When a friend is hurting, surely there's more than the suicide hotline

September 5, 2019
Hilal Dogan, BVSc, CCTP
Hilal Dogan, BVSc, CCTP

Frequent Fetch dvm360 speaker Dr. Hilal Dogan practices medicine in Denver, Colorado. She started the Veterinary Confessionals Project as a senior veterinary student at Massey University in New Zealand.

dvm360, dvm360 September 2019, Volume 50, Issue 9

It serves an important purpose, but there are other things you can do to help your veterinary colleague who's considering suicide. Here are some ways to help.

When a fellow veterinary professional admits they're entertaining thoughts of suicide, what do you say? Who do you encourage them to reach out to? Is directing them to the National Suicide Prevention Lifeline enough? What if the person hurting is you? Do you really want to call an 800 number, stay on hold and then spill your guts to a total stranger?

Spotlight on suicide

September is National Suicide Prevention Month-a chance for mental health advocates, prevention organizations, survivors, allies and communities to unite to promote suicide prevention awareness-and it's no secret that this is a huge issue in the veterinary profession. This month we are focusing on this important subject in a special dvm360 Spotlight Series; watch for them online and in print. In the meantime, if you're struggling with suicidal ideation or even just plain old burnout or depression, be sure to access our list of veterinary-specific mental health resources at dvm360.com/mentalhealthlist.

Don't get me wrong-I'm glad 800-273-TALK exists as a resource. However, I've heard countless times that people can be on hold for a long time after calling the hotline. One Fetch dvm360 conference attendee told me her daughter was on hold for 45 minutes before she hung up. That's insane. Even if you aren't in a crisis, that's an unreasonable amount of time to be on hold. It may make you feel like your situation doesn't matter to anyone else, which could have disastrous consequences.

So back to the question: Who should you refer someone to for help if not an 800 number? Just like how the sun should never set on a pyometra, I think the hold button should never be pressed on a suicide hotline or a delay taken with someone who may be suicidal. The risks are too high, and you may only get one chance. Luckily the daughter of the Fetch attendee did not become another statistic-she was able to get help.

Help yourself

Of course, some people say they'd never call a suicide hotline in a crisis even if they weren't put on hold. How can we help those people? Laurie Fonken, PhD, a licensed psychotherapist and director of counseling and wellness programs for the College of Veterinary Medicine and Biomedical Sciences at Colorado State University, says she encourages them to go directly to a mental health crisis center. These centers are open 24/7, and Dr. Fonken will often accompany a person to the facility and wait while they check in. Here, people in crisis can talk directly with a mental health professional. If you want to be ready for this situation, do some research on facilities in your area and keep their numbers and addresses in your phone. (Editor's note: You can start your research with a call, 8 a.m.-8 p.m. EST Monday through Friday, to the Treatment Referral Helpline at 877-726-4727.)

The internet is another great option. All sorts of social media support groups have popped up lately, such as Not One More Vet in the U.S. and Vets: Stay, Go, Diversify in the U.K. Joining these groups and reading about what other people are dealing with may help you find your own solution, or at least realize you're not alone. Facebook and Instagram groups for your specific role-practice manager, owner, relief veterinarian, house-call veterinarian, emergency technician, veterinary receptionist and so on-can also be a source of support. Vet Tech Probs, for example, on Instagram and Facebook finds humor in the daily struggles of veterinary technicians. Being a part of as many of these groups as possible can help you build a community of support online.

Backlash concerns

Shining a spotlight on suicide tends to generate backlash (consider the reaction to the Netflix series 13 Reasons Why), and I think this will continue to happen until the stigma is completely smashed. When I launched the Veterinary Confessionals Project, I faced a backlash in which people were concerned that suicidal individuals would not be able to receive help if they expressed themselves in an anonymous format. I explained that the Confessions were a way of getting something off one's chest and releasing it into the world, where they knew “somebody” was reading it, and that in itself was therapeutic.

Just so everyone knows, when people express suicidal thoughts and leave their contact details, I do reach out to them directly. I just had this happen a couple of weeks ago, in fact, and we ended up texting and emailing. This person gave feedback letting me know our communication really helped, and even a week later we're still emailing back and forth.

In the veterinary profession, I often get the sense that help for those who are struggling needs to come from within the profession itself. People need to be able to say to each other, “I went through that, too, and it was really awful, but it gets better,” or “Here's how I dealt with it,” or “I have a similar story, and it scarred me for life, but I'm past it now.” There's often an assumption that someone who hasn't gone through a similar experience just can't understand. I don't think that's completely true, but I do realize that some challenges are unique to veterinary medicine-euthanasia and everything surrounding that subject is one example. In the end, what helps people considering suicide feel like they want to stick around? It's the feeling of being heard, understood and supported.

Help others

Connecting authentically with one another is the No. 1 weapon we have as we fight the good fight and smash the stigmas surrounding suicide and mental illness. Even if you yourself aren't having thoughts of suicide, how can you help your colleagues? I recently posted a resource on the Veterinary Confessionals Instagram page about a method called Q-P-R, or Question-Persuade-Refer. It's trademarked, and there are courses that people can take to become certified in it. It's supposed to be akin to cardiopulmonary resuscitation (CPR)-a technique anyone can use if faced with someone they think might be suicidal.

In an attempt to find out more, I asked Dr. Fonken about the Q-P-R method, and she thinks it's great training to have. She's taken the modules herself, and she encourages students and faculty to try them as well.

The AVMA offers a one-hour online “gatekeeper training” based on the Q-P-R method free of charge to every member and veterinary student.

“It gives you the language to use so you can get comfortable saying things like, ‘Are you thinking of harming yourself?'” Dr. Fonken says. “Veterinary professionals aren't trained to handle situations such as this, yet they may be the persons in the first line who would notice it.”

Dr. Fonken also says that lack of training can make someone feel less than confident. Not knowing what to do or say can provoke anxiety, and people may end up avoiding a conversation because they just don't know how to deal with it. Questions such as, “Would you be willing to work with me?” or “Can I get you some help?” can help open a conversation, Dr. Fonken says. Knowing what you can do and how to refer that person to someone who can help can be vital in saving a life. You don't have to treat them-someone else is qualified to do that. But helping to guide them to a safe place can be key.

“We tend to compare how we're feeling on the inside to how others look on the outside. We judge ourselves for this and worry that we may come across as weak if we're vulnerable and ask for help. "-Dr. Laurie Fonken

Recently, after I posted the Q-P-R method information, someone commented that a person struggling may hesitate to speak up because they don't want to be “taken away in a straitjacket.” In that moment I realized how much the stigma around mental illness and suicide still exists today, even though we're talking about it more openly. In the past, people who confessed to suicidal ideation or who attempted suicide got locked up. And I can imagine the thought of being locked up forever sounds a lot worse than killing yourself-not to mention the fear of it permanently affecting your career and status in the workplace. It's evident to me that we still have a lot of work to do breaking down the stigma around mental and emotional health problems.

The stigma of cancer

Did you know that cancer used to have a negative stigma attached to it? These days there are 5K races for cancer awareness, displays of support and solidarity through the shaving of heads and the like, and all levels of fundraisers. But 60 years ago, according to the Pulitzer Prize-winning book The Emperor of All Maladies by Siddhartha Mukherjee, social and healthcare workers were hesitant to even utter the word “cancer.” Merriam-Webster's second definition of cancer is “something bad or dangerous that causes other bad things to happen,” which reinforces the word's dark and foreboding nature-just like mental health issues and suicidal thoughts are viewed today. Here's an excerpt from Mukherjee's book:

Cancer was an all-consuming presence in our lives. It invaded our imaginations; it occupied our memories; it infiltrated every conversation, every thought. And if we, as physicians, found ourselves immersed in cancer, then our patients found their lives virtually obliterated by the disease. In Aleksandr Solzhenitsyn's novel Cancer Ward, Pavel Nikolayevich Rusanov, a youthful Russian in his midforties, discovers that he has a tumor in his neck and is immediately whisked away into a cancer ward in some nameless hospital in the frigid north. The diagnosis of cancer-not the disease, but the mere stigma of its presence-becomes a death sentence for Rusanov. The illness strips him of his identity. It dresses him in a patient's smock (a tragicomically cruel costume, no less blighting than a prisoner's jumpsuit) and assumes absolute control of his actions. To be diagnosed with cancer, Rusanov discovers, is to enter a borderless medical gulag, a state even more invasive and paralyzing than the one that he has left behind.

Suicide and mental health problems are where cancer was 60 years ago. If the stigma around something as scary as cancer can be obliterated, who's to say we can't achieve the same with suicide and mental health issues? No one.

Dr. Fonken agrees: “I think there's a real fear of sharing if you're struggling, because everyone else looks like they're doing so well. We tend to compare how we're feeling on the inside to how others look on the outside. We judge ourselves for this and worry that we may come across as weak if we're vulnerable and ask for help. It's important for people to know that they aren't alone and that they'll be supported.”

A vital factor in preventing suicide in the veterinary profession is workplace culture, Dr. Fonken says. She urges practice owners and managers to create a culture where people feel safe enough to talk about these things without fear of negative repercussions.

“This example needs to be set by the leaders but carried out by all the staff consistently,” she says. “That way others can see it's a supportive environment, and you can ask for help and won't be fired or gossiped about. Because then you'll have an employee who will get help, then come back and be stronger and better. That sets the example for others that it's OK to ask for help.”

Anyone can have thoughts of suicide at any moment, even children and teenagers. It doesn't mean you are forever broken or that something will always be wrong with you. As a doctor, I truly believe getting to the root cause is the only way we will find a cure, and that starts with us wanting to help ourselves first.

In addition, we as a profession need to smash the stigma around mental health problems. We need to demonstrate that suicidal ideation is completely normal. It's a signal that perhaps you need to reevaluate your life. Your brain is telling you, hey, something is wrong here-stop and try and figure out what it is.

If you don't work at a place where you feel safe, or the culture is not supportive of mental health issues, then find someone you trust, even if it's anonymous, and spew your guts out. You will feel better afterward, trust me.

Frequent Fetch dvm360 conference speaker Dr. Hilal Dogan practices in Denver, Colorado. She started the Veterinary Confessionals Project as a senior veterinary student at Massey University in New Zealand.

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