone else. And it is, it's that reaching out. Please stop me. Please stop me. Please care enough. Listen, don't be afraid to ask the questions. They're hard questions. Do you have a plan? Tell me about your plan. Don't be afraid to take action. I am working with a family member on a website right now. My son doesn't want to go in the hospital. He doesn't want to be locked away. But your son has all ready told you how he's going to kill himself, and you've said he has the means. Dial 9-1-1. But he's going to get mad at me. But, maybe in a week when he's better and can still play with his cousins, maybe he won't be mad; and if he is, maybe a month later. When he finally gets to graduate from high school, he'll be happy. You have to -- you just have to separate yourself from what the other person might feel and do what's in their best interest. Don't be afraid to show you care. I can't tell you how many times my dear mom and dad took me to an ER and stayed. They didn't just drop me off. They stayed with me. Thank you. [Sniffles] They showed they cared. It wasn't, aw, Sarah, not again. It was, okay, which ER do you want to go to? Which one has the nicest people that you like? Where do you even start talking to someone, especially if they're some random person on Facebook that you only knew through Facebook? You know, how do you start the conversation? Well, there's two ways. There's the indirect way and there's the direct way. Either way works. Either way is effective. Basically, what is your style? What are some indirect ways you can ask someone about this? Go ahead.

 

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>> Did you ever wish you could just go to sleep and not wake up? Indirect -- or direct. Have you ever considered suicide?

>> What are some other indirect ways? Or direct ways? Be creative, guys. I know you've got it in you.

>> [Inaudible] What are your goals after you graduate? Since I work with students in a university and if they say they have no concept of what they're thinking about doing, they're like well, [Inaudible] kind of working backwards instead.

>> That's actually a great way to do it. What are some other ways? We've got to get these questions in our minds so that when we come across these people that need our help, we all ready know what we're going to ask. Chuck, you look like you're --

>> Yeah, I was thinking like, indirect, do you ever think about doing something and maybe I wouldn't be here or even would kind of harm you in some way? Without just coming right out and saying are you thinking about killing yourself.

 

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>> Yeah.

>> Do you have plans for suicide or something like that?

>> Yeah. I mean, obviously, it depends on how well you know the person. Right?

>> You know it feels kind of off, the person on three who is drinking and driving, are you trying to commit suicide, because, you know, you seem to be doing some pretty risky behavior here.

>> I'm like [Inaudible] like what they've said all ready. Like, if the person is hoarding drugs, for instance, I might make reference to the, you know, do you have plans for those to kind of link in with what they said.

>> Yeah. Making questions that link in to what they've said often shows them that you are paying attention and that they matter. Rachel, you were going to say something?

[ Inaudible ]

Yeah, being human.

>> Yeah.

 

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>> You know, are you at the end of your rope? How many of us get to the end of our rope? Right? We get to the end of our rope. So, the good thing is the majority of people, when they are in a balanced frame, when their brain is balanced, they know that when they get to the end of their rope, they tie a knot on the end. You know? And when our brain is balanced, we know where our resources are and where to get help. Well, I need to call my mom or I need to go for a walk on the beach or whatever it is. When your brain is balanced, you know how to find those supports. When your brain isn't balanced, I mean, I've had severe panic attacks, where I had my little anxiety medication in my pocket and I'm having a complete meltdown. And I call my nurse because I'm freaking out and she's like well, Sarah, do you have your meds in your pocket? In your purse? Oh, yeah. Well, why don't you take this one. Okay. Okay, now, let's just talk for 10 minutes. [Laughing] And it's like, oh. Hey, thanks so much. Duh. Thanks. But it's because when the brain is imbalanced, you're not able to focus on what your options are or what, the kinds of things you can do to help yourself. That's why it is so important that we have other people, like you guys, who are willing to ask them questions, either directly or indirectly. And so these are some of the questions when you're doing these. You know, obviously, a lot of you are professionals and so you will be doing professional risk assessments. And, for those of you who aren't professionals, these are some of the questions that can be asked, but it's best to turn it over to a professional. So, you ask them if they have thoughts of suicide or thoughts of death. You ask them if they have a plan. You ask them about their plan. The greater the detail the plan is, the more likely it's going to happen. The more lethal, the greater the risk. My grandpa's gun is in the garage. Okay, then, 9-1-1.

 

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You know, it's all ready thought out. They've all ready got it planned. Ask them if they have the means to complete that plan. These are the questions that a policeman is going to ask on the PERT team. And if the PERT team shows up and you're with them, because I've been in this situation, if you don't know the person well enough or had enough conversation with that person to know the answers to these questions or to be able to say, well, these are the other 5 of the 12 flares that I've seen in their life -- I mean, I was called by a mom to go check on her daughter. I went to check on her daughter. Her daughter has not left her room probably in three weeks, with the exception to use the restroom and to eat. And she was only eating bread and water. I got there, talked to her, knew she needed help, called 9-1-1. 9-1-1 got there, she was in there brushing her hair, [Chipper Voice] oh, hi. How's it going. Oh, yeah, I'm fine. [End Chipper Voice] I didn't have this solid background, because it was just a mom who called me and asked me to go check on her daughter. So, the police were there for about an hour. They did an assessment and they [Inaudible] and decided she was okay. And they left. And I'm following her mom saying, well, they left, and she said, well, you did the most you could. And, you know, that's why we have to know the background. We have to have the answers to those questions. When I went up to Alpine to talk to that lady, the second pillar of the recovery model is choice and accountability, and empowerment is the third one. So I gave this lady, once I recognized what was going on, I gave her the option. You have two choices. It's your choice. But your choices are I can call 9-1-1 or I can drive you to the ER. Those are your two choices. I am giving you these two choices because I love you and I want what's best for you. And so, she didn't want to [Inaudible] neighbors and have everyone staring at her, so we packed her bag and we went to the ER. When we got to the ER, again, she's with the doctors and she's laughing and she's talking, and the doctor's are going to let her go, and I said no. She's researched this. I was in her bathroom. She showed me how many it took and she has that many. And they are all ready laid out for her on her counter. And the doctor had talked with her for 45 minutes and didn't get that out of her. And I said that to him and he said, never mind. She's staying.

 

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>> I had the same thing that happened with my son. He saw like three different doctors in a 48 hour period.

>> Mm-hmm.

>> before he ended up in the emergency room in a psychotic episode. And they all said he was fine. And he took hisself to the ER complaining of chest pain, because he knew that they would keep him there. So he had the wherewithal to know he needed help. But he knew if he just showed up and said I'm [Inaudible] my brain, I can't get it to shut off. He had never had any history of that illness. That they would just let him go. And he was there. They did a whole work-up. Saw a psychiatrist. And they said he was fine at that point. And he was completely psychotic.

 

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>> Mm-hmm.

>> And the same thing happened after I had a girl in Gingham, where he was in the mental hospital, and bring her home. And the same thing happened here. Three doctors.

>> Yeah.

>> And then my husband had to take him to the ER because he couldn't fight [Inaudible].

>> Yeah.

>> So, I mean, there is something intrinsically wrong with our mental health [Inaudible] in this country and anything I can do -- I mean, I'm ready to go to Washington and start screaming.

>> I think, when I've taken people to the ER, and I've taken a couple, you have to tell the doctor in no uncertain terms that they are in danger of themselves.

>> All right.

>> They are a danger to themself. Go ahead.

>> As a parent or a neighbor, not for the professional, but I'm not under that thing that you have to be quiet, can I videotape? Because by the time the police get there, he's just fine.

>> Yeah.

 

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>> Yet I've spent, you know, 45 minutes on the front porch with a man who is just talking about what he's going to do.

>> Yeah. You have to. You have to do something. And when he gets -- when the police get there, you have to be able to say, you know what, he has said this, this and this, and if it's necessary, look. I recorded it. That's what he said. You also -- in order to strengthen your case, you have to be able to say, you know, I know the 12 flares of suicide. We have done this, this, this, this, this, this, this. Or they've talked about this in detail, this in whatever. You have to be able to solidify your case. That way the policeman pays no attention to the person standing there smiling, [Chipper Voice] I'm fine, [End Chipper Voice] because they have all the evidence. And it's hard for parents as well because they don't have that -- they have that confidentiality thing. So if the child doesn't sign the release form, the parent has no ability to ask the doctor what's going on. But the parents can call and tell the doctor what's going on. They can talk as much -- the parent can talk as much as they want to the doctor about what's going on. They just can't get information from the doctor. So, if you're working with a family who has this problem, tell the family members well, you need to talk to the doctor, you need to tell them exactly what's going on, to a counselor, whomever. Show them your evidence. Go ahead.

 

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>> Just to kind of piggy-back on that, one of the things that happens often is if someone is really depressed and they start doing better, that's when the risk gets much worse. So if somebody, [Inaudible] family member, friend will say oh, she's on the mend and that when the person has enough energy to actually carry out the plan, that's when the risk is highest. So, to be aware of that, too; that even the [Inaudible] hadn't helped, they may still be at risk.

 

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>> That's very true because when they're in severe, severe, severe depression, they don't have the energy to do anything. But when the depression is kind of starting to life, they start getting energy. So, yes, some people do manipulate others by threatening suicide. But, that is such a small percentage of those who actually talk about suicide. Regardless, you always must take it seriously. I like the little -- you can't really see it, but he's got a smiley face on there. I'm hearing. So, here we are intervening. Recognize the signs. [Inaudible] work past your own reluctance about becoming involved and don't be afraid to speak up. You know, the lady that I took to the ER, it was Christmas Eve and she didn't want to miss Christmas with her kids. And she was mad when I finally showed the doctors and convinced them what was going on and they kept her. Because she wanted to be Christmas with her kids at least, which I thought was kind of funny. I knew she wasn't going to do it that day. She was going to do it maybe on the 26th. But, after Christmas, when she was still in the hospital, I got this call. Sarah, thank you so much. Reassure them they're not alone and not only that they're not alone -- they feel like they're very alone -- but reassure them that regardless of how alone they feel, you care. You care about them and you will support them in getting help. Encourage them to talk openly about how they're feeling. Don't say well, no, I don't want to talk about that. I don't feel comfortable talking about that or change the subject.

 

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It's something that they need to know that you are willing to listen, that your feelings are real and that they need real help. And listen carefully. Resist the urge to give advice or talk about your own experiences, unless you've had experience in suicide prevention. Perhaps someone intervened for you. Like, when I was with this lady, you know, I said, you know what? I've been there. I have had this experience. Tell me more about what you're going through. She was freaked out going to the hospital. I said you know what? You can wear your pajamas every day. What do you want to pack? When I go to the hospital, I pack sandals. I pack pajamas and I pack a good book or crossword puzzle. And she's like, oh, I wouldn't have even thought of those things. Oh, okay. It like kind of broke the awkward, oh, I'm going to a psych ward. And you can tell them, you know when my friend goes to the hospital, she is wearing some flip flops, brings a couple comfy pairs of jammies, and she likes words so she brings a word puzzle. You can use my experience. That helps you normalize it. Everyone has seen the creepy movies about people in mental wards, and I can promise you, there's a whole mess of people in there. I was scared to death the first time I went. And in my journal I recorded, the weird thing is, the people in here are normal. [Laughter] I thought that was pretty funny. So here are San Diego's Access and Crisis Line. But if there's any questions, just call 9-1-1. And when you talk to the operator, tell them that you are having a psychiatric emergency. And instantly they know that instead of bringing, you know, six people or six cars with guns, they need to send the two cops that work on the Psychiatric Emergency Response Team, who comes out with a counselor. And that's the National Suicide Prevention line. Any questions? Comments? Yes.

 

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>> [Inaudible] Can you go back one slide?

>> Sure.

>> The last bullet says if you refrain from using your own experience and yet you just said to talk about your own experience. So --

>> I think the difference is I have taken a peer support training class and in that class, it taught me how to hone my experiences so that I wasn't making it about me. I still understood that it was about them. They were in crisis, not me. But I just kind of tried to normalize it for her because I didn't want her feeling like she was alone. So, if the person is trained and they know how to not make it about them, you know, me just saying I have been there is different than, oh, I've been there and this is what I did and this is how I did it and this is how many times I did it and I did this and this and this. Oh, and then it didn't work so I did this and this, and then, oh my gosh, you know.

 

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>> That's different.

>> Total difference.

>> Yep. Okay.

>> Can you repeat the question, Sarah?

>> Oh, the question was about the last bullet on here. It says resist the urge to give advice or talk about your own experiences. And, you know, I do have to underline resist the urge to give advice. Because I have been in the situation where someone says well, why don't you just, you know, just go and watch a movie? Go watch something funny. You know, do something like that. Or I felt like what I was trying to tell them had just been completely blown off, ignored; it wasn't that important. And while, in that other person's eyes, they were -- they were really oh, you know, when I'm sad, I watch a funny movie. It works for me, it should work for you. But, if you were saying, you know what, I've been there. I'm sorry. I got help. I'd like to help you. Okay? Okay. any other questions? Comments? Go ahead.

 

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>> Would it be possible for me to get a copy of your slide presentation?

>> Yes.

>> Okay, cool. I'm going to give it to my team at work.

>> Okay.

>> It's going to be part of all of our training.

>> Yeah.

>> Sarah, can I send out the, you know, this PowerPoint to the list serve people?

>> Of course.

>> Okay.

>> Of course. Yeah. And the last slide is just my resources. So I'll polish those resources before I give them to you. [Laughter] Okey-dokey. Thank you so much for coming. It means the world to me. [Applause]

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