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Why there should be a minimum standard of care across all psych wards

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Psych wards are designed to be a place where someone struggling can feel safe. Whether the person is having thoughts of suicide, struggling with self-harm, experiencing drug or alcohol abuse, attempted suicide, or just needs a safe space, a psych ward is supposed to be the place. Yet, people discharged from a psych ward are 100-200x more likely to die by suicide upon release.

Every psych ward is different, just like every hospital is different. Some have more funding than others, however, that does not mean the standard of care should be different. Many times, when you are admitted into a psych ward, you do not get to choose which one. Often times, it is hard to find multiple options for psych wards near you, if it is voluntary. Plus, you have to consider the financial cost, as it may vary based on insurance, type of hospital, etc.

Many psych ward visits are involuntary. Most people need serious intervention and support at that time. It does not matter who you are or where you come from, you are deserving of quality treatment that benefits you. Treatment that acts as a starting point in your recovery. You do not deserve to come out of the psych ward in a worse position. You do not deserve to be just a checked box that relieves the hospital / state of legal concerns. And you definitely do not deserve to be forced to try a medication that does not work for your actual diagnosis.

Imagine if we had a minimum standard of care that forced hospitals to allocate more funding toward behavioral health.

An individual hospitalized in a psych ward, whether voluntary or involuntary, deserves 1 on 1 time with a licensed mental health care professional that helps both parties get an understanding of the situation. Many struggling do not always know what they are going through and would benefit from exploring what they are feeling and experiencing with help. A lot of people do not have a confirmed diagnosis and may need support in learning what they are experiencing and what treatment options are available to them. When exploring the situation together, the psychiatrist may get a better feel for which medication options may be right for the patient, if the patient needs / wants medication.

Furthermore, group therapy could explore building a coping toolbox. Imagine if a group of people who are struggling with similar diagnoses were working together to explore coping mechanisms.  There could be mixed groups and groups for specific mental health symptoms / conditions / crises. People experiencing a mental health crisis often feel alone and being able to share their journey and their feelings with people who truly get it can be life-altering. Someone with schizophrenia and someone with anxiety disorder are both struggling with real mental illnesses but may need different treatment plans and different types of support. Customizing the experience for every patient to collaborate and connect not only with people experiencing similar situations but also to everyone there would be more rewarding than if it were just one or the other.

In addition, all patients should go home with a customized treatment plan. The treatment plan should include therapy / behavioral health facility recommendations, whether it is in-patient or out-patient. It should also include a list of coping mechanisms the patient feels comfortable with in addition to other coping mechanisms available to try. And the treatment plan should include a safety plan that helps the patient know what they can do if they experience another mental health crisis. 

Lastly, treatment should not be financially out of reach. When someone is held within a behavioral health facility, the cost (or a high portion of the cost) should be covered by insurance. The hospital should also charge a reasonable amount, rather than take advantage of the ability to profit on one’s mental health condition / crisis.

A standard of care within our psychiatric system is imperative to the success of our future. Suicide is the 2nd leading cause of death from age 10 to 35. People who need support should receive the help and support they need to jumpstart their recovery.

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Suicidal thoughts are more than “I want to die.”

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Suicidal thoughts, also known as “suicidal ideation,” is often misunderstood. This is partially due to the stigma on mental illness as a whole, depression, and suicide. We live in a world where individuals do not feel worthy of help until they have a gun to their head or pills in their hand. Why? Because, we have minimized suicidal thoughts.

Suicide is often treated as a joke.

  • “I am going to kill myself if I fail this test.”
  • “This meeting made me want to jump off a bridge.”

Suicidal ideation is often invalidated.

  • “They are not going to hurt themselves; they are just looking for attention.”
  • “You are just being dramatic.”

Suicidal ideation is very common.

Almost everyone will experience suicidal ideation at some point in their lives. However, this does not take away from the danger and impact of suicidal thoughts. Without proper support, passive suicidal ideation (thoughts with no intention of action) can turn into active suicidal ideation.

Suicidal thoughts are more than “I want to die.”

Early detection can be a key in suicide prevention. However, due to lack of conversation, education, and awareness on suicidal ideation, we often miss the warning signs.

Suicidal thoughts include feeling:

  • Hopeless
  • Overwhelmed by negative thoughts
  • Unbearable pain
  • Useless
  • Desperate
  • Like a burden
  • Not good enough
  • Lonely
  • Physically numb
  • Fascinated by death

(mind.org)

Research shows that suicidal ideation often starts by the time you are 8 years old. It is not always in the traditional sense, of “I want to die” or “I want to kill myself.” Often times, it starts as simple as:

  • “My parents’ divorce is my fault. Everything is my fault. I ruin everything.”
  • “I hate my life. Nothing ever goes right.”
  • “I have no friends. No one likes me. I am alone.”
  • “I am ugly, stupid, and useless. No one is going to like me.”
  • “Everyone would be happier if I was never born.”

Imagine if we started teaching people how to cope with suicidal ideation. What if we started education people on how to advocate for themselves and what they are experiencing? Imagine if we made treatment widely accessible and stigma-free. Here are my opinions on a few of the most common questions on experiencing suicidal ideation.

When do I seek help?

When you ask yourself this question, it is time to seek help.

Are these thoughts normal? Does everyone feel this way?

You are not the only one experiencing these thoughts. Suicidal thoughts are very common and occur way too frequently. However, none of that means you do not deserve support. When you are experiencing thoughts of suicide, even if it seems minor, talking to a doctor or mental health professional can be extremely helpful. Without any treatment or support, these thoughts may worsen and consume your life.

Should I talk to my doctor about my suicidal ideation?

It is important to disclose your suicidal thoughts to your doctor so that they may help you to evaluate the severity. Sometimes, a doctor might recommend self-care and allowing yourself time to rest and recuperate. Often times, a doctor might check your vitamin and hormone levels, as deficiencies can be linked to lower moods. In other situations, the doctor may recommend a form of mental health treatment.

Will I be hospitalized if I tell my doctor or mental health care professional?

This depends on the doctor / mental health care professional, your mental health medical history, whether or not you are high risk of harming yourself or others, and any additional factors the provider sees fit. Typically, hospitalization within a psych ward is used for individuals with active suicidal ideation: thoughts and a plan.

How do I talk to my doctor or mental health care professional about my suicidal ideation?

Be honest! Share exactly what you are feeling and be sure to clarify if you have thought of a plan of harming yourself, even if you are not certain you would go through with it. Tell your doctor whether or not you would consider following through on the plan. This can help your doctor better understand where you are at. Explain when the thoughts started. Did something trigger these thoughts? Is there a new stressor in your life? And disclose how often you have the thoughts and when they typically appear. Do they only occur at negative with your intrusive thoughts? Or do they happen when you get behind the wheel of your car? Are they constant? Everything you can share with your doctor about your suicidal ideation can be extremely useful in diagnosis and treatment plan.

What if my doctor does not believe me?

Often times, especially when it comes to mental health, we will be invalidated or ignored. That does not mean you do not deserve support. What you are feeling is important. You matter and your life matters. If you feel you need help, resources, or support, then you need help, resources, or support. Try different doctors until you find one that not only listens to you but also makes you feel safe to open up. Advocate for yourself. Be tenacious in the way you advocate for yourself. It is your life and your health.

Which doctor should I talk to?

This depends. Mental health care professionals, such as therapists, counselors, psychologists, psychiatrists, and social workers can be a great resource, as they specialize in mental health. If you do not have access to a mental health care professional or have not found one that works for you yet, your primary care physician can be a great start! Your primary care physician may even be able to recommend local therapists, counselors, psychologists, psychiatrists, social workers, treatment facilities, or behavioral health facilities.

Long story short, everyone deserves support.

Even if the thoughts seem insignificant, having someone to share what you are feeling with can be instrumental. You do not have to go through it alone. If someone opens up to you about their suicidal thoughts, do not judge them or invalidate them. If you are unable to provide the support that they need, then help them find someone who can. When your child comes home from school crying, listen to them. Pay attention to the words they are using. Offer support where you can and reach out to a professional to help them develop coping mechanisms that may work for them.

Remember, suicide is the 2nd leading cause of death ages 10-25 and 10th leading cause of death overall.

We can no longer stay silent or expect people to suffer in silence.

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Mental health and higher education system.

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Is college for me?

The question every high school student dreads. Our higher education system is designed to help us gain the necessary tools and lessons needed to be successful within our chosen career paths. College courses teach you how to learn while simultaneously preparing you for work in your field.

Today, college is highly publicized as a necessary step. Most jobs require a bachelor’s degree, while many require a masters or doctorate level.

Research has shown that 50% of students feel their mental health is poor or below average. Suicide is the 2nd leading cause of death between ages 10-35 and has risen significantly among the 10-24 age group since 1950.

The fact is: Our student population is struggling. According to Healthy Minds Network, 39% of college students in the US are diagnosed with depression. And, according to Imagine America Foundation, 1/3 of students who are diagnosed with depression drop out of college. And, according to a 2018 study by DOI, out of 67,000 surveyed students, 9% had attempted suicide.

Yet, our higher education facilities have only made minimal accommodations available to students.

Currently, in our Higher Education System, we offer “reasonable” accommodations to students living with mental illness who have qualified for disability. Although this seems like a great solution, it creates a wide gap that sets our students up for hardship. Many mental illnesses are often not diagnosed under the age of 18, such as borderline personality disorder (bpd). Furthermore, symptoms of anxiety and depression often begin to form during adolescence, but many children do not receive treatment or support, because symptoms are written off as typical adolescent behavior.

Therefore, because it is difficult to receive a diagnosis from a licensed mental health professional prior to adulthood (18+), many college students do not have a confirmed diagnosis that will allow them to apply for disability. We have seen most colleges add a Wellness or Counseling Center to their campuses. The counseling services are free and available to all students. However, they forget to mention that it may take over a month to get an appointment. Furthermore, they only offer a limited number of sessions, which discriminates against students needing long-term care.

Outside of the limited counseling services, the ADA has required both public and private universities to provide equal access to education for students with disabilities, as long as the accommodations do not fundamentally change the nature of the activity, service, or program. For a mental health to be considered a disability, documentation is required. This would not be a problem if majority of people were not undiagnosed. We do not live in a society of self-awareness with mental health nor where seeking professional psychiatric services is normalized. The stigma and financial barriers making it near impossible for many college students to obtain treatment.

Why are these counseling services insufficient?

Although many college campuses offer counseling services, they do not offer enough. Think about the amount of money invested into a piece of paper. Think about the number of lives lost every year to suicide. One study reported that 1 in 5 students have had thoughts of suicide with 9% making an attempt and nearly 20% reporting self-injury. Yet, funding sufficient counseling services is “too expensive” or “unnecessary.”

Imagine if you are experiencing debilitating anxiety attacks, depressive episodes, or manic episodes, but you have no official diagnosis. You are a financially struggling college student. Your family either does not believe in mental health so they will not help you pay for services, or your family cannot afford to help you pay for services. You also do not have a car and no bus routes drop off near an off-campus counseling office. Therefore, you cannot go off-campus for support. Thus, you call your campus Counseling Center. They have a 6 week wait for an appointment, meanwhile you have midterms next week. Without an official diagnosis and documentation, you cannot qualify for disability. Or you get in before exams, but your diagnosis is not considered “debilitating enough” for accommodation. Therefore, you have no accommodations. The day of your exam, you are experiencing the debilitating anxiety attack, depressive episode, or manic episode. You cannot stand up or pull yourself together to get to class. You genuinely feel helpless, and you desperately want support. But the system that you were told is meant to “set you up for success” is now working against you. You manage to make it to your exam and hide your symptoms long enough. Because your mind was overwhelmed by your mental health condition / symptoms, you were unable to concentrate. You exhausted countless hours trying to study, but you were unmotivated, unfocused, and restless. As a result, you failed your course. However, you were not taking only 1 course, you were taking 4, and all exams lined up in the same week. Exams count for 40-50% of your grade, meaning if you fail one, you likely fail the class. Your GPA drops, you lose financial aid, and can no longer afford to be a student. You either failed out or dropped out.

Does this seem dramatic? Yes? This is the reality for millions of college students.

In comparison to physical illness.

Students experiencing a physical illness are significantly more likely to receive an excused absence and assignment extension. Why? Because it is easier to obtain a doctors note. Have you ever heard of a doctor, let alone a college infirmary, telling a sick patient they have to wait 6 weeks for an appointment? No. When someone is sick, they get into see the doctor right away. Mental health is not treated with the same respect and importance. If the student could not obtain a doctor’s note due to high volume of patients and extended wait times, the professor is often likely to believe the student. However, if the student explained they were experiencing high anxiety or depression, the professor is apt to assume it is an excuse.

Our higher education system does not treat mental illness in the same regard as physical illness. Thus, students who are struggling are often forced to struggle in silence.

Other mental illnesses at play.

When we talk about mental health, we often focus on depression and anxiety. Let us discuss other mental health conditions that may not benefit from the current limited accommodations.

A student living with an eating disorder, specifically anorexia nervosa or bulimia nervosa, is likely to be consuming insufficient levels of nutrients and calories. Therefore, their energy levels are reduced, and it is more difficult to concentrate. These students are not always able to keep up with the high demand of coursework. Research shows that 40% of incoming freshman at colleges / universities are likely to be living with an eating disorder. With 4-6 weeks wait to receive an appointment at the Counseling Center and lack of education / awareness on eating disorders, many students do not receive help. However, their grades are affected. With 40% of the population affected, you would assume colleges would have a system that helps individuals living with eating disorders. Yet not all universities offer ample free nutritionist services nor support in overcoming the eating disorder. Essentially, you are being punished for a mental illness that was not your choice.

Now, let us talk about a student living with ADHD. Under the ADA rules, only some people living with ADHD qualify for disability. Research shows that 5% of college students live with ADHD. Yet, without qualifying for disability, no accommodations are made. Many college courses are not designed to accommodate students with ADHD to begin with. A high percentage of courses require students to sit in silence and take notes for 2–3-hour periods at a time. Then, offer only long, 2-hour exams as grades. There is no accommodation built into the course structure that offers stimulation, positive feedback, or energy release. Again, based on design, you are being punished for a mental illness that was not your choice.

Let’s take it a step further. When a student has an allergy attack, they can easily go to the doctor and get a doctor’s note. However, a student facing a panic attack does not have that same luxury. It is not as easy to get an appointment with a mental health professional that same day to receive a doctor’s note in order to excuse an absence from class. What about students experiencing a manic episode or psychosis? They may not even know they are in an episode at that point, let alone be able to get a doctor’s note to excuse them from class.

Not only is there a lack of accommodation built into course structure, but also a lack of accessibility to receive a doctor’s note for an excused absence. Both of these make it extremely difficult for students living with mental illness to succeed in our higher education system.

Mental illness is not a choice.

Currently, our higher education system treats mental illness like it is a choice. The current system works against those living with mental illness, even though research proves suicide is the 2nd leading cause of death among college students. The system provides minimal accommodations that offer little support and create a wider gap between students living with and without mental health symptoms / conditions. Imagine reaching out for support and being told, “We can only help you up to three times a year, but the first appointment available is in 6 weeks.”

Again, with physical illness, this is NOT an issue. We provide immediate support and resources to help the student get better and receive any accommodations needed.

Colleges, state education departments, and federal education department, why is my success at college not as important as someone without a mental illness? You have no problem collecting my tuition payments and loan repayments. If I were on a premiere sports team, there would be accommodations made for my success. Yet, you are not willing to make ample accommodations to help me succeed because mental illness is not your priority.

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How do you advocate for your mental health?

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When it comes to your mental health, be tenacious. Advocate for yourself. Find support systems and treatment options that work for YOU.

One thing I have come to realize, through my own journey and hearing the stories of others, is a lack of assertion. When it comes to our mental health, we often take a long time to reach out for support. At first, we tend to ignore our symptoms. Then, we question if they are real or in our heads. Next, we compare ourselves to others. Then, we deny any potential conditions. And, finally, after the symptoms and/or condition have overwhelmed us, we reach out for support.

Why do we wait so long to receive treatment that we deserve? Think about it. When your arm starts hurting, especially after a trauma, do you wait years to get an x-ray? When your vision starts to worsen, do you wait years to get glasses? When you have a cavity, do you wait years to get a filling? When you have a headache, do you wait years to take medication? When you live with a heart condition, do you wait years to go to the cardiologist? Yet, when you live with a mental health condition or you are facing poor mental health symptoms, why do you take years to see a doctor?

Then, once we see a professional, we often assume they know everything. Mental health is a tricky field because it is an invisible illness. The doctors, therapists, and / or counselors do not see a picture of your brain that clearly shows a proper diagnosis that results in a specific treatment plan. Because the professionals are not experiencing the symptoms first-hand and cannot see what is going on inside your mind, mental health diagnoses can become a guessing game.

One of the most common misconceptions I have experienced within the mental health community is this idea that your first diagnosis or your first prescription medication or your first therapist is going to be the right one. What many people do not know is that it can take an average of up to 10 years to receive the right diagnosis. Many people do not know that the average person tries more than one medication before finding the right one for their mind and body. Many people, also, do not know that it can take an average of up to 5 therapists to find the right match.

So, if it can be extremely difficult to receive the right diagnosis and treatment plan, what should I do?

Get curious about your mental health diagnosis and treatment plan; and ASK ANY AND ALL QUESTIONS THAT YOU HAVE.

Be tenacious. Research your symptoms and educate yourself on various mental health conditions that relate to your symptoms. Reach out to others who are experiencing similar symptoms and find out what they have tried. Then, create a list of questions to ask the mental health care professional.

Do not be afraid to be “annoying” by asking too many questions. It is your mental health; you can ask as many questions as you would like to. If you do not understand a diagnosis or a symptom, ask the doctor to explain it to you. Ask questions about the medication being prescribed and what side effects to look out for. Ask about alternate treatment options and next steps. Ask what you can do in addition to taking the prescribed medication and / or attending therapy.

Furthermore, do not be afraid to ask what external or internal factors can be affecting your mental health. Have you checked your vitamin and hormone levels recently? Are you exposed to hazardous / toxic chemicals? Do you live in an area of high pollution? Does your home have mold? Advocating for yourself is not only sharing your symptoms, but also asking questions that help you and the doctor get a full picture.

Mental health care professionals are humans, just like us, they may make mistakes or overlook certain symptoms. They do not physically or mentally experience what you are experiencing; therefore, it is difficult for them to know everything about what is going on. By researching and asking questions, you can learn more about what they are thinking and collaborate on the best treatment plan.

Understand that the first medication you try may not be the right one.

Everyone’s body is different. Therefore, everyone’s body reacts differently to medications. If prescribed medication, be sure to understand that the first medication may not be the right one for you. And understand that it does not always mean that no medication will work for you. It simply means, this time around, the medication prescribed was not the right fit.

It is also important to remember that just because the medication prescribed to you works for someone else with the same mental health condition, it does not mean that it will definitely work for you. As noted previously, everyone’s body reacts differently.

However, when you start to experience side effects, especially severe side effects that make you uncomfortable, tell your doctor right away. You do not have to wait it out, because the doctor prescribed it. Call your doctor and share your concerns. It may be a normal reaction as the body adjusts or it may be a sign that the wrong medication was prescribed. Advocating for yourself by consulting your doctor will help you explore your options.

Lastly, look at therapy like you look at dating. You may not find your match the first time around, but the perfect match is out there.

Every therapist is different. From energy to method of practice to personal experience to specialty, every therapist brings a different approach and perspective to the table. It may take time to find a therapist that matches your specific needs.

When you are searching for a therapist, do not be afraid to ask questions. What do you specialize in? What approach do you use (ex. holistic, biofeedback, psychotherapy, cognitive behavioral therapy)? What is your availability? Ask however many questions you would like, within the appropriate boundaries. You are going to therapy for you. You are the consumer; you are allowed to be selective in your approach.  

When you finally choose a therapist, if you do not feel like the connection is right, look for a new therapist. You do not have to stick with the same one, even if you have been going to them for years. It is okay to change therapists, just like it is okay to change phones.

I, in my searches, use the 3-appointment rule. I go to the same therapist 3 times before deciding if they are the right fit for me. At the first appointment, I am usually nervous, and the therapist knows nothing about me. It tends to feel a little awkward. Plus, the appointment tends to be more of a focus on history rather than my current situation. During the second appointment, I tend to be more relaxed, and the therapist has a general understanding of my background, therefore, we dive a little deeper into my history and current situation. Then, by the third appointment, I have a good idea of the approach the therapist uses and if it feels right for me. This 3-appointment rule has worked out well for me; however, it may not work for everyone. An important part of advocating for yourself is exploring what you are looking for in support and understanding how long it takes you to get a good feel for those part of your support system.

All in all, remember to always speak up. Ask questions. Do not let people patronize you or invalidate you. You deserve to be heard and educated on what you are experiencing. The mental health care system can feel complicated, but you deserve the right support that works for you. Never stop advocating for yourself and your mental health.

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What do we do when someone feels hopeless?

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I do not want to be here anymore.

That heartbreaking phrase is something no one wants to hear. Even more so, that is a feeling no one desires to experience. So, what do we do when someone feels hopeless? Do we engage in a conversation and provide support, or do we ignore it to protect ourselves? The answer to this simple question is a key component to suicide prevention.

Let us explore 4 scenarios.

Fran feels hopeless. Fran grew up in a world where everyone told her to “grow up”, “suck it up”, “build a bridge and get over it”, “stop being a baby”, etc. thus, Fran suppresses all of her feelings. Anytime she has reached out for support in the past, Fran felt like she was gaslighted and invalidated. As a result, Fran is afraid to feel, and even more terrified to speak up about it. Fran’s mind is now in control of her every thought. She thinks about dying all of the time, when she is walking, when she is eating, when she is driving, and when she is sleeping. Fran wants to give in to her hopeless thoughts, but she chooses to reach out for support one last time, in hopes that someone extends a hand back to her. Fran decides to open up about her hopeless thoughts. She shares with a confidant that she is profoundly struggling and having thoughts of suicide.

In scenario 1, when Fran opens up, desperately hoping for empathy and support, Fran’s loved one reacts out of fear. Instead of listening and holding a safe space, the loved one immediately says, “Do not say that! Do you know what that would do to me?” Fran immediately shuts down and feels like no one understands her. Fran interprets the response as the loved one does not care about Fran but only about themselves. As a result, Fran decides suicide is the only answer, because no one truly cares about her to provide the support she was begging for.

In scenario 2, when Fran opens up, desperately hoping for empathy and support, Fran’s loved one reacts by blowing her off. Instead of listening and holding a safe space, the loved one immediately says, “You are being dramatic, stop trying to get attention.” Fran interprets the gaslighting as confirmation that suicide is the only answer because in the moment she needed it most, no one cared to truly listen and understand, instead they chose to belittle her feelings.

In scenario 3, when Fran opens up, desperately hoping for empathy and support, Fran’s loved one reacts by listening and providing a shoulder to cry on. For the first time, Fran feels like maybe her life is worth living, maybe she is loved and needed more than she realized, maybe she is not the burden she felt like she was. Fran appreciates the support and views it as a sign to keep going. However, when the loved one does not follow up again, Fran starts to question if she has a support system, and the thoughts begin to worsen.

In scenario 4, when Fran opens up, desperately hoping for empathy and support, Fran’s loved one reacts by actively listening, repeating validating statements, asking non-judgmental open-ended questions when appropriate, and providing support. The loved one even offers to help Fran find resources that are available, if Fran is comfortable with the hands-on support. A few days after the conversation, Fran’s loved one follows up by checking in and reassuring Fran that they are there if and when she needs support, someone to talk to, or help in finding resources. Fran feels loved, safe, and not alone for the first time in a long time.

Let’s Review.

I understand it can be extremely difficult to engage in conversations about suicidal ideation (suicidal thoughts); however, as these 4 scenarios show, our reaction when someone reaches out is an essential part of prevention. I understand that in the moment, it can be hard to know the proper way to react and respond. I understand that no one may have educated you on mental health conditions, depression, or suicidal ideation so you are uncomfortable around the topic. I understand that it can be terrifying to hear a loved one feels hopeless, and you did not know. I understand that there is a stigma on all thing’s mental health, and you were never provided the tools and resources you needed to learn the right way to approach the conversation. However, we have to start doing better.

That heartbreaking phrase that no one wants to hear is something many people around you are thinking and feeling daily. In fact, there are people who are so close to the edge that they can only think about how much they do not want to be here. If they reach out, if they find the strength and courage within themselves to speak up, I ask of you, please do not gaslight them and please do not invalidate them. Take them seriously at their word, actively listen to them, show them you care, and support them in a way that makes you both feel comfortable and safe. You do not have to act as their therapist, but you can connect them to a Crisis Hotline or to a therapist. You do not have to sit with them all day everyday to “watch” them, but you can sit with them now and follow up. You do not have to “save” them, but you can assure them that they are not alone in this.

You cannot save someone, they can only save themselves, BUT you can let them know that they ae not in this alone. You can be a source of love and comfort. You can be a reminder that everything eventually will be okay. Even in scenario 4, you cannot save Fran, but because you offered the support she needed, you made her feel like there was a reason to keep going. The thoughts did not suddenly disappear, and Fran was not healed immediately, which is why scenario 3 did not work. Following up is a key part of prevention and support.

So, what do we do when someone feels hopeless? We listen. We validate. We support. We show empathy. We follow up. We provide a safe space. We let them know that although they have every single right to feel what they are feeling, they are seen, they are heard, they are loved, they are worthy of this life, and they are more than enough. Even more than that, we make sure they know that they are not alone. When someone’s life is hanging on by a thread, our response can save their life or push them over the edge.

And remember, not everyone will feel comfortable opening up and reaching out for support, especially if they were gaslighted and invalidated in the past. Do not be scared to reach out and check in with your loved ones frequently. Be a consistent reminder in their life that they are not alone, and that you are there for them.

I will leave you with this, when someone is drowning and they reach their hand out for support, are you going to push them down, ignore them as they drown, throw a life raft and walk away, or reach out your hand and pull them back into safety?