Transcript
Neil.
Tim is a certified athlete trainer with a NATA hall of famer.
He is He's a director of athletic training program and assistant professor Concordia.
Spent 35 years as a clinical athletic trainer and adjunct professor, Mister Niles's chair, the NATA sponsor, an association consensus statement on psychological concerns and the students athletes.
He's also served as a writing group for the NAT position statement and pre participation physical exam.
In medical qualifying conditions.
He is also a member of the NACA NCAA task some student athlete mental health and wellness, sleep and wellness is served over the 2010 panel on managing concussions.
This is Brienneille was also a chair of the NA team committee on professional ethics from 5 2015 to 2019 and offered the update of the NA code of ethics.
Scott is master's degree from Syracuse University.
It's Bachelor's from Ohio University, and as a member of the Ohio University alumni and Mister Neal had the or while ago, you're working on your master's again.
Is that correct?
Yes.
I'm I'm the oldest intern in my agency at University of Michigan at 866
Wow.
Finishing up my master's degree in social work.
To attic to attic counseling credential.
So going back in being a student is a it's a new game.
Right?
A lot different than it was 42 years ago when I got my full dentures.
Well, I'm married for that.
And and love this topic and love what's been discussed today.
So go ahead and bring us through the the next round.
Okay?
My share screen.
Yes, sir.
I'm just getting the host.
Okay?
Okay.
Thank you again for asking me to participate in this.
I listened to Woody's presentation.
I thought it was fantastic.
He brings a lot of practical experience and some really great information to the to the audience relative to these psychiatric emergencies.
And I guess the probably the the ultimate and psychiatric issues is suicide and suicide ideology.
And what I wanna do is walk you through some things that the athletic trainers should be considered of when working with people.
I've worked with numerous athletes who had suicide ideology, suicide attempts, as well as other acquaintances and friends of my personal life I came across some people who had suicide attempts at the VA hospital.
So I have some familiarity with this.
But I don't think you ever have enough information and consideration in this very troubling topic for not only athletics, but society at large.
I have no conflicts of interest to report.
And again, my views are my own.
Our learning objectives today would be used to discuss the prevalence of suicide, discuss the importance of identifying suicide ideology, The review of the Columbia Suicide Severity Rating Scale, which many of you may not be familiar with, but that is the basic gut tool and instrument we use in counseling to evaluate clients with every session.
Discuss privacy and confidentiality issues, and discuss immediate and follow-up steps.
Again, I'm gonna give you a trigger warning.
I do a lot of talks on many sensitive subjects, so I've learned over the years to put in a trigger warning.
Does discuss suicide suicide ideology, and it can be disturbing for some members of the audience.
If you feel uncomfortable with this presentation, please feel free to drop out.
And if you're troubled by this, please seek the assistance of a mental health care professional.
And as I talked about a little bit about the first talk is as an athletic trainer, I probably recognized referred hundreds of athletes into mental health care.
And as Woody brought up earlier in his fine presentation, I never once acted as a as a counselor or someone who's providing psychological psychotherapy services to an athlete, few years ago thinking about it.
My wife was an RN, kind of nudge me in that direction.
She said, You're great with people.
You have great insight.
You recognize these things.
Go ahead and and do what you need to do to become a counselor, which 75% of most counseling sessions are performed in this country by social workers with master's degrees.
And that's where I I went down that path.
I'll be finishing up.
There'll be 62 graduate hours with a lot of clinical experience.
In that area.
It's been very rewarding, and I'm looking forward to adding that that that new element to what I'm already doing as a professor.
We are aware of so many people in our lives or in athletics that have taken their lives or have attempted to take their lives.
You you know the story of Katie Meyer from Stanford.
Many years ago, Owen Thomas, who was the captain of the football team, University of Pennsylvania, both seemingly very successful and very happy, very intelligent, very attractive, people that everybody thought had the whole world refer them And, unfortunately, the end of their lives because of suicide ideology and of things that in their lives that cannot control.
When you read obituaries now, I just was looking through the paper the other day, and you're seeing more and more people coming out, talking about how Joe Smith lost his life to his mental illness.
So it's becoming more and more in the mainstream.
We're trying to reduce the stigma of mental health And I think that's an important element because people hiding in the shadows, people who are not able to fully express that kind of pain they're in, they're looking for some way out.
And if it isn't through support, isn't through psychological services, that off ramp for them sometimes is an attempt to kill himself.
Suicide data Again, the race for people in this ten to twenty four year age group had increased over the years, over these these past several years.
For people in the United States, aged 20 to 24, which a lot of us work with, the suicide rate also increased over a 6 year period.
Approximately 800,000 lives or losses size to suicide each year worldwide.
I think that number in reality is probably double that.
Some people have accidents or you think they're accidents or they're drownings where people actually went out.
They didn't drown by accident.
They drowned they drowned themselves as a form of suicide.
One car accidents that's get into a tree when all the road conditions are normal, people are thinking of suicide.
A lot of the people who die of overdoses of fentanyl and other things, sometimes they're accidental overdoses.
They're actual suicide.
Females are aged 10 to 19 or more likely to have a suicide ideation and a temp suicide.
However, Males in that same age group are more likely to die of suicide.
More disturbingly, there are 19% of high students report seriously considering suicide.
9% of high school students attempt suicide.
High school gay and bisexual teens attempted suicide.
You have a higher rate of 11% of all black teens.
Think about this or a temp suicide.
So the thoughts and the attempts are out there.
People are unless you're personally involved in them.
It's like something that's in the abstract.
What in fact, it is is very prevalent.
One of the things that you learn in counseling is just because you've never seen mental health problems or you've never seen someone thinking about suicide, does it mean that that person have not seen you?
So it's much more prevalent than we would appreciate.
Suicide ideation, Thoughts of engaging in suicide related behavior.
That's what it is.
Suicide ideation is to the mind what the physical pain is to the body.
It is a relentless ongoing mental and emotional signal that something is wrong.
There's there's something known as a suicide misery index It's a three step theory of the suicide suicidal suffering and thoughts of anyone's life.
Usually, it's a combination of pain and hopelessness, You're in mental pain, emotional pain, you feel hopeless.
I think really what's really key that I recognized early on in my half, like, training career.
I look for now and people like council, and I look for students that I engage in on a daily basis and our our health professions building here.
Liz, who is your support group?
Who do you talk to?
It's really, I think, very key for people to understand this concept.
Support doesn't mean when you're having a bad time.
Support is also who do I share good news with.
We know that loneliness is one of the key factors in shorting people's lives.
And loneliness is can be defined many different ways.
But, again, it is, who do I turn to?
When something good or bad is happening to me.
And I come home or I'm by myself and I can't express to someone something good happened today.
Or something's really troubling me, or I had a bad day, and that's what event.
And there's nobody there.
That is a major stressor on someone's psychological well-being.
What you end up doing is you're progressing the idea of a suicide to making a suicide attempt.
And in between that period is where we are operating in terms of what's your plan, what's your intention, what have you done to do this, which we will go through.
I think it's really important for people to grasp this concept by mental health America.
NATA liaison to this group, and they have a tremendous philosophy, which is the before stage 4 theory.
We want to try to capture mental health early.
So when you equate it to like stage 4 cancer, it's very ominous diagnosis, survival rate goes down.
So the same thing occurs in terms of mental health.
In stage 1, you have mild symptoms or warning signs of mental health problems.
Stage 2, the symptoms increase in frequency and severity interfere with activities enrolls.
Stage 3, things are starting to get a lot more worse, and you have been relapsing episodes of mental health crises.
People that that Woody, for example, sees when things are tumbling further and further downward.
And then lastly, at all, on stage 4, symptoms are persistent, severe, and have jeopardized one's life.
Now you're at the end of of things.
You look helpless.
You look hopeless.
You think it's permanent.
And the only way to end your suffering and your pain is to end your life.
So I would encourage people to go to mental health America.
They have great information not only just on this, but other elements of mental health in the United States.
Aphleck trainers are gatekeepers to stopping suicide.
In addition to all the other things we gotta do is athletic trainers, I believe that our role is not just to deal with an injury.
Our role is to take care of someone's loved one.
It could be someone, someone's son, daughter.
For people in professional ranks, it could be someone's wife or someone's husband who plays in it professionally.
We should be dedicating ourselves in learning and in our clinical experiences and practices.
To learn to keep that always front and center.
And our jobs can become overwhelming at times whenever the push and pull, your time schedules, unreal expectations of athletes and coaches and everyone else.
But keeping that in the main focus, I think, really helps us provide holistic care, and this includes the gatekeeper to suicide ideology.
We are in positions to observe others and to take life saving action.
If we were to sell someone collapse, we go get our AED.
If we saw someone stung by a b and they started having shortness of breath, anaphylactic warning signs, we get an EpiPen, for example.
You would identify external expressions of mental pain.
I think One of the things that Woody talked about is really good presentation was the fact that people are traumatized.
There are darn few people that have not been traumatized one way or other in their lives.
You have male adaptive parental styles.
You have people who have been bullied in school.
You have people who are bullied because they're sexual identity, their orientation, the way they look, and every which way you can you can imagine people have been traumatized.
They can be traumatized sexually.
So you have to understand that most people are struggling with some form of trauma in their life.
And how well they manage it is what helps leads them to to living a more fulfilled life.
I think we need to show compassion to people.
I think it's really important that it's a hard thing to do is to have different sides of you.
So when people ask me to describe myself, I'm a little bit like a chameleon because I can be really intense about what I wanna do as an athletic trainer.
I can be intense as a professor about the kind of standards we want our students to have.
But as a counselor, I'm a totally different person.
Totally different person.
My old wife of 44 years that wouldn't even recognize me.
I'm a different type of person in terms of showing empathy and being quiet, listening, and trying to give perspective to people as they try to go through their journey of mental wellness.
You wanna ask clarifying questions regarding the individual state of mind, and most importantly, you wanna know what your referral mechanisms are.
Your approach to the person that may have a suicide ideology, you're getting hints, you're you're seeing things, you're hearing things, secondhand, thirdhand, that's a time to go and approach this person.
I think you wanna inquire the person about how they're doing.
And what I've always found is the best way is to ask someone an open ended description.
Describe for me how life's going for you.
Describe how you're coping with all these various stressors and you can list for them.
Who is your support unit?
I talked about that briefly before.
Is it your parents?
Is it your girlfriend?
Is it your boyfriend?
Is it your roommate?
Is it your teammate?
Who is it?
And how available are they to you?
One of the things that I try to train people in doing is, whenever you're talking to somebody, I don't ask somebody, how are you?
They always say, oh, I'm fine, you know, and they're thinking about all these dark thoughts.
And I do have my own wife.
So when she comes home every day, she's an RN case manager here in in Harbor, in a in a in a practice.
I ask her when she comes home, describe how your day is going.
That way I can engage with her, I can get her voice intonation, I can see her body language, whether it was a good day, a stressful day, a challenging day, a funny thing happened with a patient today.
That way and I stay with her, I'm listening to her.
I'm not looking at my phone.
I'm not looking over her shoulder at the TV.
I'm engaged with her.
And even though it takes a lot of discipline of practice, to do it all day long.
I strongly encourage people to do that.
You would express a concern for them as a person and not as athlete And once they start to get an expression or you get the impression that suicide ideology is present, That's the time to start your evaluation.
And that evaluation is usually by the Columbia Suicide Severity Rating Scale.
You can go online.
You can get these these cards.
You can laminate them.
I would study them for familiarity.
These help and this is from a psychometric standpoint from in terms of research, We do a lot of research in my master's degree social work program when you're looking at efficacy of different kinds of theories and approaches.
The Columbia Suicide severity rating scale, psychometrically, is one of the most sound suicide screenings that you can utilize and this is that's used ubiquitously throughout counseling and and social work practice.
This is what I would do every time I do counseling.
So I have 2 clients this afternoon.
I will not specifically ask for these.
However, if I get an inkling, and they're talking to me how their life's going, I will go down those to make sure we're clear about any form of suicide ideology that the client may have.
So let's walk our way through the key elements of this.
First of and they're all excuse me, graded by color.
So yellow means caution, orange is more awareness and red is an alert.
So the first question is, you're talking with somebody and you're saying offhand, I just wish I was dead or I you know, if I was dead, this would end all this stuff, So you just don't dismiss that.
You asked them, so in the past month, have you ever wished you were dead?
Or you can go to sleep and not wake up and you just ask them directly that and you stay silent.
And let them tell you.
Now I've had this with with several clients because, no, I don't wanna die.
So I'm just so I'm just so upset and p o ed about this and the other thing.
You know, I just I just made her off hand comment.
I still will continue all with some of my questions.
So the second question would be, have you actually had any thoughts about killing yourself?
So some woman say, I've had thoughts about killing myself.
So you asked them, what is brought on these thoughts?
So what they would acute warning signs would be a sudden or chronic stressor.
They feel hopeless.
A lot of were relationship issues.
Some may be a job issue, some may be a housing issue, some may be a traumatic issue, some may be an abuse issue.
So you go down you go down this thing, and what you look for is what are chronic and unmodifiable risk factors, so what this person's had.
So you'd understand what's going on with your athletes or your friends or loved ones.
So are they involved in a mental health disorder right now?
So the athletes I've been referring to mental health care as an athlete trader.
I didn't know what was being discussed, but it did have an awareness who who was going to counseling.
So whatever they had an episode when they acted out, I would talk with them.
I'm gonna get a gauge about where they are and whether they need to go back to counseling that day or go to a emergent circumstance.
We do know that older men have a higher rate of suicide.
So we look at gender, we look at age, we look at prior suicide attempts.
One of the key elements of depression in men, middle aged and older men is anger.
They're quick to anger.
It's hard for them to come back from anger.
They hold grudges, etcetera, etcetera.
Those are signs of depression and potential suicide ideology.
People with substance abuse.
They have guilt and shame about things they've done.
They have sudden mood changes.
They may be a victim of bullying.
Not just as a middle school or high school, people, you know, in different settings can be bullied by their families, etcetera.
And they have a family history of suicide.
What we also look for when we talk about water protective factors for them, Would you have support, friends, and family?
The religious beliefs, I work with clients whose religion for bids suicide.
And they will tell me, nope.
I would never kill myself because it's against my my faith.
They have a sense of purpose.
What am I gonna do with my life?
They're future oriented.
They they have strong support network.
They believe that there would be a negative impact of their suicide on their friends and families.
However, if you do get a yes, then yes, I am thinking about killing myself, and you have chronic and unmodifiable risks and they have very little protective factors, you want to continue down that pathway.
And the next one you wanna ask about them, have you been thinking about how you might kill yourself?
Just come straight out and ask them.
They'll say hurt yourself, hurt suicide killing yourself.
And how would you do it?
What are your plans?
And that's where the real middle ground happens.
In terms of intent and planning.
If I'm really in if I'm intentionally wanting to have a really good dinner for example, I'm gonna plan out, like, my wife gets late home on on most days, so I make dinner.
So tonight, we're gonna have marinated chicken breasts.
I'm gonna make her a special kind of mashed potatoes, and she really likes peas.
That's her favorite vegetables.
So I'm gonna make all that up.
And maybe think about a dessert that she likes.
So that's an example.
I'm intending to having a good dinner and here are my plans.
So someone who's thinking about really killing themselves, they're gonna tell you what they think they might do.
They may shoot themselves.
They may jump off a building.
They may try to hang themselves.
They may try to walk out in front of a bus.
They walk out in front of a train.
So then now your your heightened state of awareness is even greater.
So you have greater concern because now now they are making plans.
Have you ever had any thoughts and had some intention of acting on them?
So now they have Thoughts, plans.
Now what is your intentions on acting on these suicidal thoughts?
What are you really is your intention?
Do you really mean to tell me that you're gonna climb to the top of that 9 story building that garage over there and jump off?
And kill yourself.
Is that what you're is that what you're telling me?
When you ask someone directly, sometimes they will hesitate and say, no.
I don't really mean that.
And just, you know, they don't really intend to kill themselves.
If they say sound or say, yep, they'll now the alarm bells are going off.
So next, you wanna do have you started to work out or work or worked on details of how to kill yourself.
Did you intend to carry out this plan?
Have you started to work out?
Have you worked out the details of how to kill yourself?
Yes.
I'm gonna go across the street.
I'm gonna go I'm gonna walk up the stairs.
I'm gonna take the elevator, and I'm gonna jump off.
Or I have a rope.
I'm gonna go over to the hardware store.
I'm gonna give a rope.
I'm gonna hang myself.
So now everything's really high at this point.
Have you done anything or started to do anything or prepared to do anything to end your life?
Have you done anything or started to do anything or prepared to do anything?
Dan your life such as have you collected pills?
Have you rushed to be held and done and tried to shoot yourself?
Have you tried to hang yourself and inform?
Are you cutting yourself?
And I'm not talking about there's there's some disorders where you cut yourself to alleviate anxiety, for example.
But when you're cutting, arteries and veins, then it's a different different set of circumstances.
Have you gone to the roof, but you did not jump?
Are you giving away your possessions?
Have you actually written a suicide note?
These are things that you should be asking people as you are enacting your plan.
Which we'll talk about.
The levels of lethality are really important for you to understand.
The most lethal methods are firearms.
It is not only lethal, but it's irreversible.
Jumping from a height is very lethal and is irreversible.
What's your jump?
You jump?
I've actually talked to people who survived their suicide attempts.
One was a gentleman that actually one of the few survivors from the Golden Gate Bridge.
He jumped.
He broke, like, multiple bones in his body, almost drowned.
Most saved, and then he realized with a lot of therapy, that's not really what he wanted to do.
But what do you tell you is As soon as he jumped, he he wasn't gone 10 or 20 feet down.
He thought himself, this is a bad idea.
What they're doing is they're applying a permanent solution to a temporary problem.
Jumping from the height again is very lethal and is very irreversible.
Hanging or strangulation can be very lethal.
It can be reversible if the rope breaks off or the person steps back up.
Hills and overdoses could be legal, lethal, but it could be also irreversible.
It takes some time for people to die by the use of pills if they plan it out where they're not gonna be touched or communicated with by people for 18, 12 hours, something like that, it could be lethal.
But once you get thinking after you take the pills is a bad idea, you could throw them back up and save your life.
Whereas you pull the trigger, no.
You start jumping.
No.
We wanna look at risk level.
So what we do is I I do assessments like this all the time.
In terms of risk levels, you're looking at high and you're looking at moderate and low, you look at factors, suicide out, succidiality and then in intense interventions.
When it's really high, they have really high severe symptoms of suicide ideology.
They have persistent suicide ideology with a plan and intent, again, in rehearsal, which we just talked about.
They need to be taken to the hospital or 2 at inpatient mental health facility.
Moderate, they have some imminent factors, some protective factors that are involved but they do have suicide ideation with a plan, but they're really not.
I've done any attempts yet.
Again, I would on the side of caution and take them to a place where they can be further evaluated by mental health care professionals and let them ascertain what should be the next course of action.
People with low risk levels, they have modifiable risk factors, strong protective factors.
They're having a very difficult time in their life.
They may have thought about suicide in the last month or 3 months, but they have good protective factors.
And they have strong support unit.
They have a religious belief.
They're looking forward.
They have future plans.
They have a sense of purpose.
They really don't have any plans or intent to hurt themselves.
So what there you wanna do is symptom reduction, see where they are and refer them into mental health care.
And then continue to follow-up with them in in the next day to see how they're doing and whether or not they're they're acting on a on needing seeking help.
I will tell you that even the best of intentions, the best of care, the best of evaluations, doesn't prevent suicide.
If someone's really bent on it, it's gonna be hard pressed to stop them.
They may be very good at telling you some things that they think you might wanna hear That's why you continually go down these various questions and you challenge them.
And I think this goes back to what what he talked about and what I talked about earlier is You have to start engaging with people.
You have to look at them.
You have to talk with them.
Get off the phone, get off the computer, and really have intentionally be present with people.
To gauge their body language, to gauge their voice intonation, to express yourself in a way that they know that you care about them in a holistic way.
And we have concerns for you, and we're here to help you and try to get you into some some assistance.
Pregnancy versus confidentiality.
There's a distinction here.
Privacy entails being aware of sensitive information about a person.
That privacy could be about your health care or sexual history.
It could be about a numerous things.
Okay?
You're keeping that private because it's sensitive.
Confidentiality entails not reporting it to other people.
I'm keeping what you told me.
It's private information, and I'm keeping it confidential to myself.
However, confidentiality is suspended whenever a person expresses suicide intentions or acts in a suicidal manner or in a homicidal manner You're threatening to hurt or kill somebody else.
Then as a mandated reporter, you are now reporting to your authorities, reporting to whatever your chain of command is, or to the police relative to these issues to seek further assistance.
So privacy versus confidentiality.
And I would tell people once they're talking with me when they tell me I keep private, I keep confidential, but My confidentiality ends at the river's edge where they are threatening to harm themselves.
Via suicide, or they're threatening to harm other people by homicide.
And that way, everything's up front when I do my first intake evaluation of clients.
Your initial response where are we hearing this?
It could be very upsetting for you if you've never been around it.
And as for the first time, it's pretty pretty overwhelming at times.
So what I tried to do is I tried to tell people to just stay calm, learn voice, have a dialogue.
And I think the most important critical component for people in connection is to let them recognize you see what's going on.
You acknowledge for them what you're seeing.
So like in critical instance incident stress management, we have a safer model where we stabilize the person.
We acknowledge what we hear We help facilitate the ongoing process of them expressing themselves, and then we either we we we we educate and we refer that person for assistance in that psychological first aid moment.
It's the same here with suicide ideology.
You're acknowledging what you're seeing.
You see, I can see this is upsetting you greatly, and I wanna get help for you.
We never minimize a threat.
I don't control them.
I don't make fun of them.
Get past it.
You know, there's more fish in the sea.
There's this.
There's that.
By doing that, you stigmatize their feelings.
You offer to stay with the person.
You wanna help them get something to eat or drink.
Of course, no alcohol.
You wanna be in their proximity with them.
I've had a athletes that that express suicide ideology.
And while I'm waiting for the physician to show up for half an hour so they can take over and they can make determinations about where we need to go with this athlete, I just haven't set my office.
And they're just sitting there trying to chill out.
And I'm just just doing my thing.
I'm normalizing the circumstance.
I don't heighten it any higher than it needs to be.
So when you come across these things, you're having a dialogue and you're destigmatizing these issues, why you're getting your emergency action plan going.
The process when people are really threatening to hurt themselves I think you wanna ask them some things like clarify is like, do you really wanna die?
Or do you just wanna have your life changed for the better?
They wanna have they wanna be less abused.
They wanna have, you know, a job.
They wanna have more certainty in their life.
Most people in counseling struggle with uncertainty.
They they don't they don't deal well with uncertainty.
About how where's my life going?
How's things have happened to me?
How they gonna affect me?
And as a counselor, we try to help them gain some certainty about how they can do things.
And if you're right there, you've got you're taking notes, one of the things I always try to express to students here and the and the clients is you can only you can't control everything.
There's only three things you can control.
You can control your attitude, you can control your effort, and you can control your response.
Everything else you cannot control.
And oftentimes, people when you get going down the road of suicide, The last thing they can control is ending the pain.
They're they're just not aware of this other things I can do to try to mitigate the circumstances I'm in now, and that's what we try to help them understand.
You want a delay.
You want to have time to enact the mental health emergency plan.
So whenever you're in this circumstance, you excuse yourself and you have a buzzword or you tell somebody, hey, I need, you know, whatever it is, your buzzword, would be to enact your emergency action plan.
So that means to go to know what your plan is and enact it.
So someone can come over and take over for you and put the person in a safe place and further evaluate them.
In some cases, you might wanna contradict them.
You say, you know, you do realize that your desired outcome of killing yourself is gonna create a lot more adversity and a lot more problems for people you care for.
So you ask them, do you care about who do you care for?
And they'll tell you say what impact or what legacy would your death by your own hand due to your son or due to your daughter or due to your teammates.
What would the impact be?
And then you get them into thinking and more logical thought process, and that can help calm them down.
And again, refer them to an emergent, mental health care, either on your campus or at the hospital or whatever your search circumstance is to take into an inpatient mental health facility.
Know your mental health EAP.
You should have it with you.
You should refer to it.
I think twice a year.
Game plan it out.
What will we do?
Know where the local mental health care facility is located.
There's a protocol involved police or the campus security.
Whom is to be notified of mental health emergency?
How are the parents and family notified of this?
The question always comes up about the coach.
There's always gonna be rumors and hearsay or actual facts.
The kosher one to know, and we'll tell them this is a this is a confidential matter that has to do does have to do with their mental well-being.
And they're they're being assessed and cared for.
You'd have to go into the fact that they, you know, they even killing themselves or they got to pressure.
They got anxiety.
They got eating disorder.
They got bipolarism.
You don't need to go into that.
What you're trying to do is you're trying to address the immediate emergency.
Of their mental unwellness.
In your follow-up with them as a release or coming back onto the team or going back into the facility.
You wanna show empathy and support.
You wanna normalize.
Talk to them about their classes.
Talk to them about their favorite teams.
Talk to them about other things so they feel like, you know, they're back into a routine.
You would encourage them to continue on with your mental health care, checking Danny with individuals about their daily activities, and then continue to watch for any science and suicide.
I work with athletes at suicide ideology who've been in lockup, who've been in hospitals, who have attempted suicide.
People have had severe mental health challenges, depression, anxiety, eating disorders, cutting, I think support for the athletic trainer just to talk with them.
You know, describe how things are going right now.
Describe how your day's been.
Going back to our original assessment.
So if these chart hearing things again, where they're having these thoughts again, that's a time to act and go back and go get the more help.
Is there a time for an athlete to be medically disqualified or mental health problems?
I believe there are.
Because they're not in a good place to be participating in sports even though that might be an area of support for them, but it also might be an area of stressor.
Is better off for them to separate weight from the team to address their mental health unwellness.
We found out to be very true, except in studies, we were now discovering that people with disordered eating should remain on the team because that's where a lot of their support unit is.
What you do there is you modify their activity levels so you don't exacerbate weight loss and the risk of osteoporosis, for example.
In summary, you have suicide suicide ideation is more prevalent than thought You need to be aware of suicide signs and symptoms, being supportive of individuals who are struggling with their life, It doesn't take much for people to tumble downward.
The people I've worked with in counseling started their youth, and has followed them their entire life and has marred their life.
They don't get married or they get multiple divorces.
They got substance abuses.
They've had job issues.
They've been in prison.
They have all kinds of problems.
Never graduated from school.
Things of these natures because trouble will follow you unless you know how to manage it.
You don't know how to manage it, the only way you can manage it oftentimes is by ending it and ending your life.
Do not be afraid of asking hard questions on suicide?
Be ready to enact that mental health care emergency action plan and try to stay with the person if it's safe for you while awaiting assistance for the mental health emergency action plan.
There are some great resources member of Health America, the Jet Foundation, which I'm very familiar with.
These are great resources for you to go and look for We're gonna be beefing up in the next iteration of the consensus statement relative to suicide ideology.
So some of the things we've talked about today will be included in that.
Here's some of my references.
And again, thank you for attending this presentation, and I look forward to any questions you might have.
Yeah.
Thank you, Tim.
If you could go ahead and make me the host again so I can open up my video.
Hey.
You got it?
I stopped my share screen.
I see a handrail.
Yeah.
Now you gotta go up to the little dots.
In the right hand corner of the video and then make me the host.
You gotta click on my name, which is Ronnie Harper, and then turn the host back over to me.
Okay.
I see view.
Okay.
Let's see.
I see view.
I see pair with zoom room.
I don't know where Ray is because Ray knows how to do this.
I don't.
Yeah.
Ray is gone.
So so it's all us.
I'm here.
I'm here.
You're still there.
Are you there?
Yes.
I am here.
So I have to walk outside.
So you're saying to hand over?
Now we're trying to get the host back to me, and it's Okay.
Yeah.
So I think Mhmm.
On the walk of the host mine was not on.
Let me see here.
This is a you have to click on the Ronnie, click on the participants, and then use handover the let me see here.
I'm a I'm a try to reclaim the host for a second.
And
Alright.
Cheers.
Alright.
Mickey, you now have the host.
Alright.
Well, while Nikki gets ready to pull her presentation, I'll give her introduction.
I know we're got a few minutes for questions.
I haven't had had one statement come in.
Let's see this.
This has been one of the best presentations.
Do you find that concussion patients are at higher risk?
Yes.
I do because What is a concussion?
Is it changing your chemical imbalance in your brain?
And if you're already chemically imbalanced as a result of having a mental health disorder, that's a bad mix.
And however long it takes for your brain to re regulate from a concussion can also throw you off in terms of your mental unwellness.
I didn't see one hand that went up about what are the three things that you can control again.
I think that what you have to keep in mind is that you can't control other people.
That's a that's a bad mix.
You try to control other people, an athlete, your spouse, your coworker, that does not work.
I know this from being for 44 years.
I don't try to control my spouse.
That's probably why we're married for 44 years.
But I think the three things you can control as an individual is excuse me.
Your attitude when you get up or when you go into a stressor.
What is my attitude?
Am I prepared?
Am I scared?
You can control yourself.
The second thing you do is you can control your effort.
If you give your full effort to things, and things don't work well and you can still live with it.
But most people I work with when they don't get full efforts in their lives because they're distracted or substances, and they screwed things up.
They wish they had that moment back again.
And then lastly, Paul, you can control your response.
People could be rude to you People can ignore you.
They can do whatever they want with you, but you control how you respond back to that.
And that response it says more about yourself and how you can control your own discipline than it does the person who's trying to do something to you.
And I think if you can do those things, you have a bad test score, you have a bad game, you you missed an injury, and, you know, it was a fracture instead of a sprain.
How you respond to those moments really tells you a lot about your mental wellness.
Yeah.
Well, I had a whole list of questions and we're out of time, but every question that I had ready, it seemed to always when I try to answer it myself, refer back to the mental health EAP.
Now I know what an EAP is.
When it comes to ADs and bag valve mask and I know I made one attempt at my high school at developing my mental healthy AP, and I was starting, like, literally scratch Like, I knew nothing and I had to go, like, tell us the top 3 things that someone needs to start to put that together so that then they have their sort of they're based down about how to manage it at their facility.
I think the first thing is it depends on where you're working with minors or adults.
I think the first thing is is what is your institutional EAP?
So when I get into an emergency, someone threatened suicide, they threatened to kill somebody, what do I do?
You have to go to it and know who do I supposed to call and what are these people supposed to do?
And what about what is my role on all this?
That's the first thing.
The second thing is Where are the resources in the community that we can avail ourselves to?
What is our protocol?
What resources do we have?
And then lastly, Bob, if you wanna build a phone tree or an algorithm of your team physician, counselors, legal team, whatever it might be, and what we need to know, and who should be involved in making these decisions as these events come up.
I think that's really important.
So the plan, the people involved, and go down algorithm of this happens, what should I follow?
What should I do?
Because in those moments, you can deal with an ACL or a fracture arm.
Well, we have some I'm gonna kill myself.
I'm gonna go kill that SOB.
Now you you're getting a little bit uptight.
If you're not in use to being around that, then you need something to look at to help walk you through it.
Well, I hope everybody understands the reason we had these topics in this conference was because This is an area in emergency medicine that doesn't get talked about near enough nor does it get brought into the arena of emergency medicine enough.
And this is exactly this is exactly the area that we need to be talking about because the stats that you presented, 10% is for real.
I've seen it.
Everybody has a story.
Right?
If you stay long enough and dig deep enough, 1 out of every 10 is dealing with some pretty freaking heavy stuff, and it just hasn't come to the surface enough for you too.
To, you know, move them through the next phase, but that is and that's a number that that I think you said is probably still low in in a in a lot of regards.
So it's probably about 1 every 5 or I would even argue, it's probably 2 every 4.
Because you have the thresholds where you meet criterion, and then you have subthreshold people that if they have one bad event, now they're in that criteria where they have problems.
Well, it is a it's a topic that we will keep front and center within our our arena of emergency medicine and
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