The Forever Decision by Paul Quinnett   Chapter 18

GETTING HELP

The other day 1 heard a familiar story. John, a psychologist friend of mine, consults at a university hospital. He described how a young coed had superficially slashed her wrists and then walked across the campus to the emergency room. With blood streaming down both wrists, she said to the nurse on duty, "I think I need help."

She did and she got it. But, John and I wondered, why did she have to slash her wrists first?

I don't know if reading a book like this is going to be helpful to you in the long run, but I hope that what I have to say in this chapter will encourage you to seek help before you take some kind of life-threatening action.

As a director in a community-based mental health center for 30 years, I can assure you that despite how long a waiting list we may have, all those who call us and say they have been thinking about suicide get seen that day or, at worst, the next morning. In your own community, this should be true of your crisis clinic, mental health center or other agency in the business of providing emergency mental health help. Suicide prevention is one of the primary reasons for our existence.

Your Reluctance
Maybe more than you realize, those of us in the counseling field are aware of how tough it is for any of us to reach out and ask for help. To do so means we have to admit to something that is almost un-American; namely, that we have failed to solve some problem or other on our own.

Because of the way we are raised and the way we are taught to be independent and self-healing, asking for help with a crisis in our lives can be a very difficult thing to do. If it is tough for women to ask for help, it is often impossible for men. Not just in America, but everywhere.

Recently I was talking to a young man who had been admitted to a hospital for treatment of his alcoholism. I was asked to see him because he had been thinking about suicide. Sam, a logger by profession, is a good example of how some men feel about getting help.

"Have you ever tried to kill yourself?" I asked.

"Not really," said Sam. "Not really?"

"Well, I drove my truck off a cliff once.”

Then he laughed one of those nervous little laughs. "It wasn't a very high cliff."

“Any other attempts?"

"I swam way out in a river once. Dead drunk. But I didn't drown."

"Have you ever asked for help before?" I asked.

"Me? Hell, no! I don't need any help."

And here Sam was, sitting in a hospital, addicted to alcohol, his life in shambles. Sam's life had been running steeply downhill for almost ten years. While intoxicated, he had thought about suicide several times and had gambled with his life more than once. But it never occurred to him to seek help. Or, if he ever did think he might need some help, he sure wasn't going to ask anyone for it - it wouldn't be "manly."

You might think Sam's case is the exception. It isn’t.

Not asking for help is the rule for men. Women, when it comes to asking for help are far smarter than men. Maybe that is why more of them get treated for depression and fewer of them die by suicide. Men, as we all know, don’t get “depressed.” They may become pessimistic, angry, dour, withdrawn and suicidal, but they don’t get depressed. Not much.

The point of Sam's story is that he, maybe like you, could not bring himself to admit to himself he was depressed and suicidal. As a result, he never sought help or treatment. Maybe you, like Sam, are depressed and yet cannot pick up the phone and talk to someone about what you’re going through.

Or maybe, like Sam, you don’t think your problems are serious enough.

Allow an old man one observation: If you’re thinking about suicide, something is wrong! If you need help, isn’t feeling suicidal enough an excuse? What other reason do you need?

Reaching Out
Almost any community of any size will have something called a help line or hot line or emergency call line or suicide prevention center or mental health center and, usually, their numbers are published on the first page of your local telephone directory. As of this writing, we now have a wonderful new 1-800-SUICIDE line available in America. I’m sure other countries will follow and soon suicidal people will be a tool free call away from someone who can help.

These crisis lines numbers are there for a reason. They're there for you.

Waiting by those phones twenty-four-hours-a-day are some of America's finest people. Usually trained volunteers working under professional supervision, these good citizens have stepped forward to be available to people just like you: people in crisis, people with problems, people thinking about suicide. I know these volunteers and I know them well. Believe me, they want you to call. It is their whole purpose in giving freely of their time to their community and to you.

In case you may not know it, all calls to such help or crisis lines are confidential. You do not even have to give your name. You can literally call one of these lines and share what has been bothering you with someone who has been trained to listen and to help you sort out the size and shape of your problems and who can, if you need it, refer you to someone or some group that may be just the thing you most need.

This is not to say that once in a while you won't get hold of someone who doesn't seem to be all that helpful. But, if this happens, you can always call back at another time. The point is, don't make a final evaluation of crisis lines because of one poor response on the part of one volunteer. In a word, keep trying.

Professional Help
In case you would like more information about what professional mental health help is like, what therapy is all about, and would like some guidance about how to find your way to the kind of help that might be best for you, you can find good resources on the World Wide Web, or in bookstores. But here, and so that you'll have at least a little information right now, I will quickly cover the basics and highlight a concern or two I have.

Family Physicians
Over and over again we are reminded to see our "family doctor" if we are having problems, including emotional ones. I, personally, consider this generally poor advice for people in an emotional crisis. With some notable exceptions and excluding psychiatrists, most physicians have not had appropriate training or experience to be of much help to suicidal people.

Busy professionals, many doctors frequently do not have the time to listen to someone whose life's problems are great and who may be thinking of suicide. Many of them work on a very tight schedule, seeing a different patient every few minutes. As a result, most doctors simply do not have an hour to sit down and listen to someone in trouble.

As a result, and as tragic as it is, many people who die by suicide have recently been treated by their family doctors, sometimes on the same day they take their lives. If our doctor seems too rushed and busy to talk to us, are we likely to tell him or her we are suicidal?

Probably not.

More troubling is the fact that many people who attempt suicide use the very medications supplied to them by their physicians. No doctor I know would willingly supply a lethal dose of medication to a suicidal person, but unknowingly it can and does happen.

So, if you go to your family doctor to discuss your problems, you'd better make darn sure you tell him or her that you are having suicidal thoughts and feelings. If he doesn't want to discuss these with you, or gives you the impression he's too busy to listen, or fails to refer you to someone who has the time to listen, then for Pete's sake, get yourself to someone who is trained, has the time, and understands what an emotional and suicidal crisis is.

I know many family physicians. Most of them know exactly what to do if you tell them you're feeling suicidal. Most will refer you to a psychiatrist or psychologist they know and respect and, as is their obligation, they will follow up with the doctor they referred you to and see to it that you get the help you need.

So please remember, no physician is a mind reader and, despite how depressed or hopeless you may be feeling, you can't count on your doctor to guess what's going on inside you. Most likely he or she won't routinely ask you if you are thinking about suicide. So, as tough as it may be, you simply have to say out loud how you are feeling.

Psychiatrists
Within the medical profession, psychiatrists are the ones best trained to help you if you are in a suicide crisis. Medical doctors first, psychiatrists have completed several years of specialized training in the areas of human behavior. They know all about suicidal thinking and spend most of their professional lives helping people with depression and other mood disorders. They know a ton about anger and loneliness and all the other things that make us miserable and unhappy.

Since psychiatrists are the only mental health professionals with the credentials to prescribe medications and if, for example, you think you may need a medication to counteract a serious depression, then by all means make that first appointment with a psychiatrist or a clinic or community mental health center where psychiatrists are employed. There is no point in wasting time and money on other kinds of professionals, including other kinds of physicians, if they cannot properly diagnose and treat what is ailing you.

Psychologists
A psychologist is someone who holds a doctorate in psychology and who, if he or she is offering services to the public, should be licensed by the state. They may be a PhD or an EdD, but in any case they will have specialized in counseling or clinical areas and will have had extensive training and experience in human behavior and the problems associated with living, including suicidal thinking and feelings. This is not say psychologists know a lot about suicide; some of them don’t know nearly enough, so it might be a good idea to make sure you find someone who has had specific training regarding the assessment and treatment of suicidal crises.

Psychologists work in all sorts of settings -hospitals, clinics, private practice -and all of them should have a good working relationship with a psychiatrist or other physician to whom they can refer you for medical evaluation and, if needed, proper medications to help you combat an emotional problem.

Social Workers
Like the other professions I am including here, social workers are a mixed group of professional helpers and many or most of them are trained in clinical work. While all social workers are not trained psychotherapists, many of them have specialized in this area and are as competent as any of the other mental health professionals to help you with your problems. According to their own standards for professional practice, social workers should have a master's degree in social work, state certification (if available in their state), and, ideally, hold membership in the National Academy of Certified Social Workers. The ACSW (Academy of Certified Social Workers) is your best guide to finding a social worker in your community who has all the proper skills and credentials. Again, though specific training in suicide risk assessment and treatment cannot be assumed, so check him or her out with a few questions.

Psychiatric Nurses
Nurses, since the profession began, have been an integral part of the mental health team. More recently, a specialty in psychiatric nursing has developed and more and more nurses with this training are available to help people with problems. A number of nursing schools now offer a master's degree (some even offer a doctoral degree) in psychiatric nursing and, should people like this be available in your community, you can safely bet they will have all the proper training and experience to understand and help you with your crisis.

Master's Level Clinicians And Licensed Professional Counselors
There are a large number of schools offering master's degrees in counseling and the helping professions. These go by many names, but the bottom line is that some of the programs are good and some are not so good. Some states require a master’s degree to be licensed or certified, others do not. Some of these practitioners may work in clinics or mental health centers, some may be in private practice. Some may be supervised by PhDs or MDs, others may not. And, while some of these people are excellent therapists, I know of no simple way to guide you to someone who will do a good job for you, other than to refer you to their national and state associations. (I will suggest how to "triangulate" a good therapist a bit later.)

The Clergy
Since many people turn to their priest or minister or clergy man or woman for help, it is important for you to understand that while clergymen and women know and understand human problems, not all of them will have had special training in counseling or in how to work with suicidal people. However, more and more clergy are receiving training and supervision in what is called Clinical Pastoral Counseling. If you can find someone with this background available in your church or community, then you can be sure you will have found someone able and experienced in helping you with your problems.

This is not to say that if your minister or priest has not had this specialty training, he or she is inadequate to be of assistance; rather, it just means he has not taken the courses and met the requirements for this certification. Most clergy I know do a lot of counseling and, when they feel they can't adequately help you with what is bothering you, they will refer you to someone they know who can.

Drug And Alcohol Treatment Specialists
Most drug and alcohol specialists are broadly trained in human behavior, including what to do to help someone in a suicidal crisis. However, as with any relatively new professional specialty, the training and experience of these counselors is uneven. Therefore, I cannot say that every one of them will be competent to help you with a suicidal crisis. However, if your suicidal thinking and feelings emerge while drinking or drugging or after coming down from a high and you have reason to believe your problems very likely stem from the use or abuse of chemicals, then you will be way ahead by starting out with a drug or alcohol specialist. Also, some psychologists, psychiatrists, social workers, and masters-level therapists will have specialized in chemical dependency and this, if you are having problems with drugs or alcohol, is often the best kind of professional to consult.

Five Steps to Finding a Good Therapist

1. ASK FOR A REFERRAL
Once you've decided to seek professional help, you'll need the name of someone to contact. A referral is like a recommendation and the quickest way to get a referral is from someone you know. Ask a friend, call your doctor, talk to someone at a mental health center, or call your crisis line. Many community agencies offer free information and referral services. Calling 1-800-SUICIDE will also get you help and a referral.

I suggest you talk to several people and get a list of names. Most people will give you three names of people they know and respect. You will find, most likely, the same names showing up again and again. These are the people to call-they have the best reputations.

2. CHECK CREDENTIALS
If you're nervous about accepting a referral and going to see someone, here are a couple of things you can do. One, you can call the professional organization to which they belong (County Medical Society, State Psychological Association, National Association of Social Workers, etc.) to see if the person you are considering is a member in good standing. Secondly, you can call the professional and interview him or her on the phone. This may feel a bit awkward, but if you have questions about his or her affiliations, credentials, training and such, then by all means ask those questions. Most therapists are happy to answer such inquiries. If they are not, keep looking.

3. ASK ABOUT THE THERAPIST'S APPROACH OR STYLE
If, like most people, you are unsure about what you are getting into by seeing a therapist, feel free to ask all the questions you have while you have them on the phone. It may help to jot your questions down before making the call. Will you be seen alone or with your spouse or family? What kind of therapy does the therapist practice? How much does it cost? I'm not suggesting you keep him or her on the phone for thirty minutes, but I am suggesting you get all the answers you need to feel comfortable about going for that first appointment. Since cognitive-behavioral therapy has been shown to be effective with depression, it might be a good move to ask if the person has been trained in that kind of therapy.

4. ASK THAT THE FIRST VISIT BE A CONSULTATION
Rather than make a commitment to ongoing therapy, it is sometimes wise to ask for the first appointment to be a consultation. Some therapists do not charge for this first visit. A consultation is different from therapy in that neither you nor the therapist is making a commitment to a series of therapy sessions. Rather, it is an hour during which each of you can decide if the other is someone you can work with. It is a step I strongly recommend. Not everyone likes everyone on a first meeting and a poor connection for therapy can be worse than no therapy at all.

5. IF IN DOUBT, GET A SECOND OPINION
Having secured a list of therapists and having interviewed and been interviewed by one, you may feel the two of you did not have a good take. If this happens, then by all means seek a second opinion. If you left that first appointment feeling uncertain that the therapist could help you (or that he or she was cold or indifferent or too peculiar or too anything), then call the next person on your list. Your life is just too important not to be cautious in this phase of getting the help you need.

What Kind of Professional?
Almost everyone unfamiliar with the broad spectrum of mental health professionals will, once they decide to seek help, ask the question: "Who should I see?" I wish I had an easy answer but, frankly, the world of therapists is a confusing one.

However, a general rule of thumb is that the more serious your problems, the more training your therapist should have. If you are suffering from a serious depression, unstable mood swings, or emotional problems that are preventing you from working or going to school a medication may be indicated. In this case, start with a psychiatrist. If seeing a psychiatrist privately is too expensive, then contact a mental health center or an outpatient clinic where psychiatrists work. In my experience, however, most qualified therapists know when you need the attention of a psychiatrist and, even if you begin with someone who is not a psychiatrist, they will refer you on for an evaluation and possible medications.

Unfortunately for the consumer, much of the conflict and confusion in the mental health field stems from quarrels among us professionals as to who is qualified to do what with whom and for how long and for how much. Maybe it helps to keep in mind that these are relatively new professions and that, as yet, we haven't sorted everything out. But the point I most want you to remember is that, despite our differences, all of us who have been in this field any length of time become familiar with suicidal thoughts and feelings and, generally, we know what to do to help you through whatever crisis you may be in. What we don’t yet know, perhaps you can teach us. I don’t know about other therapists, but most of what I learned about suicide I learned from my patients.

Finally, I do not believe that everyone who goes through a suicidal crisis needs professional help. There are dozens of things you can do for yourself without professional guidance. You can exercise, take better care of yourself through diet and nutrition, seek spiritual answers from your church, your God, or through meditation. You can join self-help groups that are working on problems just like yours.

You can read self-help books and undertake a host of self-improvement projects that may change both the direction and quality of your life. A friend of mine, Dr. Tom Ellis and his colleague, Cory Newman, co-authored a very helpful book for suicidal people. Entitled Choosing to Live: How to defeat Suicide Through Cognitive Therapy, you may find it very helpful. Another excellent book due to be published in 2002 is written, again, especially for suicidal persons is by Susan Blauner and entitled How I Survived While my Brain Tried to Kill Me. There are other good books that can help.

You can change damaging relationships, quit booze or drugs, and otherwise begin to take better care of yourself. You can do lots of things to get better, but if these things fail, then please remember we volunteers and professionals are there in the wings - waiting for your call. And I mean, literally, day or night.