Representation and Storytelling in Suicide Prevention and Mental Health
Frances Gonzalez, Sept 15, 2017 at 3:20pm
FRANCES: Hi, everybody. I don't have slides because I got super lazy, but I do have a notebook that I'm going to work off of. So first I want to say thank you so much for inviting me to speak here today and thank you to everybody who's presented so far and everybody who is gonna present tomorrow. They did mention this is about suicide, but I do want to mention that everything that we've talked about so far involves mental health in some capacity. And I think makes it very clear how mental health touches really every facet of our lives. And how important it is to have these kinds of conversations. So as mentioned earlier, I'm the Communications Director for the National Disaster Distress Helpline. I'm mentioning that specifically because with hurricanes, wild fires, and mass violence, if you're ever looking for emotional support specifically related to disaster, it's a federally funded line that provides crisis, counseling, and support specifically related to disaster. And it's the first of its kind.
FRANCES: But what I'm really here for is to talk about the National Suicide Prevention Lifeline. So I think it's really interesting that I'm here talking about this right now. One, because it's National Suicide Prevention month, but also because this is my two-year anniversary of working in communications for the Lifeline. So I guess in order to mark the anniversary, I'm gonna talk about something that... This is actually the first time I've talked about [it] out loud, which is my weird relationship with working for the Lifeline and my own life, essentially. So part of my job with the Lifeline is that I'm responsible for public partnerships, public strategy, relationships, and essentially helping to decide how to message the Lifeline's services. So the Lifeline is federally funded by the substance abuse and mental health services administration. It's a 24/7 crisis line. For people that are in need of emotional support. You don't necessarily have to be suicidal to call. But a lot of people are. So one of the things that we work to do is we work in education. We work in providing crisis services. But our goal is essentially just to reduce suicidality across the board. So essentially suicide is the 10th leading cause of death in the United States. Yeah. With over 44,000 people dying by suicide every year. So while murders have gone down, for instance, suicides have gone up. And trying to figure out how to stop this is one of our key points.
FRANCES: So I was drawn to the work, basically, because of that, but one of the things that always stuck with me was that—they were interviewing me and they were saying: “Why do you want to work for the Lifeline?” And I gave them kind of a bullshit response. Because I didn't want to tell them that something that I had been struggling with for a long time, which was essentially my depression and high suicidality. So I made something up. All the conversational topics you have where you talk about what a great experience it is, all that stuff. And I planned on never telling anyone that I was having this problem. I saw it as essentially just that. A problem with a lowercase p that I was trying to work through all the time. But it was something I had been struggling with since I was a child, without knowing that this was what I had been struggling with. When we grow up in my family... I'm Filipino-American. This was not something we had the words to describe.
FRANCES: The first time I went to a therapist and they said, “Do you have a history of suicidality or mental health or depression in your family?”, the answer was: “I don't know.” Because we never talked about it. And at the same time, every single time I felt that I had been pushed off a cliff, that I felt worthless, that I felt like I didn't deserve to live... All of these things were amplified by the feeling of, “How can you feel this way? When you are the most privileged person that your family has ever seen? The first person to do a study abroad.” Right? The first person to get a scholarship for college in your family. All these things made it feel worse. And at the same time, these were stories that I wasn't seeing anywhere. So when I joined the Lifeline and they said that one of my jobs was to be able to share communications and share stories, I thought, “Yeah, I wanna do that.” But I never thought that I would have to share my own in any way. And that became very difficult. So the difficult part was that...I ended up having the unique position of being part of a major establishment in mental health while also kind of hiding my own source of understanding about mental health and my own point of view about mental health, all at the same time.
FRANCES: So in the mental health field, there's been only recently a push to incorporate what's called lived experience into the field. Even 20 years ago, saying the word suicide alone was something that was sort of discouraged in the general public. And then in the past 5 to 10 years, it's become apparent that you need people who have been through these experiences. Which seems like a no-brainer for us as we're sitting here right now, but you would be surprised how many people need this told to them at any point. So the Lifeline's mission, from my point of view, from a communications point of view, boiled down to three points. But I'm going to talk about two of them.
FRANCES: One is to share the message that hope, healing, and help are possible. Suicide is not inevitable. You'll hear people say things like, “He was really depressed. Or he had just lost his job, and therefore this was something that was bound to happen.” That's not true. There are... There's no single cause for suicide. And boiling it down to one particular point is actually detrimental and minimizes the complexity of the subject. And the best way to illustrate this is to share what we call stories of hope and recovery. Which is actually a name I really want to change, because it sounds a little weird. But sharing the stories of people who have been in that position and who have experienced it and gotten through it. For every one person that dies by suicide, 278 people seriously consider it but then they don't die. Then the question is: What's the difference between that one person and the 278? And the answer is essentially that those 278 have found a way to cope. And we need to illustrate those stories and share those stories.
FRANCES: Also, the second is to share how we can all take action to prevent suicide or help others who are in some kind of crisis in our lives. And you don't have to be a mental health professional to do it. I'm not, for instance. I have a degree in writing, which is one of those degrees that one day you're super psyched you got it, and the next day, you're like, “Oh, I got that.” But it works. So I work on these stories, and part of my job is to try to gather stories from people as possible and find a way to integrate those in our work. But at the same time, I was not seeing anything that sounded like me, that looked like me, in the field at all. Lifeline has a... What we call a Consumer Survivor Committee of people with lived experience who are in the field. And a lot of them represent a lot of the high-risk groups that are very susceptible to suicide. For instance, LGBTQ individuals are at high risk. Native peoples are at high risk. Middle-aged men are at high risk. You may have seen that written up lately. And finding ways to integrate those voices. But at the same time, while we were trying to incorporate these voices, we were leaving others out. Due to, one, not knowing anybody that we could ask to be part of these things, but also from the strange necessity of choosing people to be part of a committee, essentially, with limited spaces and essentially limited voices. And so I found myself in the odd position of managing communities and committees for which I was not necessarily a part of, but knew myself secretly to be. So I would look around the table and see myself as the only Asian-American in the room. But at the same time, I could not speak to my personal experiences. And I had to listen to other peoples. Which was really fantastic and helpful, but at the same time, made me feel that mine was invalidated in comparison to theirs.
FRANCES: So, Asian-Americans are not necessarily—I'll be the first to say—the highest-risk group. But there are 19 million Asian-Americans in the US and Asian-American females are twice as likely to attempt suicide as Asian-American males, and suicide death rates are 30% higher in the ages of 15 to 24 for Asian-American females than for white females. Asian-Americans are also three times less likely to solicit mental health services than white people. So this is a problem. So the question then became: What do we do about this? So there's something called the -- why does it matter, essentially, to have voices of different people, when you're sharing these stories? And there is something that's called the Papageno effect. You may have heard about it. Thomas Keller wrote about it recently. But that effect is that it has proven that suicidality in individuals goes down the more they hear about stories of hope and recovery. The more they are able to connect with someone who has been there and has demonstrated a way that they get out. And it doesn't actually even matter the way that they get out. It doesn't matter if it's through God, if it's through medication, therapy, friend support—the fact that they did is a huge difference. And it can change and save a life. So also sharing. We all know about the problems of sharing only a distinct number of voices.
FRANCES: So one in five people will experience a mental health condition in their lifetime. And there is no qualification around that. It isn't one in five white people or one in five males or one in five females. It is everyone in the entire country. So that is hundreds of thousands of stories that are influenced by where you're from and how you grew up. And your viewpoint about mental health that we are not hearing. And we need to hear those stories. So how do we do that, essentially? One of the things that we're trying to do is work on education. How do we talk about mental health? For instance, we have reporting on suicide guidelines. Where we ask people not to use the word commit when they say that someone has died by suicide. We prefer "they killed themselves" or "died by suicide". Mainly because the word "commit" is associated with crimes and we need to destigmatize that.
FRANCES: We also need to talk more about mental health and emotional well-being in our schools, in our military, in our governments, in all of these places where there's a high risk for people being in crisis but they're too afraid to talk or they don't have the vocabulary, the way I didn't have it when I was growing up. We also need to create outlets for those conversations. I think one of the things that I'm really lucky to have is that I have a platform. I have a very large platform. That other people may not necessarily have. Our Facebook page has 300,000 people on it. I have no idea how many of them are actually looking at anything. But they're technically there. So then the question then becomes: How do we amplify the voices that are already existing? How do I find the stories that are already being shared and share those stories? In a way that includes other people and invites a larger discussion? So... Yeah. That's mainly... I want to open the rest to questions, essentially. And a discussion. Mainly because I do think that these things should be a back and forth. Instead of necessarily holding forth. And every single one of you, I'm sure, has a mental health story in your lives as well. Or not.
ELEA: Hi! I'm gonna pass out these pieces of paper, so you can actually write questions and then one of the volunteers will collect the questions and will give them to Frances to answer.
FRANCES: Thank you. Yeah. I didn't warn you ahead of time, which I should have. But that didn't really cross my mind until very recently to do.
[OFF-MIC, audience member begins to shout out a question]
ELEA: I’m having everyone write it down so we can read it on the mic so it can be interpreted—not interpreted, sorry, captioned by our live remote captioner, so we actually can capture all the questions. So that's why we're passing it [the papers] down and writing it for posterity. Thank you! [sing-song] Accessibility!
MIRABAI [via the live captioning screen]: Woo!
ELEA:Yes, that is a live person. There's Mirabai. Who has been captioning the whole time. Thank you, Mirabai.
MIRABAI [via the live captioning screen]: My pleasure! What an incredible conference.
ELEA: There's just gonna be a few minutes as we pass out stuff for questions.
FRANCES: I swear, your day is almost done too.
ELEA: We have a break right after this. So we're just gonna cut this [break] a little shorter and use this time so everyone has time to thoughtfully compose and write the question and we can re-collect it.
[Staff hands Frances an initial stack of questions]
FRANCES: Cool. So one of the questions—the first question—“hi, thank you. Is: Are you working with peer organizations and those of us who do mental health media, and what collaborations do you have at the moment?” The answer is... Yes. And a lot. So peer organizations—peer support. We are a national network of over 150 crisis centers that operate locally. So the way that happens is you call this one national number, and you get routed to the center closest to you, based on area code. The idea is that you'll talk to a counselor who can connect you, if you need it, to local resources, without having to just say... Look up something and be like... I don't know if this is right for you or not. A lot of those centers utilize peer supports. And we also do work with peer organizations in our community work. But the Lifeline doesn't operate one on its own or something like that. I would love to work more with mental health media. Of course. So one of the things that we always do is we try to build really great relationships with media, so that then we can ask them to do things that share our message. That essentially remind people that resources are available to share stories of hope and recovery whenever possible, and to follow those reporting on suicide guidelines that I mentioned earlier. Collaborations that we have at the moment... There are a lot. We are backup for the Veterans Crisis Line. We also work with the NFL on the NFL Lifeline. You may have heard of this dude named Logic, recently. He's this rapper. His name is Logic. Yeah. He dropped a song recently that was... The phone number was our phone number. Which was named after us. And he worked with us to do that. And the song is actually one of the great representations of how it is possible to creatively address suicide in media, while still utilizing prevention messages. Like, a story of hope and recovery, essentially. He performed at the MTV Video Music Awards recently, and all of the people there—he had 50 suicide attempt survivors and suicide loss survivors on stage with him and they were all wearing shirts with our number on it. Piece of trivia. A lot of people who called our number and didn't know what it was were very upset because they were worried that something was wrong with Logic. And were checking up on him, which is very sweet, but also something that none of our counselors really had an answer for.
[Staff hands Frances a secondary large stack of questions]
FRANCES: Oh my gosh. Thank you. Thank you. I had one of those moments where I looked at everybody and thought no one was gonna have any questions and thought it was gonna be one of those really weird things and I just duck my head and sit down. “Most of the people I know who think of suicide are also dealing with addictions or self-harming. Are there better ways of dealing with the combined issues?” So I'm gonna preface this by saying I'm not actually a mental health clinician. Like I said earlier: Writing degree. But we will say that... I will say that a lot of the suicidality is... There's other things going on at play, a lot of times, as well. So a lot of people who are suicidal have experienced depression. A lot of them are dealing with addictions. There are actually a list of factors that make you a little more—potentially more high risk. Having any of those factors doesn't mean you're gonna be suicidal, but it does increase the possibility that you might become suicidal or that might happen. A lot of these things involve things like chronic pain. Addiction is one of them. And all of these things are risk factors, essentially. But I will say this: Better ways of dealing with the combined issues is: Pay attention. Right? One of the ways to tell if someone in your life might be suicidal is to... If you witness any change in, essentially, their personalities or the way that they're behaving. Are they sleeping more? Are they sleeping less? Are they talking about feeling worthless? About not being needed anymore in their lives? Are they doing risky behaviors? Are they isolating themselves? All of these things are potential warning signs of suicide. And there are ways that you can handle this... Not necessarily handle, but there are ways you can address this directly yourself without necessarily being a mental health professional. One of the things that we're trying to share this month for National Suicide Prevention Month is something called the one-two steps. So these are five steps that help guide you through how to help somebody in your life that might be suicidal. Because we get told a lot that you should help someone, but when you're faced with that situation, and you go... Christ. I don't know how. How am I supposed to do that? And these five steps essentially walk you through. So the steps are essentially to ask someone. To have that conversation. Are you suicidal? To listen to them, for their reasons, without judgment. With an open mind. Without trying to fix the problem. To ask them questions about how they might do it and remove the means from them, if necessary. The next is to connect them with resources. So that you're not the only person supporting them. And then the fifth is to follow up with them. In the days and weeks... So all these steps are proven or evidence-informed to help reduce the risk of suicide in people.
FRANCES: Another question: “Southeast Asians like Cambodian or Vietnamese folks are linguistically isolated. As their offspring, when you gather your elders together, how do you start the conversation on suicide and war/PTSD?” That is a really good question. Even starting the conversation is a big deal. Sitting down with them and saying, “Hey, like, this is either something that I've experienced, this is something that somebody in my life has experienced, this is something I've seen in the news—what do you think?” Opens up a whole new world of conversation. And you might get reluctance at first. Nobody in my life, in my personal life, knew I was suicidal, until I published an article about it. Which is maybe not the best way to go about it, to be completely honest. But before that, I didn't know how to tell them. And it was not something that was ever talked about at all. After that, we had one conversation about it. But it was better than no conversations about it. There are also a lot of local resources that might be helpful for you. For instance, if you're in New York City, there's NYC Well, which actually has resources in multiple languages. And actually, the National Suicide Prevention Lifeline has a translation service in over 150 languages. So if you're looking for support, or if you're looking for advice on how to have these conversations, that's available for you.
FRANCES: Next: “I recently heard that most hotlines don't allow people who have had suicidal ideation to take calls. Can you talk about if this is true and why?” Well, this one I actually can't talk about too much. Because I'm not... I don't run a crisis center. But I can say that one of the projects that we're working on with the Lifeline is how to better integrate lived experience into the crisis center community. So this will be on a case-by-case basis. We'll have different centers who have different rules or recommendations about this kind of thing. And it'll be helpful for you to go look at your local center, talk to your local center and find out what their guidelines are and potentially work with them if they have a restriction that you don't believe in, to work with them to change that. If you're looking for your local crisis center, it's on our website. SuicidePreventionLifeline.org.
FRANCES: “I may have missed this. Having now shared your story, would you like to share with us (inaudible)”—okay. I have to go.
[Volunteer motioning to Frances about time]
ELEA: You can answer this one last question! And then we're gonna go to break.
FRANCES: All right. I'm still suicidal. One of the reasons I want to change the phrase "hope and recovery" is because for me, it implies that these things happen in your past. And that you recover from them. And they are a blip in your radar and that you move on with your life. And sometimes you do and sometimes you don't. What happened was I ended up going to the hospital, I think, in January. And I have been lucky enough to work at a place that is extremely supportive. Which is lucky, since it's a mental health place. And have learned a lot from our own resources, in fact. But I did not get treatment until I was 26. So at this point, I'd gained maybe about 40 pounds. I was in a terrible abusive relationship. I had taken to wandering the streets of the city at night, because I didn't know what else to do with myself. And thinking like this is... If this is how the rest of my life is going to shape out, I don't know if I can do this for 60 to 80 years. And I didn't realize that this was not a thought that people had all the time. Because I had been living with it for so long that I didn't think was weird at all. I just thought... This was something that just happened. And the more I worked at the Lifeline and the more I saw how important it was to have stories out there from people who live with these experiences, the more I felt like a hypocrite for not sharing my own. And I won't say that somebody who works in the field and doesn't share their story is that. Because sharing your story is hard. And it can be dangerous. And it's difficult. But I felt like, in my position, as someone who was encouraging people to share stories, collecting them, disseminating them, to live with that secret myself was... Hypocritical in a way that I couldn't live with anymore. And so I'm here right now.
FRANCES: Okay, if you wrote a question and I didn't get to answer it, feel free to come find me and we'll have a chat. And thank you very much.
Frances is the Communications Director for the Mental Health Association of NYC, where she runs public communications and partnerships for mental health programs such as the National Suicide Prevention Lifeline and the national Disaster Distress Helpline. Her digital strategy experience spans nonprofit, local government, and startups, including the Clinton Foundation and New York City 311. An NYC native, she has an MFA in Fiction from The New School.