Tanzina Vega: This is The Takeaway. I'm Tanzina Vega. Just a note to our listeners. This next segment discusses suicide and suicidal thoughts. People thinking about suicide are often encouraged to seek out some professional help, but many mental health professionals have little formal training in suicide prevention. There are currently no national standards requiring mental health professionals to be trained in treating suicidal patients and only a handful of states mandate this training.

While we've gotten better at talking about things like depression and anxiety, suicidality is still poorly misunderstood and treated even as the rate of suicide is rising in the United States. The latest available data from the CDC estimates that more than 48,000 people died by suicide in 2018. With the pandemic still ongoing, concerns about mental health are in the spotlight.

Stacey Freedenthal: We don't have good evidence yet of what the results of this pandemic are in terms of suicide. We do know there's an increase in suicidal thoughts and we also know that some places are reporting an increase in calls to hotlines, but we don't know about actual suicides yet.

Tanzina: Stacey Freedenthal is a psychotherapist and associate professor at the University of Denver Graduate School of Social Work and author of the book Helping the Suicidal Person. For more on this, I spoke with Stacey and Kelechi Ubozoh, a mental health consultant, suicide attempts survivor, and author of We've Been Too Patient: Voices from Radical Mental Health. Here's what Kelechi told me about how suicide is thought of by some in the mental health community today.

Kelechi Ubozoh: Mental health is still a struggle for folks because there's still this idea that you're someone who is mentally ill or you're mentally healthy, but everyone has mental health and the way that we experience it, the way that it shows up, our struggles are different, but there's not someone who doesn't have mental health as we're finding out with this pandemic.

The way that suicide is treated, or even I've been treated by disclosing in different spaces that I thought were safe around being a suicide attempt survivor, there's been a lot of fear, there's been a lot of judgment, which does not help people who have suicidal thoughts in isolation is something that impacts us a lot. I would say it's still very much stigmatized, unfortunately.

Tanzina: How do you explain the lack of training here?

Stacey: There's myriad reasons why I think it's present. One is, as Kelechi was saying, there's stigma. There's stigma among mental health professionals, and there are many mental health professionals who resist working with suicidal clients. That can be present among faculty and developers of programs, that they're not placing the right emphasis and importance on this really pressing problem.

Tanzina: Kelechi, you yourself are a suicide attempt survivor. When you attempted to get help, how were you treated? What was your experience like?

Kelechi: I attempted 11 years ago. One of the things that happened to me is that I'm a Black woman and the way that I was treated when I needed support was abysmal. I present well, so a judgment that can happen depending on who you are, your culture, how you look when you need help. People didn't take me seriously. I actually went to get suicide prevention because I was having thoughts of harm and they turned me away. I had to go back to the same hospital because I attempted. I was trying to actually get support to go inside the hospital, but I looked too well for them. They didn't take me seriously. They were like, "No, we can't see you." I had to come back when I attempted.

Then when I was in the actual hospital, it was like adult daycare. We weren't really getting any treatment and we were watching movies. The thing I like to tell people was the minute I knew that the system was the problem was all of these folks who have attended or are struggling, were sitting watching Silence of The Lands in a psych ward and you cannot make that up. A part of me wanted to laugh because it was so ridiculous and the other part of me was like, "If this is treatment, how do people get better?"

That's my story and that's my experience. That was a really unfortunate experience. That's not everyone's experience. If that is the treatment, the next thing I would do is never go back. I would never tell anyone when I'm struggling again because the treatment was so traumatic.

Tanzina: I have to say, Kelechi, what you're describing I think is something I actually had written this down. Do people take it seriously before you shared that? I wonder if that's something that happens, particularly as you said, with women who are professional, with women who present well, with women who are people or women of color, in particular Black and brown women. Whether or not people do take her seriously. Stacey, what is the gap there? If somebody comes in and says, "I am experiencing thoughts of harming myself," how could someone not take that seriously?

Stacey: People operate at extremes and you've got at one extreme, the professionals who didn't take Kelechi seriously and don't take others seriously, but then at the other extreme, you've got professionals who, for lack of a better phrase, freak out when they hear the word suicide and they immediately think, "Oh my God, I've got to get this person to an emergency room. I've got to call 911," when really what the person needs is to be able to tell their story and to be heard and listened to.

Kelechi: I wanted to add to what Stacey said, that has been a lot of people's experience, especially in communities of color or in the trans community, who have a really difficult and challenging history with law enforcement, law enforcement shouldn't be the first responder to a mental health crisis and a lot of folks get really scared when you start talking about suicide. If we were able to normalize the conversation that talking about suicide does not cause it and that some folks, when they're asking for help, it might be I need to have you listen, I need to just have you stay with me while I'm crying. Doesn't mean I need you to take me away.

Really, the challenge is, how are we treating people when they're disclosing or sharing? If we judge them or if we say that they're broken or if we try to basically isolate them, then how are they going to be truthful the next time this happens?

Tanzina: Stacey, you have had first-hand experience trying to get help with your own suicidality. How has that informed your work?

Stacey: Oh, it's completely informed it and, again, Kelechi, my experience was on the other end of the spectrum of yours and that's when I first went for help for suicidal thoughts in my 20s. I was taking terrified that I would be hospitalized against my will just for mentioning the word. I tested out the therapist and I said, "I'm thinking of doing something drastic," just to feel out his reaction. He got visibly uncomfortable and it stressed me out.

I backpedaled and he said, "What do you mean something drastic?" I said, "Quit my job," and then he was visibly relieved. I tried somebody else so that I could speak up honestly about what I was experiencing and he first tried to get me the promise not to do anything to hurt myself, which if only it were that easy, but then when I couldn't make that promise, he recommended hospitalization. It was my fears come true.

Tanzina: This is a pandemic that has imposed isolation on people. It has imposed, as a result of that isolation, a lot of loneliness which was already a problem in this country. How do we get through this for people who are experiencing suicidal ideation right now?

Kelechi: I can only share what has been helpful for me as a Black woman and what has been helpful for some of the folks around me. I think one of the things is actually doing crisis planning. You could do this as Wellness Recovery Action Plan, which is called a WRAP, but really thinking about what are the things that come up when you're struggling and what are the things that will help mitigate that and really thinking about if something really bad happens, if you're having lots of harmful thoughts and you really need support, who is on your team? Who can help you go to a crisis center?

Do you have a therapist that you can call? Is there a friend or family member that you want involved in this? If you're a friend or family member, trying to understand what are the resources and what are your boundaries because not everyone is going to be able to sit with someone when they're struggling, but you can point them to resources. We do have the National Prevention Suicide hotline and they do help people who are friends of family who might need more support understanding folks.

It's not the perfect answer, but I think interrupting isolation is probably one of the biggest things. How do you interrupt isolation? Then how do you connect to resources you want? Another thing is if there are lethal means nearby and there's something you're worried about in your house and that's been on your mind, is there someone you can connect to to remove them from your house? All things considered with safety because I think that's one thing to also consider.

Tanzina: Stacey, what do we know about which suicide prevention approaches work best? Which ones are most effective?

Stacey: The one thing we know that can prevent suicide is connection. There was a study, it was a very, very simple study, where people who were discharged from a hospital for suicidal thoughts, half of them received postcards just saying, "Basically, we're thinking of you and hoping you're doing well," not even asking for a response, and the other half did not receive those cards, and the half that received the cards had lower suicide rates in the years to come.

What a simple intervention to let people know that they're being thought about and cared for. There are also therapies that have evidence of effectiveness, not with everybody, but more so than no treatment at all or just standard treatment, and those are things like cognitive behavior therapy, dialectical behavior therapy, and there's something called the collaborative assessment and management of suicidality, which is commonly called CAMS. There are treatments that have evidence that they can reduce suicide attempts, other suicidal behaviors, and thoughts in the people who receive them.

Tanzina: Kelechi, I'd love to close with your thoughts on that, because one of the things we've been talking about on The Takeaway as well is how people are attempting to find joy in this moment. I think this is a conversation, and I'm starting to turn that around to talking about hope. Where are you seeing rays of hope?

Kelechi: Even though people are struggling in a way that we haven't seen before, I have never been asked so many times to connect with people around mental health. I have been trying to bring awareness around this topic around suicide, and people are listening. Their hearts are open because they're experiencing it, they're understanding what isolation means for them, and I think that does open up our understanding, and sometimes pain and loss actually opens us up to have more connection with one another.

When I think about this right now, when I think about the pandemic and when I think about suicide, I think because people are open to having these conversations, they might be open to receiving support and open to being part of that connection in that force.

Tanzina: Kelechi Ubozoh is a mental health consultant and author of, We've Been Too Patient: Voices from Radical Mental Health. Stacey Freedenthal is a psychotherapist and author of the book, Helping The Suicidal Person. Kelechi, Stacey, thank you so much for your time and for sharing your experiences with me.

Stacey: Thank you very much too.

Kelechi: Thank you.

Tanzina: If you or someone you know is having suicidal thoughts, please call the National Suicide Prevention Hotline at 1-800-273-TALK, that's 1-800-273-8255 or text Home to the Crisis Text Line at 741-741.

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