My reflections on working with suicidal patients: Jacob Schonberg, Peer Support Specialist, UNC Wake ACT
I have been working in community mental health for the last 13 years, 11 of them with ACT teams. In that time, I’ve taken many different trainings, on a variety of subjects, from a variety of trainers with different skills and backgrounds. Not surprisingly, none have influenced me as much as the trainings I’ve been to that were facilitated by peer specialists. Peer specialists bring to the table something that most providers are not able to bring, namely the experience of having been through the interventions that they are teaching others to provide. Earlier this year, I was able to attend such a training, facilitated by the Wildflower Alliance called “When the Conversation Turns to Suicide.”
There are a variety of assertions put forward by the peer advocacy movement when it comes to mental health treatment and dealing with suicide is no exception. The first part of the training I attended reviewed these assertions. The concepts that risk assessment is questionable in its usefulness, or that involuntary treatment could be a significant trauma, are not new ideas to me. In many ways they line up with my own experience as a patient in the psychiatric system. I had also heard the assertion that suicide risk actually goes up following acute hospitalization, not down. What I had not heard was a viable alternative to traditional treatment interventions.
When working as part of the mental health system, people we work with that are at a significant safety risk need something, but what? And we need to do something, as providers, to provide some sort of support or assistance. Again, what? We can’t sit back and do nothing (ethically, legally, or just as human beings), but how can we be helpful while minimizing any potential harm? For the first time in this training, a framework was presented to me that marked all my necessary boxes for this issue. Developed by the peers of the Wildflower Alliance, they termed their framework “V-C-V-C.”
When I was in my darkest place, living at home on social security with not a hope left in the world, these four things would have meant so much for me. When I look back at the people I’ve worked with over the years, when they were truly struggling, how would this have changed their experience? In order to help people, we have to recognize that their feelings and experiences are real. That reality may not agree with ours, but I assure you it is very real to them. Ask questions. Learn about what they are thinking and feeling rather than just assessing for risk and contracting for safety. Be vulnerable. This is probably the hardest element for professionals, as we are trained to separate ourselves from the people we work with. By default, we limit what we share with those we serve. We need to change that. This doesn’t mean giving people your birthday or your home address, but the power of shared emotion, shared fear is so potent, it lets others know that you are listening, that you care, and that your interaction is real, not just another clinical assessment. That connection that comes from vulnerability is what I was so desperately seeking, as are many others who struggle with these thoughts. Connection is often the core of what is missing in people’s lives, and when we can provide genuine connection, we provide hope.