Compliance Conversations with CJ Wolf: How to Prevent Suicide

[Trigger warning: Suicide]

Folks, we’re gonna dive into a hard subject today. It might not be the cheeriest of topics, but it might very well be one of the most important ones. Today, we’re going to talk about suicide prevention. Why? Because talking about it smashes the stigma we have as a society about mental health struggles and it gives folks the opportunity to learn, grow, help each other, and maybe help themselves. And as compliance professionals in healthcare, and as human beings, there’s nothing more important than the health and wellness of our friends, families, and coworkers.

Why Suicide is Relevant Right Now

Since 1999, the suicide rate has increased by 35% in the United States. And for ages 10-34, it is the second leading cause of death.

How to Help Prevent Suicide: Helping Family and Friends

There’s no difference between mental health and physical health. Your brain and body are equal in their importance. Yet, we don’t act skittish about physical health problems and we all learn the signs and symptoms of serious health issues. If somebody clutches their chest and they say “I have chest pain” we all have been trained to think that guy’s having what? A heart attack. It should be the same with mental health issues. We should all know the warning signs and the steps to take to help.

If we hear someone say something like, “It doesn’t matter anymore” you know, or, “nothing matters anymore” we need to take it seriously and did a little deeper.

Signs that someone might be thinking about suicide:

  • They’ve been depressed but are suddenly “fine” and even “cheery.”
  • Saying things like, “nothing matters.”
  • Loss of interest in things they used to enjoy.
  • Chronic depression
  • Getting their affairs in order or giving things away suddenly
  • Withdrawal

If you notice signs that someone might be thinking of suicide, the first step is to sit down with them and have an open, calm, nonjudgemental, non-shaming conversation. Don’t make it about you and don’t argue with them. Ask them directly if they’re thinking about killing themselves. Tell them that you love them and are there to support them and ask how you can help them. Determine from there the next best steps which can be anything from helping them get into a therapist or in-patient program or even taking them to the emergency room.

Another thing you can do to prevent suicide is to focus on mental wellness. Reach out to friends and family regularly to check in with each other. Make it a point to join a book club or a hiking group and go to holiday dinners (even if your relatives are a little bit annoying, or skip the fam and make a plan with friends). A tight community reduces our risk of mental illness.

How to Get Help if You’re Struggling

“There are people there who care for you, even though they don’t know you. I care for you, you have value, and though you may be struggling, you may be feeling like there’s nothing worth living for there are those who are concerned about you and concerned about your health and want you to be happy.”
–CJ Wolf.

The most important thing you can do is talk to someone. Call a friend, family member, or a hotline and tell them that you’re thinking about harming yourself. They can stand by your side and get you the help that you need.

National Suicide Prevention Lifeline: 800-273-8255

High-Risk Populations: Men and LGBTQAI Youth

Some important risk information to consider. Folks between the age of 10-34. We’ve seen a surge in children committing suicide after experiencing online bullying. Of all the people who die by suicide, seventy-eight percent (78%) are male. Lesbian, gay, and bisexual youth are four (4) times more likely to attempt suicide than heterosexual youth and transgender individuals are twelve (12) times more likely to commit suicide than the general population. It’s crucial for anyone who is thinking of harming themselves to remember that it truly gets better. And that you’re not alone, and you’re not broken. Mental health struggles are a part of life, and it’s okay to have struggles. You can get through it.

“...there are support groups for youth, for LGBTQIA youth, and there are so many people who love you and are here and who are supportive. I think sometimes the youth are so innocent and want to please parents and authority figures and you just need to know you are who you are and it’s okay who you are, and your worth is immense.”
–CJ Wolf.

Tune in to the most recent episode of "Compliance Conversations: Suicide and Prevention," to hear what you can do to get help if you need it, or what you can do to help a friend or family member. In this episode we cover:

  • Suicide Statistics
  • High Risk Populations
  • Suicide Help and Prevention

Essential Resources


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Episode Transcript

CJ: Welcome everybody to another episode of Compliance Conversations. I’m CJ Wolf with Healthicity, and today, I have Healthicity’s content strategist Misty Evan’s with us. Welcome Misty.

Misty: Hello, thank you.

CJ: Today, we’re going to talk a little bit about suicide prevention. We know that the holiday season is a happy time for so many of us, but many people still have a difficult time. And it’s not just around Christmas time and the h.olidays, but they have trouble all year long. We thought about it at this time because it’s the antithesis, sorry, it’s the opposite of what many of us are trying to celebrate this time of year, so we thought this would be a good discussion and we’re going to flip things around a bit. We’re going to have Misty ask me some questions. You know I’m not a licensed psychiatrist, though I did spend many years in medical school, graduated medical school, and started my training. The training I started was in psychiatry, so mental health has always been something that I’ve been interested in and followed along throughout the years.I have done a little bit more research and preparation for today. We’re going to have Misty ask me some questions today.

Question: Misty, what kind of questions should we discuss regarding suicide prevention?

Such an important topic.

Misty: Fantastic, yeah, it is a critical topic. The holidays can be rough for folks for all kinds of reasons. So,

Question: Just how big of an issue is suicide?

Can you share some statistics that show how common it is?

Which age or other group types are at most significant risk?

CJ: Yeah, one thing that surprised me while I was preparing for this little bit is the suicide rate since 1999, so in the last 20 twenty, Misty, do you think the suicide rate has gone up, down, or stayed kind of level?

Misty: I don’t know. I feel like with the pandemic; it would probably go up?

CJ: Yeah, so from 1999, we’re talking the last 22 years, overall the suicide rate has increased by thirty-five percent (35%).

Misty: Oh wow.

CJ: That’s a lot, right?

Misty: Yeah, that’s huge.

CJ: We think of things increasing by 35%, and a lot of us, if you were investing, you’d love for your investments to increase by 35% over twenty years. This is one we don’t want to increase over 20 years, but since 1999, the suicide rate has increased by 35%. So, it’s a problem, right? And it’s been a problem for eons, it’s always been a problem, but it’s getting worse. And the statistics I’m sharing with you are focused on the United States, so I didn’t look worldwide; I think most of our listeners are U.S. based, but 35%.

The other part of your question was who does it affect the most? Just think of the entire United States population. It is the tenth (10th) leading cause of death for all age groups. And for ages ten (10) through thirty-four (34), so our young people, it is the second (2nd) leading cause of death.

Misty: Wow.

CJ: For people ages ten (10) through thirty-four (34). The leading cause is unintentional injury, car accidents, and those sorts of things. So unintentional is the leading cause [of death] for ages ten (10) to thirty-four (34), and then intentional, which is suicide, is the second (2nd) leading cause of death. And for a year, overall, the number of people who committed suicide was around 48,000 people. So it’s a lot of people. When we’re talking statistics, the other thing is that more women attempt suicide than men. Men are almost four (4) times more likely to die by suicide. So women may be attempting it more, but men are more successful, so of all the people who die by suicide, seventy-eight percent (78%) are male. Both are, right? If someone’s attempting suicide, that’s a severe situation; we need to take care of it. Most men, when men try suicide, they’re usually successful. So seventy-eight percent (78%), that’s almost eighty percent (80%) of all the people who die by suicide, are male. So males are four (4) times more likely to die. The other interesting thing that I thought was nearly half of all individuals who die by suicide have a diagnosed mental health condition. So that means half of the people who die by suicide have been diagnosed by somebody with a mental health condition. So we kind of know who may be the greatest risk because half of them have already been diagnosed with a mental health condition, and then research shown that about ninety percent (90%) of people who have died by suicide have experienced some sort of mental health symptom. So they might not have been diagnosed yet, but they’ve experienced some symptoms. So those I think are some important statistics to give us some background on this concept of how we prevent suicide. It’s important to know who’s doing it, who’s more successful at it, what age groups, those sorts of things. I found that really interesting.

Misty: Yeah, that is really interesting and really sad. On a previous podcast, when you interviewed another psychiatrist, he was talking about increased mental health issues because of the community’s breakdown. Would you say that’s probably contributing to the suicide rate?

Question: Would you say that’s [breakdown of community] probably contributing to the suicide rate?

Did you read anything about that? Less family time, less support in the community, people are less part of the community than they used to be.

CJ: I think that could be a part of it. Suicide, it’s a complex situation, and it’s different for a lot of people. There are a lot of commonalities. Causality, you know what causes it; it’s a very complex thing because you have mental pressures, you have stressors, and combined with maybe some predispositions to using drugs or using alcohol, plus some genetic variants and genetic contributions, but I think what you stated is real. You know, I was looking up “does the suicide rate increase during the holidays,” and it’s a myth, it doesn’t. I thought, hey it probably goes up because people are sad. The rate goes down slightly between November and December. To your point about family and friends, a lot of people postulate that the reason it goes down in November and December is there is so much family contact. So if you’re feeling depressed and you’re having suicidal thoughts in September or October and you don’t act on those come November and December most people are going to be around family and friends and it’s a little more cheery. It seems like the rate actually goes down a little bit in November and December so that’s kind of a myth that the Christmas time and the holiday season is one where rates go up. But to your question about this breakdown of community and closeness to family and friends. I think what I just shared about rates going down in November and December probably explains what you just asked, which is why the rates are going up and I think that has something to do with it. So one thing that I, you know, when it comes to risk factors.

Misty: Yeah I was going to ask.

Question: What are some signs that we should all watch out for as it relates to suicide risks among ourselves and those we know too?

CJ: Yeah, absolutely there are some high-risk populations. I’ve already mentioned males. Males that are exhibiting signs and symptoms of suicide are more successful and so they’re a higher risk population. Some things though, people that say “It doesn’t matter I’m here” you know “nothing matters anymore” so little comments like that should clue us off to maybe they’re not automatically suicidal but it is something that should trigger in your mind “Oh, maybe I should dig a little deeper.” Think of the things that we really react to. If somebody clutches their chest and they say “I have chest pain” we all have been trained to think that guy’s having what?

Misty: A heart attack.

CJ: Right, a heart attack potentially. Or somebody is starting to slur their speech or feeling paralyzed on one side of their body. Many of us are like, we better get you to the emergency room because you might be having a stroke. And that’s good, heart attacks and strokes kill a lot of people, and we should be aware of those symptoms, and we should react accordingly, meaning we are quick to react. We want to call 911 or get them to emergency help. The same sort of thing should happen when we hear certain clues for somebody who might be suicidal. And those things are where they’re getting their affairs in order, they’ve been depressed, and one that was interesting was they all of the sudden they have kind of a clear mind after a period of severe depression and thoughts of suicide and all the sudden they’re chipper and cheery. They might have decided that they’re going to end it. So if people say things like “There’s just no reason to live,” “there’s nothing for me here,” “nothing really matters.” So it’s not always “Oh, I want to go kill myself.” These other clues and statements lead us to su,spect a person has suicidal thoughts. And you know what, the best thing to do is to ask them straight up “Are you thinking about committing suicide?” or “Are you thinking about hurting yourself?” “Are you thinking about killing yourself?” and you can do it in a nonjudgmental way, but you just approach the subject very clearly.

Misty: Matter of factly.

CJ: Yeah, and it’s not like by you asking, they’re going to think, “Oh, I never thought of that before. Maybe I should go kill myself.” You know, some of us are a little afraid because we are putting something in their mind. No, we’re not.

Misty: Well, I also, I understand that. There’s also such a stigma around mental health in the world and the United States and I think people don’t talk about it openly and get really skittish. Even talking about things like anxiety or depression, depression definitely leads to suicide risk, right?

CJ: Yeah.

Misty: And most folks, even though depression is really common among large groups of folks. Even for women who have just had a child, postpartum depression is extremely common and it’s still not talked about and people don’t want to admit to it and family doesn’t know how to approach it. So I think what you’re saying is, just openly straight-up approach people and talk with them. It’s also a great way to fight stigma.

Question: So how do people do that?

CJ: So I think the previous podcast we were talking about, the psychiatrist that I interviewed, I think that’s a good one to listen to because he talks a little bit about just kind of community and those sorts of things. Those things are more foundational, they help prevent suicide because you’re going in the opposite direction. You’re building mental health, you’re building mental strength. When we’re talking about, and I like to use this analogy of a heart attack, so if somebody’s had this chest pain, they make it to the emergency room and they get this emergency treatment, do you just then say “Okay, we’re done.” No, you’re like you are at risk for another heart attack and what do you do? You tell them to adjust their diet, you have them exercise, and you have them take certain medications. The people around them, you say look if this person has this symptom you do this and I think that’s very similar for mental health. Let’s say someone is not suicidal but they’re depressed, you get the treatment. There’s psychotherapy, there are certain medications, there’s exercise, there are all sorts of things that can help just like when you’ve had chest pain. You don’t just leave it there after the emergency treatment you do something about it to change moving forward. Some of the things though, if you’re actually in a crisis you should just talk openly and honestly. You should not be afraid to ask a question like “Do you have a plan for how you would kill yourself?” That would tell you a lot. The other thing you can do if you’re really concerned, a lot of suicides, the number one cause of success for suicide is a firearm. So if there is a firearm in the home it should be removed or locked and the person has no access to it. If they have access to it they could, in a moment of weakness or concern, have access to that, and then if they kill themselves with a firearm or try to most likely it’s going to work and that’s irreversible. The other thing is people stockpile pills. Another thing you can ask, you can ask simple direct questions like “Can I help you call a psychiatrist” or there are hotlines you can call. Maybe Misty can put in the show notes some of those hotlines. So you can call 1-800-950-NAMI. So NAMI is the National Alliance on Mental Health, and then there’s also a text. You can text NAMI, N-A-M-I to the number 741741 if you prefer texting over an actual phone call. Maybe we can put those in the notes. But you can ask, “can I help you call your psychiatrist, can I take you to an emergency room?” If there’s a lot of people around and you’re talking about this, maybe it’s a family situation, just have one person speak at a time, you don’t want to overwhelm this person. You want to express support and concern but you don’t want to argue, you don’t want to threaten or raise your voice, you don’t want to debate that suicide is morally wrong or from a religious standpoint this is wrong or it’s a sin.

Misty: Yeah, shaming does not help any situation.

CJ: Yeah, you don’t really want to debate that. If you’re nervous yourself, try not to fidget or pace and try to be patient. But like any other emergency, if it’s really severe, you don’t want to leave them alone, and you want to get them to help where they’re going to be in a safe situation. Because let’s say you ask somebody do you have a plan for how you would kill yourself and they say yeah, I’m going to go do X, Y, and Z, that plan is realistic and you find out they want to do that plan there’s nothing wrong with calling 911 and explaining what’s going on or taking them to an emergency room. If that’s needed or, as I said, maybe you call the hotline with them and leave them in a room where they’re safe and can talk privately with that person. But we all learned how to do CPR or how to do Heimlich when someone is choking. If someone is having a mental crisis it’s also severe and we need to have some sort of steps to react.

Misty: Yeah, absolutely.

Question: What about folks who might be listening to this podcast who are in a rough place right now and might be considering self-harm, what would you say to them? What can they do?

CJ: Yeah, for yourself what I would do is reach out to somebody who you know cares for you. People care for you. If you’re listening to this and you feel all alone there are people who care for you and if you’re having a hard time finding somebody like that call these hotlines or text these hotlines. There are people there who care for you, even though they don’t know you. I care for you, you have value, and though you may be struggling, you may be feeling like there’s nothing worth living for. There are those who are concerned about you and concerned about your health and want you to be happy. I would say reach out. The important thing is to reach out to somebody and hopefully, you have a family member or friend you can talk to. If not, call these anonymous hotlines and text lines and there are people there who will care for you. I think that’s really important.

Misty: That’s so true. That’s such great advice.

CJ: A couple of other things that I thought I could talk about are some risk factors. So if there’s a family history of suicide or suicide attempts that’s a risk factor. So you may be working with somebody, or a friend or family member and you know that someone else in the family tried to commit suicide or did commit suicide that’s a serious risk factor. Another serious risk factor is substance use. So drugs can kind of create mental highs and lows that can worsen or exacerbate suicidal thoughts. So when there’s substance use and these feelings that can make things worse so that’s a serious risk factor. The other thing that’s really a major risk factor is alcohol. So of all the people who die from suicide, one (1) in three (3) people were under the influence of alcohol at the time of death. One in three, so alcohol, a lot of people return to alcohol to deaden those feelings and try to escape that a little bit but one (1) in three (3) who actually die from suicide are under the influence of alcohol at the time of death. I already mentioned access to firearms so that’s a risk factor. A serious or chronic medical illness, we’re not talking about mental illness at this point but a serious or chronic medical illness. Maybe somebody has chronic diabetes or they have chronic liver failure or some other sort of chronic disease, that’s also a risk factor. I already talked about gender as a risk factor. Women attempt it more but men are more successful so that’s a risk factor. A history of trauma or abuse is also a risk factor. Prolonged stress and then a recent tragedy or loss could also be a risk factor.

The other things that I wanted to mention, Misty, are some kind of behaviors that might clue you off to a psychiatric emergency. If somebody is collecting pills or buying a weapon during this time period where they’re depressed or have expressed some of these feelings it could be a sign that they’re actually going to go through with this. Giving away possessions can be a sign that they’re actually going to try to commit suicide. Tying up loose ends, like maybe organizing your personal papers or paying off debts, might be a sign that they’re ready to take the next step, and then saying goodbye to friends and family might be a sign. These are signs that I would say are similar to, when we were talking about a heart attack, someone clutching their chest and saying “Oh, I have chest pain” and we react with urgency in that scenario. These types of things are potentially behaviors that you’re observing that should trigger you to say this might be a psychiatric emergency and I need to get immediate help for this person.

Misty: And what about, just curious here because you see it in the headlines a lot:

Question: Are there any different signs or symptoms for children?

Because I know you said ages ten (10) through thirty-five (35) are the highest risk and we’ve been seeing an increase in suicide of kids after online bullying and stuff.

Is there anything separate in children that you would see? Like withdrawal or anything?

CJ: Yea exactly, withdrawal from things they find pleasure in. So if they used to play soccer and they loved it, like you knew it was their passion or something they loved and now they’re like “I don’t want to do it, it doesn’t matter. So withdrawal can absolutely be a sign. I’m glad you brought that up because, in youth, not all in these categories commit suicide but these categories need to raise your awareness. Lesbian, gay, and bisexual youth are four (4) times more likely to attempt suicide than heterosexual youth and transgender people are twelve (12) times more likely to commit suicide than the general population. So people in those kinds of, you know…

Misty: Marginalized groups

CJ: Yeah, they’re kind of in these groups where they might be considered on the fringe or outcast or whatever. I know society is changing attitudes towards this and trying to be more accepting but this is still a major struggle for lesbian, gay, and bisexual youth and transgender folks. That’s a hard thing to deal with and they are at a major increase and that usually happens more in those youth years. That’s when they’re discovering these feelings, discovering their orientation, discovering who they are and what they are and if those discoveries go against what they’ve been taught or what the belief system might be in a family, they are at an increased risk of suicide for sure.

Misty: Oh geez. So awful.

Question: So what can they do to find support?

Like I know there are a lot of community centers and support groups.

CJ: Yeah, that’s a great question. You know I’m here in the state of Utah, and I know people in this category that have had suicidal thoughts. There’s the Pride Center, there are support groups for youth, for LGBTQIA youth, and there are so many people who love you and are here and who are supportive. I think sometimes the youth are so innocent and want to please parents and authority figures and you just need to know you are who you are and it’s okay who you are and your worth is immense and there are a lot of support groups out there. Youth groups, as well as adult groups, can support you through this and you’re not alone. I guess that’s the most important thing. I think for that particular age group, and for the LGBTQIA group, they feel isolated and alone but you’re not.

Misty: And it gets better.

CJ: It does get better.

Misty: And it gets better when you get older thank goodness. Teen years are so hard.

CJ: Yeah they’re hard right? Even if it’s not an LGBTQAI issue, the teens years are hard. You add on something like that where society is not fully accepting, some communities are not fully accepting, that can be a real issue.

Misty: Well, this is all really great advice and great information CJ.

CJ: Yeah, the last thing I would kind of leave with you, Misty, maybe we can put this in the show notes as well. So NAMI, the National Alliance for Mental Illness, put out a little brochure called navigating a Mental Health crisis and that’s what it’s titled and it’s a NAMI resource guide for those experiencing a mental health emergency. Maybe we could put a link to it as well, it’s a PDF, you can download because we as a society we’ve taught CPR, we’ve taught first aid, we’ve taught Heimlich maneuver. I’ve kept referring to some of the things we do when someone is having these emergencies in other medical situations. Well, suicide can be an emergency, suicide risk so this may be something helpful for people to learn and read through and I think as a community, as a nation we need to raise awareness. This is real, again this is the second (2nd) leading cause of death for people ten (10) to thirty-four (34) years old so it’s serious and we need to treat it in a serious manner just like we treat chest pain and all these other things that are serious. I’m not trying to put one above the other but we need to treat this in a serious way and I think this guide, navigating a mental health crisis, can be helpful to a lot of people.

Misty: That’s fantastic, and for families, there’s nothing wrong with your family member who is struggling. They’re not broken, you as a family are not broken if you’re dealing with it.

CJ: Misty that’s such a great point I’m glad you bring that up because there is this stigma but really it’s life. You know a lot of us, especially in this digital world; we put on our best face out on social media platforms. We put out the fun trips and the new haircuts and the new clothes and this and that and you try to put out there this perfect life and that’s not real. No one has a perfect life and this stuff is normal and it happens to everybody. Mental health is really no different than good diet nutrition and exercise. I mean there are techniques to be more mentally healthy and less mentally right? So there are actions and activities that make us less healthy from a mental standpoint so really we just need to get rid of that whole stigma and be like look, this is a part of life. Our mind is in our body. It’s a part of our body, these feelings are a part of us, it affects us physiologically and if it gets bad it can get to a point where it risks our lives. So yeah, you’re spot on. There can be that stigma within families but it’s not a big deal to have mental health issues. Getting therapy it’s healthy; I mean I’ve gone through it, I think a lot of families do.

Misty: Me too. I’m a millennial so I don’t really have friends who aren’t in therapy. Everybody I know goes to therapy.

CJ: Yeah, I don’t think it’s a weakness. I think it’s a strength to recognize. Just like I go to the gym to work on my muscles, I want to go to somebody who can help me work on my mental muscles. My mental health, there’s nothing wrong with that, and life is better because of it. So anyway, that’s a whole other issue but I’m glad you brought it up.

Misty: Yeah, thank you CJ. This is such helpful information and I love how supportive you are. It’s really important for people to hear this time of year and all year.

CJ: Exactly, thanks to Misty for letting us flip the table here and ask some questions and everybody thank you all for listening to another episode of Compliance Conversations. Until next time be healthy.

Misty: Thank you CJ.

Questions or Comments?