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If you’re feeling suicidal, delight verbalize to somebody. You tin attain the National Suicide Prevention Lifeline at 1-800-273-8255; the Trans Lifeline at 877-565-8860; or the Trevor Project at 866-488- 7386. Text “START” to Crisis Text Line at 741-741. If y'all don’t similar the phone, consider using the Lifeline Crisis Chat at www.crisischat.org.
Transcript
Introduction
Jonathan Singer: Hey at that topographic point podcast listeners, Jonathan here. I am thence excited nigh today’s episode, y'all know, 1 of the things that is most challenging inwards the footing of mental wellness services (that includes verbalize therapy as well as instance administration as well as medication as well as all sorts of things that nosotros have got out at that topographic point to assist folks do amend inwards their lives, 1 of the biggest challenges is engagement. The modal number of sessions that somebody attends is one. That agency if y'all human face at all the sessions that people attend as well as all the people that attend sessions that the most number of people alone attend 1 session. Now, 1 session mightiness live corking if y'all have got a really discreet, slight job that y'all demand a picayune chip of assist alongside to hold going. One session is truly problematic if you’ve got some deep-seated issues that have got been problematic inwards your life for a long time, or, if they’re life-threatening, such every bit inwards the instance of folks who are suicidal.
I’m truly excited nigh today’s guest, Dr. Dana Alonzo, because handling engagement for folks who are suicidal, that’s her wheelhouse; this is her expanse of expertise. One of the things that she learned inwards her enquiry is that clinicians saw that success inwards handling was because of what they were doing, but if the handling wasn’t successful, they blamed it on their clients. Now, this is a huge problem. This agency that clinicians (not all clinicians—obviously I’m non talking nigh you, but, y'all know, maybe your colleagues), that instead of thinking nigh what they tin do to engage this somebody inwards treatment, to hold the handling going, at that topographic point is this mental attitude that, ‘well, if handling goes well, it’s because I’m doing well’ [the therapist] as well as ‘if it doesn’t become well, it’s because my customer did something wrong.’ Now, if you’re suicidal, you’re already thinking that you’re doing things wrong. You’re already thinking that life isn’t working good for you. And if y'all have got a clinician that thinks, ‘Well, if they don’t desire to come upward back, that’s their deal’ as well as thence that is problematic for the customer as well as their likelihood of living, on multiple levels.
So, I wanted to verbalize alongside Dana nigh her operate inwards handling engagement. Now, Dana Alonzo received her Ph.D. from Fordham University’s Graduate School of Social Service, where she was awarded a National Institute of Mental Health Research Training Fellowship. As the Co-Investigator at the Developing Centers for Interventions for the Prevention of Suicide at New York State Psychiatric Institute she conducted studies examining hazard as well as protective factors across cultures related to mood disorders as well as suicidal behavior. She’s been funded past times the American Foundation for Suicide Prevention, the National Alliance for Research on Schizophrenia as well as Depression, as well as a duo of organizations inwards New York State. Her enquiry has focused on the evolution of novel interventions aimed at improving handling engagement as well as adherence amidst suicide attempters. Dr. Alonzo founded the Suicide Prevention Research Program at Fordham University’s Graduate School of Social Service. Dana is the co-author, along alongside Robin Gearing of the Springer text, Suicide assessment as well as treatment: Empirical as well as evidence-based practices. You tin notice that on our website or simply Google Dana Alonzo as well as Suicide as well as I’m sure y'all volition notice it.
In today’s episode, Dana as well as I verbalize nigh engaging folks at hazard for suicide inwards mental wellness services. She starts out past times explaining form of a classic cognitive behavioral perspective for why folks inwards a suicidal crisis mightiness notice it challenging to seek help. We as well as thence sort of flip that around as well as nosotros verbalize nigh some of barriers, the systemic barriers to help-seeking. This includes clinicians’ attitudes towards clients who are suicidal, availability of treatments, preparation of graduate flat professionals, as well as nosotros become on to verbalize nigh some of the things that people tin do to engage folks who are suicidal (or truly anyone who is seeking mental wellness services). So, I promise that y'all truly savor this episode as well as that y'all acquire something out of it, whether you’re working alongside a suicidal customer right now, or not, because, 1 of the things that is truthful nigh mental wellness is that you’ve either worked alongside folks who are suicidal or you’ve non yet worked alongside folks who are suicidal. Now the links to some of the things nosotros verbalize nigh inwards the demonstrate are on socialworkpodcast.com. If y'all desire to follow social operate podcast on Twitter, simply become to @socworkpodcast or the facebook page where y'all tin connect alongside a community of folks over 14,000 potent at facebook.com/swpodcast. One of the ways y'all tin back upward the podcast is past times filling out our survey. If y'all are on iTunes, become on iTunes as well as laissez passer on us a 5-star rating as well as tell us what y'all think nigh the podcast (I mean, hopefully goodness stuff). The to a greater extent than 5-star ratings as well as the to a greater extent than reviews, the easier it is for folks that have got never heard of the podcast, to hear it, as well as hear what nosotros do.
And now, without farther ado, on to Episode 111 of the Social Work Podcast. Engaging people at hazard for suicide: Interview alongside Dr. Dana Alanzo.
Jonathan Singer: Hey at that topographic point podcast listeners, Jonathan here. I am thence excited nigh today’s episode, y'all know, 1 of the things that is most challenging inwards the footing of mental wellness services (that includes verbalize therapy as well as instance administration as well as medication as well as all sorts of things that nosotros have got out at that topographic point to assist folks do amend inwards their lives, 1 of the biggest challenges is engagement. The modal number of sessions that somebody attends is one. That agency if y'all human face at all the sessions that people attend as well as all the people that attend sessions that the most number of people alone attend 1 session. Now, 1 session mightiness live corking if y'all have got a really discreet, slight job that y'all demand a picayune chip of assist alongside to hold going. One session is truly problematic if you’ve got some deep-seated issues that have got been problematic inwards your life for a long time, or, if they’re life-threatening, such every bit inwards the instance of folks who are suicidal.
I’m truly excited nigh today’s guest, Dr. Dana Alonzo, because handling engagement for folks who are suicidal, that’s her wheelhouse; this is her expanse of expertise. One of the things that she learned inwards her enquiry is that clinicians saw that success inwards handling was because of what they were doing, but if the handling wasn’t successful, they blamed it on their clients. Now, this is a huge problem. This agency that clinicians (not all clinicians—obviously I’m non talking nigh you, but, y'all know, maybe your colleagues), that instead of thinking nigh what they tin do to engage this somebody inwards treatment, to hold the handling going, at that topographic point is this mental attitude that, ‘well, if handling goes well, it’s because I’m doing well’ [the therapist] as well as ‘if it doesn’t become well, it’s because my customer did something wrong.’ Now, if you’re suicidal, you’re already thinking that you’re doing things wrong. You’re already thinking that life isn’t working good for you. And if y'all have got a clinician that thinks, ‘Well, if they don’t desire to come upward back, that’s their deal’ as well as thence that is problematic for the customer as well as their likelihood of living, on multiple levels.
So, I wanted to verbalize alongside Dana nigh her operate inwards handling engagement. Now, Dana Alonzo received her Ph.D. from Fordham University’s Graduate School of Social Service, where she was awarded a National Institute of Mental Health Research Training Fellowship. As the Co-Investigator at the Developing Centers for Interventions for the Prevention of Suicide at New York State Psychiatric Institute she conducted studies examining hazard as well as protective factors across cultures related to mood disorders as well as suicidal behavior. She’s been funded past times the American Foundation for Suicide Prevention, the National Alliance for Research on Schizophrenia as well as Depression, as well as a duo of organizations inwards New York State. Her enquiry has focused on the evolution of novel interventions aimed at improving handling engagement as well as adherence amidst suicide attempters. Dr. Alonzo founded the Suicide Prevention Research Program at Fordham University’s Graduate School of Social Service. Dana is the co-author, along alongside Robin Gearing of the Springer text, Suicide assessment as well as treatment: Empirical as well as evidence-based practices. You tin notice that on our website or simply Google Dana Alonzo as well as Suicide as well as I’m sure y'all volition notice it.
In today’s episode, Dana as well as I verbalize nigh engaging folks at hazard for suicide inwards mental wellness services. She starts out past times explaining form of a classic cognitive behavioral perspective for why folks inwards a suicidal crisis mightiness notice it challenging to seek help. We as well as thence sort of flip that around as well as nosotros verbalize nigh some of barriers, the systemic barriers to help-seeking. This includes clinicians’ attitudes towards clients who are suicidal, availability of treatments, preparation of graduate flat professionals, as well as nosotros become on to verbalize nigh some of the things that people tin do to engage folks who are suicidal (or truly anyone who is seeking mental wellness services). So, I promise that y'all truly savor this episode as well as that y'all acquire something out of it, whether you’re working alongside a suicidal customer right now, or not, because, 1 of the things that is truthful nigh mental wellness is that you’ve either worked alongside folks who are suicidal or you’ve non yet worked alongside folks who are suicidal. Now the links to some of the things nosotros verbalize nigh inwards the demonstrate are on socialworkpodcast.com. If y'all desire to follow social operate podcast on Twitter, simply become to @socworkpodcast or the facebook page where y'all tin connect alongside a community of folks over 14,000 potent at facebook.com/swpodcast. One of the ways y'all tin back upward the podcast is past times filling out our survey. If y'all are on iTunes, become on iTunes as well as laissez passer on us a 5-star rating as well as tell us what y'all think nigh the podcast (I mean, hopefully goodness stuff). The to a greater extent than 5-star ratings as well as the to a greater extent than reviews, the easier it is for folks that have got never heard of the podcast, to hear it, as well as hear what nosotros do.
And now, without farther ado, on to Episode 111 of the Social Work Podcast. Engaging people at hazard for suicide: Interview alongside Dr. Dana Alanzo.
Interview
[05:56]Jonathan Singer: Alright. Dana, give thank y'all you thence much for beingness hither on the Social Work Podcast as well as talking alongside us nigh engagement as well as folks at hazard for suicide.
Dana Alonzo: Thanks for having me.
[06:06]
Jonathan Singer: So, y'all as well as I both do suicide prevention research, that’s our area. One of the corking things nigh the in conclusion xx years is seeing that at that topographic point are all of these treatments that have got been developed that have got truly been shown to cut down suicide hazard for folks. But you, it’s thence interesting; y'all focus on this affair that happens right before, right? It addresses this number of engagement. Can y'all verbalize nigh that?
Dana Alonzo: Right, thence 1 of the things nosotros know is that an Evidence Based Practice tin alone live every bit effective every bit the patients who are at that topographic point to have it. And unfortunately for this really highly vulnerable grouping of individuals at hazard for suicide nosotros know that they simply don’t become to mental wellness handling at the charge per unit of measurement that would live helpful to mitigate their risk. And I think at that topographic point are a number of reasons why that is as well as I think 1 affair that enquiry has shown us thence far is that individuals at hazard for suicide tend to engage inwards a serial of cognitive distortions that impact the way that they experience themselves inwards human relationship to others as well as the world. And they tend to translate experiences inwards a negative way. And these kinds of repeated negative experiences over fourth dimension tin Pb to difficulty alongside managing emotion, alongside maintaining interpersonal relationships as well as tend to Pb to a lack of expectation for positive experiences inwards the future. We also know that these kinds of cognitive distortions impact the way individuals at hazard for suicide engage inwards conclusion making processes. So, at that topographic point are several dissimilar stages that are involved inwards making a decision, coming upward alongside an effective solution as well as individuals at hazard for suicide tend to acquire stuck inwards that procedure at a bunch of dissimilar points. The initiatory of all is that it is truly hard for them to topographic point an accurate trigger for their distress. So they’re searching for cues inwards the environment. And because they tend to engage inwards these cognitive distortions that I mentioned earlier, they have got a really hard fourth dimension figuring out what the right trigger is. Alright, thence if they tin overcome that hurdle as well as truly topographic point the right job they tin displace along, as well as and thence they tend to acquire stuck alongside identifying a possible solution. They acquire overwhelmed inwards that procedure as well as either have got problem generating whatever form of solution at all or generate a bunch of solutions as well as and thence acquire stuck trying to figure out which 1 is the best. Or they come upward up alongside a corking solution as well as they seek to position that into activity as well as because they’ve identified the incorrect trigger, what they notice is their endeavour is unsuccessful as well as they can’t resolve their problems as well as this feeds into that whole lack of positive expectations nigh the future.
[08:46]
Jonathan Singer: So at that topographic point all these ways of thinking nigh what’s going on alongside them as well as the people around them that doesn’t gibe reality. And as well as thence there’s this procedure nigh similar “What’s the job as well as how tin I solve it?” as well as it’s truly complicated.
Dana Alonzo: That’s absolutely correct.
[09:04]
Jonathan Singer: So this sounds similar this is all on the suicidal somebody that it’s non nigh our scheme of aid which nosotros know is truly problematic. Where does that all necktie into this?
Dana Alonzo: Right, Absolutely, thence assuming that an private is able to overcome all of those hurdles nosotros simply talked nigh as well as truly create upward one's take away heed that handling mightiness live an selection for them as well as inwards the confront of truly depression expectations for success, they all the same say, I’m going to laissez passer on it a try.
[09:33]
Jonathan Singer: Which is amazing! [chuckles]
Dana Alonzo: Right, Absolutely, right, as well as it happens! Right? And it’s of import to recognize that it’s a truly of import clitoris inwards this grouping of individuals. That they risk, putting themselves out at that topographic point as well as making themselves vulnerable for something that they truly think isn’t going to assist anyway. But, 1 time they acquire to handling what nosotros know is that providers/clinicians, tend to have got a truly potent reaction to individuals presenting alongside suicidal ideation as well as what enquiry shows is that clinicians tend to experience a greater flat of fright working alongside clients who have got suicidality every bit role of their presenting problem. They tend to job their nonverbal demeanour inwards a to a greater extent than negative as well as judgmental way. So fifty-fifty when they’re able to incorporate themselves from making judgmental statements nigh ‘Why would y'all do that? This is, at that topographic point are other ways, we’re going to operate on this as well as figure out amend ways’ Which they think mightiness live supportive, what their nonverbal demeanour is expressing is judgment inwards some way or dislike or disapproval. Research has shown us that clinicians tend to persuasion clients who experience suicidality every bit less likable as well as to a greater extent than blameworthy for their problems. So, combined when y'all think nigh the individuals struggling alongside these problems, they’ve overcome the hurdle of identifying the right trigger. They’ve figured out a bunch of solutions, they’ve tried as well as it didn’t work. They all the same deal to acquire themselves to handling as well as and thence they introduce for handling as well as and thence they notice a clinician who is judging them at best as well as fearful of them at worst.
[11:10]
Jonathan Singer: [Chuckles] That sounds awful.
Dana Alonzo: Right, absolutely. And as well as thence the expectation is that they’ll say “Oh but that’s okay, I’ll hold going.”
[11:19]
Jonathan Singer: After all of these things, the somebody who maybe fifty-fifty similar 4 hours before was thinking ‘I’m going to kill myself’ as well as is at nowadays inwards front end of a clinician, has to as well as thence overcome all of the clinicians' issues, every bit good every bit their own. [chuckles]
Dana Alonzo: Absolutely. And it’s reasonable, actually, that the clinician mightiness experience fearful or mightiness non know what to do when the customer presents this way because the bulk of instantly practitioners are social workers, similar over 65% at this point. So, most probable when someone who is suicidal goes for outpatient handling they’re going to consider a social worker. And most social operate programs don’t supply preparation inwards suicide assessment as well as handling as well as when preparation is provided, the average amount is 2 hours.
[12:04]
Jonathan Singer: Right, which is terrible. So, you’re maxim it’s reasonable to await non because it’s truly okay…
Dana Alonzo: Acceptable, no.
[05:56]
Jonathan Singer: But it’s given that the piteous flat of preparation inwards social work, every bit good every bit psychology as well as other programs, that’s form of where nosotros are, which is problematic. And I know that y'all instruct a class, nosotros won’t acquire into all of that, but you’re doing something actively to address that as well as at that topographic point are another folks around the country.
Dana Alonzo: Right, what’s non reasonable is that nosotros await that the customer says, “Oh good I know that the somebody mightiness non have got received much preparation inwards this as well as thence I’ll conduct alongside it as well as consider if it gets better, right, similar that’s ridiculous.
[12:40]
Jonathan Singer: [chuckles] Yeah, yeah. That is. Okay so, given that there’s non the flat of didactics as well as preparation that at that topographic point needs to be, what do nosotros do?
Dana Alonzo: So, I mean, a duo of things. I think 1 of the things that I’ve tried to pass fourth dimension agreement is from the client’s perspective, what is it that makes a hard for them to engage inwards treatment. So, we’ve heard this form of stuff, “It’s hard to shape a trusting human relationship alongside my clinician because I experience similar they’re judging me or I experience similar they simply don’t sympathise how I arrived at the signal where this was my option.” But I’ve also spent some fourth dimension talking to clinicians who operate alongside high-risk clients as well as identifying from the clinicians perspective, what are the barriers to as well as facilitators of handling engagement of suicidal clients, to see, as well as 1 of the things that’s of import to know, is do our perceptions gibe what our clients’ perceptions are. And oft times nosotros notice that they don’t, as well as we’re making a lot of assumptions. What was most surprising to me nigh this report that I conducted doing in-depth focus groups alongside clinicians who are inwards New York City as well as the Tri State area, working alongside inwards as well as outpatient (large outpatient) mental wellness centers as well as identified every bit working alongside high-risk clients, was that if they felt engaged inwards the process, then, past times default the customer would. It did non acknowledge what the client’s experience mightiness live at all. But when it came to identifying barriers to treatment, customer insight into their disease was the number 1 barrier identified. Right, thence clients are fully responsible for why they don’t engage as well as clinicians are fully responsible when it’s going well.
[14:15]
Jonathan Singer: So, wait; is it reasonable to say that that’s really much similar a ‘Pass the Buck’ response on the role of the clinicians?
Dana Alonzo: Well, to me it sure feels that way. It feels similar the proposition is that I do everything I tin as well as should as well as when it doesn’t become right I don’t demand to human face at myself as well as say do I truly do everything I tin as well as should. Right, because instead, I say, “Well, manifestly it’s because the customer isn’t doing their part.”
[14:39]
Jonathan Singer: Which is especially problematic when you’re talking alongside folks who are ambivalent nigh living inwards the initiatory of all place. [laughter]
Dana Alonzo: Absolutely.
[14:48]
Jonathan Singer: So when y'all said that the social workers felt engaged, what did y'all mean? What do y'all hateful past times engagement?
Dana Alonzo: So I think that’s truly a truly interesting query as well as it was the query that I had for those clinicians. So, ‘Define what it agency when y'all engaged alongside these clients.’ And what I hear varies sure across clinicians, but I acquire a lot of ‘I experience connected to them emotionally inwards some way. I experience similar I tin sympathise their experience inwards some way. I experience similar nosotros have got a connective that’s based on trust where the customer tells me things that they mightiness non experience comfortable telling someone else.’
[15:26]
Jonathan Singer: It sounds a lot similar therapeutic alliance, rapport, as well as those sorts of things. Is that right?
Dana Alonzo: Absolutely. When I think of engagement, as well as I think of my operate I’ve done inwards interventions as well as how I mensurate engagement. I’m interested inwards to a greater extent than than simply the form of physical presence inwards the room. Right, that’s 1 piece, is y'all have got to live at that topographic point to live engaged. So, ‘Do y'all demonstrate upward for your initiatory of all session? How many sessions do y'all demonstrate upward for afterwards?’ But the psychological ingredient every bit well. Right, as well as thence ‘How connected to your worker do y'all feel?’ on the flipside. ‘How satisfied are y'all alongside the aid that you’re receiving?’ ‘How good do y'all experience similar the aid that you’re getting is moving y'all towards your goals?’
[16:01]
Jonathan Singer: Okay thence you’ve developed an intervention that addresses this number of engagement. So, what do y'all do inwards the intervention?
Dana Alonzo: Let me initiatory of all tell y'all a picayune chip nigh where the intervention came from. And 1 of things y'all tin imagine is that oft times the clinicians’ perceptions nigh the flat of engagement vary greatly from the clients, right? And this is something that I looked at early on, as well as did some enquiry inwards a large urban psychiatric emergency room inwards New York City. And spoke alongside people who were presenting at the Emergency Room for either severe suicidal ideation or post-suicide attempt. And nosotros talked nigh issues related to mental wellness handling utilization as well as their experience inwards the emergency room as well as the likelihood that they were going to follow upward alongside the handling that had been recommended. One of the things that I would hear fourth dimension as well as fourth dimension over again from patients is that, how depersonalized the experience of seeking assist was for them as well as that piece clinicians mightiness think that they’re doing a truly goodness project alongside call for all of the questions they demand to enquire to do an accurate hazard assessment, right like, ‘Are y'all having suicidal thoughts; Do y'all have got a plan? How oft do y'all have got these thoughts? How long do they last?’ right as well as the whole checklist of things thence that they tin walk away feeling similar ‘Great, nosotros had a corking conversation, I have got a clear sense that this somebody is at hazard or non at hazard as well as my project here, my operate hither is done.’ What clients were feeling, at to the lowest degree inwards the emergency room was ‘They’re simply call for me the same questions they enquire everybody else as well as I am non a somebody to this worker.”
[17:35]
Jonathan Singer: Right, the worker is trying to depository fiscal establishment check off boxes as well as say, ‘We’ve established a flat of risk, at nowadays nosotros tin sort of transcend along this somebody to the adjacent somebody or something similar that.’
Dana Alonzo: Exactly. And as well as thence non alone did the Dr. do that, but as well as thence the nurse did that, as well as and thence the resident did that as well as and thence the resident came dorsum alongside their attending as well as they did that over again together as well as thence right? Multiple interactions that were never meaningful every bit far every bit the customer was concerned. [These findings] were the most of import affair from the clinicians’ perspective. So, there’s this mismatch here. The other affair that learned from the emergency room when I was doing the study, is that at that topographic point is this perception that, at to the lowest degree when I was doing the study, that ER’s tend to live the initiatory of all signal of contact for individuals at hazard of suicide. That they tend to live out inwards the community, non utilizing services as well as they destination upward inwards a suicidal crisis as well as become to an emergency room as well as finally acquire assist that way. The bulk of individuals inwards my report had truly attempted to start outpatient handling inwards the twelvemonth prior to the ER visit. Something happened inwards that outpatient experience that was non satisfying for them or didn’t operate for them as well as they dropped out. Then they were inwards the community, struggling, non knowing what to do. Having all those things inwards the beginning, having a hard fourth dimension figuring out what their trigger is. ‘What else should I do? I’ve already tried handling as well as of course of report it doesn’t operate for me’ as well as these lack of positive expectations as well as thence they don’t’ become back, right, as well as at nowadays they destination upward inwards the community as well as truly do have got nowhere else to go, as well as and thence they destination upward inwards the ER.
[19:05]
Jonathan Singer: Got it, thence they went through that problem-solving affair y'all were talking nigh inwards the beginning.
Dana Alonzo: Exactly.
[19:09]
Jonathan Singer: And they couldn’t successfully resolve it as well as thence as well as thence they found themselves inwards the ER.
Dana Alonzo: Exactly, as well as thence 1 of the things nosotros realized was nosotros have got an chance to non alone cut down the over-reliance on emergency rooms which nosotros had been seeing increasing inwards this population, but also unnecessary inpatient psychiatric hospitalizations, which tend to live the default discharge manner from an emergency room every bit presently every bit the discussion ‘suicide’ is said. Right thence ‘Oh, they’re hither for suicide, we’ll simply transportation them to the inpatient psych unit’ as well as inpatient psychiatric infirmary stays are non alone financially burdensome but tin live psychologically burdensome as well as tin live extremely lamentable as well as when hazard is non at a flat that truly needs that, what it does is transportation a message to the customer ‘Don’t tell anyone you’re having these thoughts because you’re going to have got to destination upward admitted to the hospital,’ right?
[20:02]
Jonathan Singer: Yeah as well as I know that inwards my enquiry alongside kids, 1 of the things that’s come upward up is that kids who were truly at depression hazard as well as maybe hadn’t truly thought a lot nigh suicide found themselves inwards a unopen environs alongside kids that knew a lot nigh suicide.
Dana Alonzo: Right.
[20:19]
Jonathan Singer: And thence at that topographic point was truly this transition of knowledge around suicide hazard that position these low-risk kids at higher risk.
Dana Alonzo: Right, absolutely. And as well as thence y'all notice that the charge per unit of measurement of engagement inwards handling next discharge from an inpatient unit of measurement for suicidality is extremely low. Right, non surprisingly, right? Oftentimes that inpatient hospitalization could have got been avoided as well as people were simply sent that message, ‘Don’t verbalize nigh this, right, you’re simply going to destination upward right dorsum there.’ So enquiry shows something similar inside 3 months of an inpatient infirmary remain for suicidality, 38 pct of individuals volition no longer live inwards treatment. Right, as well as 3 months is the highest hazard catamenia for repeat attempts, thence most people who are at corking hazard are non getting the needed handling as well as that’s a problem, right? So, from that report I developed an intervention during intake appointments at an outpatient mental wellness clinic to assist bolster the engagement inwards handling inwards outpatient mental wellness services.
[21:18]
Jonathan Singer: As you’re talking nigh this, I’m getting this moving-picture demonstrate of a bunch of picayune circles as well as similar an arrow, right? It’s this idea, okay thence y'all have got 1 circle is folks inwards the community, right, folks who are suicidal. And as well as thence you’ve got the providers inwards the community, there’s this interaction alongside them that doesn’t work. And as well as thence fourth dimension goes on as well as the suicidal customer moves out of the outpatient circle, as well as and thence they’re simply form of floating as well as and thence there’s the inpatient circle. ER/inpatient, they float into that as well as it’s all along this timeline, as well as I know that this materials isn’t linear, it makes it easier to clitoris but it’s non just linear. Is that your conceptualization of how this works? And if so, where does your intervention come upward in?
Dana Alonzo: So, I’ve spent a lot of fourth dimension trying to sympathise the suicide prevention procedure every bit it looks currently, or has looked traditionally rather. What y'all tend to consider is a lot of enquiry inwards the expanse of hazard assessment. We’ve developed a lot of standardized measures that have got at nowadays shown to live valid as well as reliable for assessing for diverse characteristics of suicide risk, similar either marking of ideation, or marking of intent, or fifty-fifty reasons for living, or want to live, want to die. Influenza A virus subtype H5N1 lot of enquiry around this. We also have got seen every bit y'all mentioned before on, the evolution of evidence-based practices to address suicidal demeanour as well as thence there’s a large chunk of enquiry inwards the land of suicidology focused on intervention evolution for addressing suicidal behavior. And as well as thence there’s a lot of enquiry that looks at disposition planning, things nosotros tin do when people are beingness discharged from aid to equip them alongside skills to assist them cut down hazard of suicide, similar security planning, for example. Like a concrete tool that nosotros tin supply to assist the customer conceptualize what they tin do when they’re inwards a crisis to avoid acting on suicidal behavior. But nowhere inwards that procedure is at that topographic point a existent recognition of the fact that clients are non utilizing services. And thence if they don’t go, y'all can’t do a corking hazard assessment as well as y'all can’t supply an evidence-based practice. Or if they demonstrate upward inwards the emergency room y'all tin do a corking hazard assessment as well as and thence y'all lose them on the handling destination as well as y'all can’t supply the practice. So somewhere they’re getting lost as well as that’s where I ended upward alongside the handling engagement piece, because what I recognize is that despite advancements inwards psychopharmacological treatments for the disorders most oft associated alongside suicide similar depression as well as bipolar disorder; despite the evolution of all these novel EBPs to address suicidal demeanour as well as lots of coin beingness poured into world awareness campaigns to convey the number of suicide out to Earth as well as seek to cut down stigma. In NY for example, inwards Washington Heights, on the sides of busses you’ll consider inwards Castilian you’ll consider ‘Estás deprimido?” Right “Are y'all Depressed? Are y'all having thoughts of suicide.” [There are] Lots of things to convey awareness of suicide to the community. And we’ve had really picayune success inwards reducing the suicide charge per unit of measurement inwards the United States, inwards fact it’s increased now. So we’ve had all these corking advancements as well as no impact as well as for me the response is we’re non getting the people who demand the results of our gained knowledge to the treatments, right, thence that’s where my focus on handling engagement comes in. And it form of shifts the suicide prevention procedure a picayune chip to pay attending to this before stage.
[24:48]
Jonathan Singer: So tell us nigh this engagement intervention. What are y'all doing to address this huge gap inwards the prevention timeline enquiry framework?
Dana Alonzo: Sure. In the intervention, there’s a combination of brief motivational interviewing as well as personalized feedback on an individualized hazard assessment that was developed for the intervention that consists of evidence-based hazard as well as protective factors for suicide.
[25:18]
Jonathan Singer: Okay thence brief motivational interviewing as well as personalized feedback, what does that truly human face similar inwards the room?
Dana Alonzo: Right, absolutely. So, if y'all imagine our suicidal customer coming inwards alongside that combination of cognitive distortions, as well as depression expectations as well as depression motivation as well as uncertain nigh whether this is truly going to truly live effective for them, 1 of the initiatory of all things that the intervention does is engage the customer inwards a conversation nigh what have got prior handling experiences been similar for you. Right? That way I have got a sense every bit the clinician, of what industrial plant for this somebody as well as what didn’t work. Because I desire to sure brand sure that I don’t do those things again, right? We as well as thence verbalize nigh ‘What are your expectations for handling this time? You’ve had these experiences inwards the past. They weren’t thence corking for y'all or they worked as well as thence but at nowadays whatever y'all learned as well as thence is no longer helpful. What are y'all hoping to exit of handling now?’ And then, nosotros displace to the personalized hazard assessment portion of the intervention as well as the suicide hazard profile is, every bit I mentioned, a listing of known hazard factors as well as protective factors related to suicidal behavior. And the clinician as well as the customer engage inwards a conversation nigh which of these factors are introduce inwards the client’s life. Right, it truly individualizes the procedure of hazard assessment because no one, no 2 people are going to have got the same hazard profile. And, fifty-fifty if the same factors are present, they’re non going to live affecting the private inwards the same way. So the private truly has the chance to tell their story. You know, this truly resonates alongside me, this thought of social isolation as well as here’s why as well as they have got their chance to explicate their province of affairs to the clinician. And the hazard factors are presented non inwards the way that, ‘Wow, y'all encounter 13 of seventeen hazard factors, you’re doomed to engage inwards suicide.’
[27:02]
Jonathan Singer: That’s truly bad! [Chuckles]
Dana Alonzo: Right, exactly! The conversation is ever linked to as well as how handling tin mitigate that risk. Right, thence ‘here’s something you’ve been struggling with. You’ve tried on your ain to figure out what to do nigh it as well as it hasn’t worked thence well. Let’s verbalize nigh how handling tin assist y'all address this factor. So, if y'all were to truly become to your appointments, this is the way that this hazard factor would live addressed.’ And as well as thence at the destination of the hazard profile, the customer as well as the clinician would engage inwards a conversation nigh ‘So what are your thoughts nigh handling now? Has it changed it all at nowadays that you’ve thought about, you’ve seen the constellation of hazard factors that are introduce as well as have got thought as well as have got had a run a hazard to hear how handling tin live helpful at addressing these issues that you’re struggling with? Does it alter at all your ideas nigh how of import handling is for y'all as well as how probable y'all are to attend your sessions?’ Right, as well as and thence they verbalize over ‘When would live a goodness fourth dimension to select this hazard profile out? Alright, you’re going to acquire a re-create of it moving forward, when mightiness y'all select it out?’ And during those times when y'all experience similar ‘I simply don’t desire to become to session today, I simply can’t acquire it together’ or ‘You know my clinician did something in conclusion calendar week that I truly didn’t appreciate, said something that was hurtful or didn’t seem to acquire what I was trying to say as well as it was truly frustrating. I’m non going to bother.’ Those are the times that you’re going to desire to select out the hazard profile as well as retrieve how of import handling was for y'all inwards this 2d as well as job it to at to the lowest degree telephone outcry upward your clinician as well as say, ‘This is what I’m feeling as well as I’m non fifty-fifty wanting to come upward inwards today,’ as well as laissez passer on them an chance to verbalize nigh that alongside you.
[28:34]
Jonathan Singer: So, it’s interesting because you’re talking nigh the hazard profile which I think most of us think nigh truly every bit this should I hospitalize, y'all know all that sort of stuff, but you’re truly talking nigh it every bit a tool for motivating the somebody to engage, re-engage, address this to remain participating inwards this process.
Dana Alonzo: Right, as well as thence it’s non a tool for assessing the flat of risk, low/moderate/severe. It’s non the standard, y'all know, ‘How oft do y'all think nigh it as well as for how long,’ as well as does this somebody have got the capacity to act. It’s truly an assessment of---the individuals's-if y'all think nigh it from a social operate perspective as well as doing an ecomap---what are the resources that the customer has both internal as well as external to assist acquire them through a suicidal crisis as well as does the private consider how handling tin live helpful at addressing each of those things. And the goal is non to destination upward alongside an thought of how potent their hazard is but how of import handling is.
[29:37]
Jonathan Singer: I dear the visual of an ecomap because y'all have got the client, as well as y'all have got these, as well as over again I dear circles, clearly. You have got all these circles surrounding the customer as well as it’s like, ‘So this is your connective to this scheme or this system, y'all know operate as well as handling as well as medication as well as whatever it all is. It’s similar what is your human relationship to those, as well as instead of beingness like, ‘Well that’s non going to happen’ it’s like, ‘Let’s verbalize nigh what y'all would do goodness from, how could y'all do this again?’
Dana Alonzo: Or what systems are missing, or which are underutilized or which are non fifty-fifty recognized every bit of import or every bit a resources that could truly live utilized. And as well as thence the in conclusion slice of the intervention taking from what nosotros learned nigh what seemed to mayhap live effective inwards prior studies is there’s a follow-up telephone contact alongside the client. Very brief, maintaining the spirit of motivational interviewing again, to enquire the customer ‘Are y'all attending your sessions?’ If yes, ‘How’d y'all do that, do to a greater extent than of it.’ Right? And if y'all do that, as well as if not, it’s non a telephone outcry upward where you’re going to job solve barriers as well as solve these problems alongside the customer but ‘Do y'all think y'all tin telephone outcry upward your clinician as well as allow them know what’s been getting inwards the way as well as laissez passer on them an chance to assist verbalize y'all through that as well as acquire y'all dorsum inwards treatment.’ Because the goal, again, is non to cut down the suicidal behavior, it’s to acquire the customer to the handling that volition do that. So it’s constantly making that connective to the importance of handling as well as trying to back upward the engagement inwards services.
[31:04]
Jonathan Singer: I appreciate y'all talking nigh this alongside regards to suicidal folks as well as where all this fits into the suicide prevention framework. In your enquiry as well as inwards your clinical experience are at that topographic point things that y'all have got learned nigh engagement inwards full general as well as engaging clients that y'all think are simply goodness full general tips for folks to select away, whether or non their customer is suicidal?
Dana Alonzo: Yeah, absolutely, I think initiatory of all as well as foremost, the thought of the depository fiscal establishment check inwards alongside your customer is something that I think oft forgotten. I think there’s an supposition that if I experience similar this is working, as well as thence it’s in all likelihood working as well as oft times that’s non true.
[31:46] Jonathan Singer: And thence what does a depository fiscal establishment check inwards human face like? If I’m a client, what would y'all do to depository fiscal establishment check inwards alongside me?
Dana Alonzo: I think truly session past times session feedback is extremely important. I wouldn’t allow a calendar week become past times without maxim to my customer at the destination of the session: ‘How was this for you? What stands out for y'all today? Is at that topographic point anything on your take away heed that I didn’t acquire to? Is at that topographic point anything y'all experience similar you’re beingness left alongside that nosotros demand to address before y'all leave of absence today?’ It tin live every bit uncomplicated every bit that.
[32:13]
Jonathan Singer: I think session past times session is great, absolutely. Is at that topographic point anything else?
Dana Alonzo: I think that it’s truly of import to acknowledge when the customer has shared alongside y'all something that isn’t working for them or hasn’t worked alongside them that you’re mindful of that as well as attentive to it. Right? Because there’s a argue as well as if the customer has taken the hazard to part alongside y'all that this hasn’t worked as well as this isn’t working as well as and thence it’s of import to sympathise why as well as brand sure y'all don’t hold doing that. So, using that feedback inwards a meaningful way.
[32:46]
Jonathan Singer: There have got been times where I’ve been inwards therapy, every bit the client, as well as I’ve said ‘You know it doesn’t truly operate for me when people concord alongside me a lot. I get, a lot of people concord alongside me inwards my life. I demand somebody to challenge me or to telephone outcry upward bullshit on what I’m doing, right? And as well as thence the therapist simply continues to concord alongside me. It’s thence disconnecting, right?
Dana Alonzo: Absolutely, it’s non feedback for the sake of feedback. It’s non ‘I at nowadays laissez passer on y'all the opportunity’ as well as thence you’ve shared thence I’ve done my job, but what do y'all do alongside what y'all hear? And y'all truly have got to live willing to hear it as well as and thence do something nigh it.
[33:27]
Jonathan Singer: Yeah
Dana Alonzo: Yeah
[33:29]
Jonathan Singer: So these all sound similar things that are pretty accessible, right, thence if you’ve been trained as well as lots of folks have got been trained inwards motivational interviewing, they know the basic concepts, right? And fifty-fifty if folks haven’t gotten a lot of corking preparation on suicide hazard assessment—this thought of hazard as well as protective factors is something that nosotros verbalize about. And thence if people wanted to acquire trained inwards your specific intervention, where would they go? How would they do that?
Dana Alonzo: The intervention has been manualized as well as nosotros have got some corking information inwards price of feasibility as well as acceptability as well as are working on effectiveness enquiry right now. So anyone interested tin contact me for to a greater extent than information.
[34:10]
Jonathan Singer: That’s great. Dana, give thank y'all you thence much for sharing alongside us nigh your enquiry as well as nigh the thoughts nigh engagement, especially alongside folks who are suicidal, I truly appreciate y'all taking the time.
Dana Alonzo: Well, this is absolutely terrible. Jonathan Singer: [Laughter]
Dana Alonzo: [Laughter]
[34:25]
Jonathan Singer: That was totally disconnecting as well as I experience unengaged completely.
Dana Alonzo: [Laughter]
Jonathan Singer: [Laughter]
Dana Alonzo: And cut? What?
[34:35]
Jonathan Singer: And…cut.
Transcription generously donated by: Kendra Wagener, MSW, AAS Certified Crisis Counselor, Forensic Specialist
References as well as Resources
- Alonzo, D., & Gearing, R. E. (2017). Suicide assessment as well as treatment, 2d edition: Empirical as well as evidence-based practices (2 edition). New York, NY: Springer Publishing Company.
- Alonzo, D., Stanley, B. (2013). Influenza A virus subtype H5N1 novel intervention for handling of suicidal individuals. Psychiatric Services. 64, 494. doi: 10.1176/appi.ps.640105
- Suicide Prevention Resource Program: https://www.fordham.edu/info/24281/full-time_faculty_profiles/8748/suicide_prevention_research_program
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