Many Hands, Many Voices: Suicide Prevention Work at MCW

 From the 5/14/2021 newsletter

Perspective/Opinion

 

 Many Hands, Many Voices: Suicide Prevention Work at MCW

 

 David J. Cipriano, Ph.D. - Director of Student and Resident Behavioral Health and Co-Chair, MCW Suicide Prevention Council

 

 Dr. Cipriano, Co-chair of MCW’s Suicide Prevention Council, describes how the council is approaching this critical topic through the development of peer support, beginning at MCW-CW …

 

 Many hands, many voices – a common call for community collaboration – describes the progress of our Suicide Prevention Council (SPC).  I reported a few months ago on our identification of two risk factors for suicide that we chose to focus on this year:  isolation and stigma.  And, I promised to report back on our progress. 

Last time, I spoke about the culture change needed to reduce these risk factors.  We began to plan for a public health model to promote such culture change.  There are three categories of prevention: Primary prevention focuses on various determinants in the whole population. Secondary prevention comprises early detection and intervention. Tertiary prevention targets for advanced recovery and reduction of relapse risk. Our model utilizes trained peer supporters as the main change agents in the secondary prevention component. 

 We looked to Drs. Alicia Pilarski and Timothy Klatt’s Supporting Our Staff (SOS) program to address “second victim” - or vicarious trauma - amongst clinicians, and our program is closely modelled on theirs. The primary prevention component seeks to raise awareness, educate, and begin the conversation through events, media, and other means.  These are the seeds of the culture change needed beginning with stigma which keeps mental health in the shadows and isolation, perpetuated by shame and pride which keep us from reaching out to peers and colleagues.  Tertiary prevention involves removing barriers to access to care for those who need it.  We have made good progress on this over the past few years, but there is more we can do.

 

A student-led suicide prevention initiative at MCW-CW

So, whose hands and whose voices?  Dr. Jon Lehrmann, Chair of Psychiatry and Behavioral Medicine and co-founder of our Suicide Prevention Council, kept directing us back to the Pilarski/Klatt SOS program.  He saw the benefits of the public health approach and of the peer support component. MCW-Central Wisconsin medical student, Margaret (Meg) Lieb, pointed out the difference between peer support programs that encourage the active outreach of peer supporters, versus passive models where it is the responsibility of those in distress to reach out.  Then, our terrific community member of SPC, Dr. Barbara Moser, jumped in with her wealth of knowledge of training tools and experiences needed to prepare these peer supporters.  

So, what’s coming next?  Meg Lieb has assembled a group of fellow students with a passion for the mental health and wellbeing at MCW-CW.  They will launch a pilot program next month. You will be hearing from several of them in this issue of Transformational Times.  Meg and her team have been putting together the training materials, recruiting peer supporters and have even secured funding through Dr. Lisa Dodson, Dean of MCW-Central Wisconsin from a grant she received.  All this, while Meg is preparing for the Step 1 exam! 

I’ll stop here and let these amazing students tell their story.  I will make another promise here – while they are running their pilot, we on the SPC will continue to make plans for extending this program to our MCW-Milwaukee and MCW-Green Bay, as well.

 

 

David J. Cipriano, Ph.D. is an Associate Professor in the Department of Psychiatry and Behavioral Health at MCW and Director of Student and Resident Behavioral Health. He is a member of the Community Engagement Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

What is it like to be suicidal?

 From the 5/14/2021 newsletter

Perspective/Opinion

 

 

What is it like to be suicidal?  

 

 

By an anonymous medical student

 

 

A medical student shares their personal journey with suicidal thoughts …

 

 

To me, being suicidal is a physical place in my mind. I’ve boarded the wrong train, or maybe it’s the right train going in the wrong direction. It’s a vast transit system: all the stops are underground so I can’t see where the train is going, and the doors are locked so I can’t get off. In addition, my vision is too blurry to read the map posted on the door.  

 

As I ride to The Wrong Place, I only know that’s the destination if I pay close attention to myself. There are telltale signs: my hobbies become boring or arduous, my favorite foods taste like saliva, and I avoid eye contact with the mirror. 

 

As another stop goes by, my arms and ankles become heavy—too heavy to lift. Taking a shower sounds like a luxury that I simply do not deserve. I do not have the energy to hurt myself at this point... until the train reaches its next stop. 

 

This next stop is at the most dangerous neighborhood I can imagine. Here, I have the will to get out of bed, say my goodbyes, and seek out my demise. At this point, one of two things will happen. I either tell a friend my plans (you know, so they aren’t surprised; it’s common courtesy really), or I call my mom. Every single time so far, someone, somehow, has listened to my spiel about why I should leave this world. The person I am speaking to invariably disagrees with me, and I can feel the train slowing down. Slowly, I can sense how absurd the idea sounds as I hear my own voice speak this strange manifesto. 

As I am connecting with this other human, their logic and compassion towards me overpower the force of self-destruction. The train finally stops, the doors unlock, and my vision clears. I choose to walk onto the platform and take the stairs back up to ground level, where the rest of my life is waiting. I am existentially exhausted, having both won and lost an argument that put my life at stake. 

 

Personally, I find the feelings of suicidality are always temporary. They fade away, and I am left to live with myself, knowing that some part of me tried to delete all parts of me. But I am not afraid for the next time I head to The Wrong Place. At this point, I know all the stops and the symptoms that accompany them. I can usually get off the train before I end up at the I-don’t-deserve-to-shower part of the journey. I can’t exactly put that on my resume but, hey, I can still be proud of myself.  

 

It's a skill in self-awareness to know when you’re in trouble and when to get help. When I am faced with an internal struggle, seeking out a third party gives me a perspective I can’t generate on my own. There are wonderfully compassionate people—counselors, therapists—who have dedicated their careers to helping people get un-stuck when they feel stuck. They have given me tools that I can always carry with me; their expertise has been distilled to a few tips and tricks that work for me to navigate stressful situations and life changes. I encourage you to seek inside yourself the will to live, the love of those around you, and most daringly, the point at which to be vulnerable and seek help; for me, it was the most difficult and most rewarding thing I have ever learned. 

 

 

 

Author’s note: After much deliberation, and due to the current climate of resident medical education, this piece will be published anonymously. Special thanks to my campus colleagues for being such an open and supportive community. 

Red Flags

 Perspective/Opinion

From the 5/14/2021 newsletter

Perspective/Opinion

Red Flags

Margaret (Meg) Lieb, MS

Ms. Lieb is the current medical student representative for MCW’s Suicide Prevention Council and a co-founder of the council’s inaugural program, Seeking Peer Outreach (SPO). In this issue, she reflects on how her past gives life to her vision for future of SPO …

I remember trembling in a bustling coffee shop as I numbed the buzz around me to delicately lay each word in place. I was clenching every muscle in my body to contain the explosions in my chest vibrating my fingertips. I was eighteen, and I was writing my first personal statement. As with every personal statement since I was firmly instructed to “address [my] red flags.” My caveat: it is impossible to explain my red flags without also disclosing my most painful, darkest, personal secrets.

How do you address a big, red, domestic violence charge without sharing that it was the first time I tried to fight back after a year of abuse? How do you justify enduring an entire year of abuse without conveying I intervened in his suicide the year prior and was terrified for his life? How do you fend off assumptions about my judgment without explaining it was my first love, and I simply did not know better? How do you describe the ways it was formative without reliving every traumatic memory and its sequelae?

After nearly ten years of writing and re-writing my sharpest pain and deepest shame for various admissions committees, I have yet to craft a different answer.

However, time gifted me the hindsight to reflect on ways I grew into my red flags, in ways, driving my purpose. For instance, I was nominated to sit as the student representative for MCW’s Suicide Prevention Council (SPC) last year. One of my mentors challenged me to imagine the intricacies of a culture in medical education where we would not be forced to question, “When is it safe to be me?” primarily when applied to well-being and mental suffering.

As I reflected on this concept and connected it to my own experience, I realized it never was safe for me. However, with each rendition disclosing my history, I grew from tolerating my forced vulnerability to comfort to strength in my vulnerability. This concept of ‘strength in vulnerability’ has been integral as I helped develop SPC’s first initiative, Seeking Peer Outreach (SPO). How do you breathe strength into brilliant, high-functioning individuals, who are also struggling to dress in the morning, to be vulnerable enough to seek help?

Make help active and accessible 

Our approach to this: make it easy and make it normal. In applying this to SPO, I’ve called it “active accessibility.” Active because we are placing the responsibility of getting support away from a person potentially suffering and, instead, giving it to everyone else in the community by setting the expectation of actively and regularly reaching out. Accessible because we considered existing barriers to requesting or receiving help and have streamlined circumventive processes.

We are augmenting active support via a subset of individuals identified by others in the community as being particularly approachable and empathetic. This group goes through additional training, is equipped with various resources to share, is tasked with checking in with all individuals regularly, and displays a specific version of the SPO logo as a silent signal. The signal conveys the pledge to share their vulnerability, support, resources, and confidentiality for anyone who may need it at any time. 

Additionally, we are enhancing accessibility through an innovative anonymous reporting platform for anyone burdened with barriers to revealing their identity. Each SPO logo will be an embedded with a QR code directly linked to an encrypted submission page. Any submission will go to the SPO peer support team, who will be able to respond accordingly. Further, every person will be provided a pin displaying the QR code and encouraged to keep it on their MCW badge. Therefore, every member at MCW will carry an anonymous means of support with them at all times.

We are not alone

When I joined the SPC, I knew there were very few people in my life who understood what I had been through; thus, I was sure no one at my institution could personally relate to my lived experience: a lonely burden to acknowledge. 

A year later, I am astounded and inspired by how wrong I was. As we selected leaders for the SPO pilot program at MCW’s satellite campus in Central Wisconsin, I was adamant that our leadership be committed to being the best example of the program’s mission. In response, a few weeks ago, I sat with next year’s selected SPO leaders, composed of 25% of the Central Wisconsin M1 class, faculty, and staff. Each person shared their personal dedication for SPO by disclosing their own big, red, scary secrets. Many secrets that were strikingly similar to my own. It was a powerful meeting that served as a beacon of hope, a seed for compassionate collaboration, and the ribbon-cutting for strength in vulnerability. 

Most notably, it would not have been possible without the influential faculty members who take extra steps to help their colleagues and students feel safe in their vulnerability. Further, I would not have been able to co-lead the formation of SPO without the same faculty who empowered my voice and simply left the door open. 

I couldn’t be more grateful for them or the skills they granted me to pass the torch for those to come.

Margaret (Meg) Lieb, MS is a second-year medical student at MCW-Central Wisconsin. She serves as the medical student representative to MCW’s Suicide Prevention Council. 

Stigma and Vulnerability: Our Experiences with Struggling in Silence

 From the 5/14/2021 newsletter

Perspective/Opinion

 

Stigma and Vulnerability: Our Experiences with Struggling in Silence

 

Sofie Kjellesvig and Sadie Jackson - MCW-Central Wisconsin medical students

Medical students are high achievers who are often adept at hiding their shortcomings and moments of vulnerability.  We, the authors, hear our peers admitting to some of their struggles: being behind on lectures or not feeling ready for an exam, for example, but these statements are almost always qualified by, “but it’s fine, I’ll be okay,” or something similarly diminishing.  In fact, there are times when we have felt unsure about whether things will truly be okay. We do not openly share these feelings, no matter how many times we’ve considered doing so.  Perhaps this is out of fear of what others may think, a belief that we are suffering alone, and the stigma that surrounds academic performance and mental health. 

We’d like to break the silence by illustrating some of the ways each of us struggled during our first year of medical school:

 

Academic challenges can break down students’ confidence and isolate them as soon as classes start. For anyone who hasn’t had a cadaver lab before, anatomy in medical school can be a rude awakening. Among the class there are seasoned veterans with extensive dissection experience, some students who have taken anatomy and held a scalpel a few times, and then students like me who had never heard of the pisiform bone, let alone picked up a probe. Anatomy scared me and I didn’t feel like I belonged in lab. With time and practice I improved, but I still found it very difficult. No matter how far I progressed, I couldn’t shake the feeling that I was not good enough and was falling behind my peers. Ultimately, I found myself asking if I was cut out to be a doctor and struggled with worsening anxiety about this. I was uncomfortable admitting how much those feelings pained me to classmates who appeared to breeze through the course.

 

Why is this so challenging? Our grading for these courses is pass/fail, so why do we compare ourselves to peers and consider ourselves a failure if we don’t measure up? What I found out when I did make myself a little vulnerable was that friends who were excellent anatomists still had their own issues at times: they had these feelings about a different course, or they were having trouble with school/life balance, or they were just finding life in general to be a lot harder during pandemic times.

 

Other challenges, especially those related to mental illness, are rarely shared by classmates. This is not because medical students suffer from mental illness less than other groups.  Mental health and suicidal ideation, understandably, are heavy topics for most people.  Even though some of us may feel comfortable sharing our experiences with those who ask, we encounter barriers that prevent us from reaching out on our own accord.  I find myself asking: when it is a good time to bring up such a topic? Is it fair to place such a burden on others who did not ask for it? Will they view me differently if I share my insecurities?  My anxiety convinces me that sharing will make others uncomfortable, beginning the vicious cycle of negative self-talk that I try so hard to avoid.  I then feel that it will be easier for all if I deal with my doubts alone.  This option becomes more appealing to me to protect myself from the guilt, discomfort, or judgment I fear may come with allowing myself to be vulnerable. When I have been brave and shared, however, I’ve found that I am not alone and that others do care and sincerely want to help. I doubt I am the first person to wind up trapped in the self-imposed isolation these fears can create.

 

Vulnerability is an important skill that, like other skills, takes time and practice to learn. Whether you’re struggling with biochemistry concepts, having difficulty managing depression, or possibly grappling with suicidal ideation, remember that you are not alone.  Students in medical education are held to a high standard and are told to behave like future healthcare professionals. Unfortunately, the very individuals we are meant to model face significant stigma and barriers to admitting when they need help, so it’s no surprise that we find it difficult to stray from these behaviors. 

By sharing our experiences here, we hope to help students realize that they are not alone and that being vulnerable is not a weakness, but a way to reduce the stigma and isolation which many of us experience.

 

Sofie Kjellesvig and Sadie Jackson are medical students at MCW-Central Wisconsin. Sofie is an M1 at MCW-CW who is interested in internal medicine. She is from Eau Claire, WI and graduated with a degree in biomedical engineering from the University of Minnesota prior to coming to MCW. Sadie is an M1 at MCW-CW who is interested in family medicine. She is from Stoughton, WI and graduated from Kalamazoo College with a biology major and studio art minor.