Show Notes:

Today we are finishing our series on suicide risk prevention, and in some ways we’re wrapping up in the place I intended for us to start. Today we’re talking about what it is like to be the person in the deep dark hole. We’re going to talk about the slippery slope that tends to send us into the hole, how to recognize the hole we’re in, ways to work at intervening to try to find a ladder back out and resources and supports that can help to do that

What leads us into the dark hole: Suicide does not happen in a vacuum. By and large, it doesn’t come out of thin air. It is most typically the “last resort” option that someone can perceive in an effort to cope with too much for too long. For some it is a means of escaping the heaviness of the world. For others it is a sense of controlling what I can in a world where I feel as if I control very little. It often feels tied to a sense of helplessness and hopelessness, and sometimes a belief that the world would be better off without me. Getting to that place doesn’t just happen, like one day I’m totally fine and the next day life isn’t worth living. Most often it is a gradual wearing down of my sense of capacity, control and hope for a future that feels meaningful.

When we face gradually additive stressors, we don’t tend to notice the impact these are having on our mental health and wellness as dramatically as we would if one terribly catastrophic thing were to happen. The gradual and cumulative effect adds a little bit and a little bit and a little bit until we feel so overcome that we can’t continue.

For many on the front lines the problem is a bit convoluted. On the one side, you are a normal person. You have normal people problems. Problems that can in their own right be pretty stressful. Children who are sick or have special needs, elderly parents you are supporting, financial strain, and the zillions of day-to-day life stressors, big and small, that we’re having to navigate. Then, you have the problems you face as a result of the work you do. Your Tuesday is being present for someone’s worst day, on repeat. You are exposed to suffering, desperation, pain and so much more within conditions that can feel toxic and/or dysfunctional. All the while you are seen to be this kind of noble person with a noble profession, that can make us feel somewhat restricted from being permitted to fall apart or be human in some of the spheres we’re in. We’re busy, trying to coordinate and negotiate the intersection of our normal people lives with our professional lives. Oh, and our professional lives colour everything. What we see, hear, know and are exposed to in the work taints how we feel and engage outside of the work. We get more guarded, vigilant, hyper-aware – we’re tuned into risk and threat and work to be ready to jump into action no matter what venue we’re in. And to manage all of that, there’s the numbness. The thing that gives a break from feeling the intensity of it all piling up…but not really. Not really, because it’s still all right there. And I have to do it all again tomorrow.

The pace and complexity of navigating these multiple facets of who we are and what our lives are composed of, along with hereditary predispositions, can move us toward physical and psychological health concerns. Sleep is disrupted, appetite, coping behaviours like substance use or screen time, fatigue, irritability, mood swings… We can gradually move down this path and into spaces like burnout, compassion fatigue, vicarious trauma, posttraumatic stress disorder, depression, anxiety, and so on.

Now, this slippery slope of gradual compounding stressors and the associated mental health concerns I’ve just listed do not in themselves mean that someone will become suicidal. However, the risk for suicide increases exponentially when stressors are high, coping is low, and mental health concerns have become present. The risk increases further if we have had any previous experiences of suicidal ideation or actions, as well as if we know someone who has attempted or died by suicide.

Unfortunately it is common that those in First Response and Front Line Work don’t know what to look for. We hear a lot of the right buzzwords about breaking the stigma, getting help, seeking support – blah, blah, blah. But not being given clarity around what it looks like to need to do these things. We look around and it seems like everyone is struggling, so we assume this is just how it is and we keep on going. We silence ourselves, sometimes even from ourselves, to keep putting one foot in front of the other. And we can march ourselves right into that deep dark hole without a clear path out. So tired by the time we get there that we can’t muster the strength to look for a path out. That’s the helpless, hopeless place.

I don’t want that for you. For any of you. It’s why we need to have these conversations – need to confront the uncomfortable things in an effort to equip ourselves. I want you to be the person who does know. The person who saw the indicators and did something about it BEFORE it got so deep and dark.

Knowing what to look for: we need to get really clear about the things that lead us into the dark hole. The thing about life is that it tends to keep moving – which can be part of the problem we find ourselves faced with. We get caught in meeting the day-to-day challenges, along with the big and small stresses that show up along the way, in tandem with a career that is predictably unpredictable. The nature of life continually moving along, is that we can get a bit dragged along for the ride, leading into some perpetual version of survival mode. We can be so caught up that we fail to notice the forest for the trees – we lose track of how we’re doing, whether our lives feel in alignment with what we want or like or would hope for. These pressures and tendencies to feel stuck by the cumulative weight of life can happen for many in the work, but this can be exacerbated by a hereditary predisposition to mental or physiological health concerns, as well as any amount of experiences throughout our lives of trauma or more severe stress. When we have overlap of these kinds of risk factors, it is going to be important to have awareness of what we need to be looking for – our own personal indicators and risk factors that let us know that we’re not doing so well, need support or otherwise need to attend to what’s happening.

For example, if I know that I have family members who struggle with depression and anxiety, that I have a family member who has attempted suicide, that I have some early life exposure to stress, that I have my own history of struggling with low mood sometimes, and that on top of my work right now I am also facing stress related to separation or financial concerns or something like that – the interaction of these multiple risk areas and stressors can quickly add up to feeling unable to cope. As these add up, we can grow increasingly helpless and hopeless, overwhelmed and out of control, disconnected and devalued. This is the place where risk becomes significant, particularly if we begin to pair this with planning or fantasizing about methods to end our lives, beliefs that others in our lives would be better off without us, untreated acute mental health concerns, and access to lethal means. As these factors combine and layer on top of one another, the day-to-day life stuff can easily tip the scales and the exposure to suffering within the work can sit differently. We can start to see ourselves in the stories of those we work with, or wish to trade places with those we are serving. Those can be some solid indicators that we are pretty deep in the hole.

How to recognize the hole we’re in: A common story for those on the front lines is not knowing that what they were experiencing was mental health or occupational stress injury. Not knowing what to look for puts us at risk of getting way deeper before we identify what’s happening or getting help, and finding it to be a much further way we need to claw our way back out. Before we talk about what to look for, let me remind again that we need to make space and time to regularly and routinely check in with ourselves. Knowing this information is only useful if we have the ability to check in with it, compare ourselves against it and evaluate where we’re at. If we don’t carve out space and time, life will continue to lure us into the survival mode tendency to keep spiralling down without knowing why we’re struggling.

Some of the most commonly identified early indicators of stress, burnout, mental health concerns and related occupational stress injuries that can lead toward suicide risk include sleep disturbances like difficulty falling asleep, difficulty staying asleep, and nightmares or panic waking; increased irritability or difficulty regulating emotions in the face of small or insignificant seeming stressors; feeling jittery or on edge much of the time, even when there is no specific reason; feeling somewhat disconnected or tuned our from things going on around you; struggling to feel relaxed or calm; struggling to feel connected to a sense of purpose or meaning; along with physiological markers such as headaches, muscle tension, gastrointestinal issues, appetite changes, and so on.

As wellness becomes more compromised these concerns will tend to get more severe, sometimes becoming interruptive to capacity to function, requiring days off work or sick leave to manage. We can start to notice feeling more helpless, less in control and experiencing less agency in being able to make change in our lives. We can feel hopeless that things will change or improve and can become fatalistic, having difficulty finding worth or value in aspects of our lives we once found meaningful or purposeful. We can begin to contemplate or fantasize about ways to escape feeling what we feel – this may lead into use of substances or engaging in maladaptive behaviours in an effort to escape ourselves and our own experience. Whether it’s drugs, alcohol, self-harm, gambling, shopping or other kinds if self-destructive efforts at disconnecting from our lives, these are attempts at coping that should signal that things are not ok.

If these sound familiar to you, and again you can reference against our Beating the Breaking Point Indicators Checklist which I created as a burnout self-assessment tool, I would encourage you to take some steps to work your way back out of the hole before it feels too deep.

How to help turn the tide and build a ladder out of the hole:

1. Treat yourself the way you would treat others you care about. We tend to reduce the standards of care for ourselves compared to how we extend care to others, and this lends to the risk we can find ourselves in. If we can’t value ourselves, or show gestures of valuing to ourselves, we will have difficulty experiencing a sense of valuing in the world and from others. We are with ourselves the most, and need to offer care and valuing to ourselves. Sometimes we don’t know how or where to start with ourselves, so try thinking of what you would tend to do or offer to others and do pieces of that for yourself. This will include saying no to things – drawing limits to protect and preserve your energy. I read something recently that said, “you are a precious and limited resource” and it’s true. Part of valuing ourselves means doing things that care for us – both by inputting things that bolster our internal resources, as well as limiting external things that cost us resources. This may include drawing limits at work – like how much overtime I take on, or switching to a different line to remove myself from toxic dynamics or environments. For many, treating ourselves well when we’re in the dark hole can feel impossibly hard – in part because we know how far we need to go to get back out and it feels overwhelming to try. If this is the case, focus on small steps and allow permission for a gradual building of these pieces. Things like going to bed 20 minutes earlier, or eating one piece of fruit, or doing 5 minutes of light stretching can be starting points that become the rungs on the ladder out of the hole.

2. Rreceive what others give. When we’re in the hole it can feel hard to see or hear the efforts others make to reach in toward us. We can be resistant to their care or receive it as pity – we can complicate what it is. Try to let what others offer stand as what it looks like on face value. The same way you would want others to receive from you if they were struggling. Try to allow people in your life to offer and support where they can in the ways they feel able.

3. Ask for specific support. While others might offer and try to enter into our hard spaces, they don’t always nail it. Sometimes what they have to offer isn’t what we need – not because they don’t WANT to offer what we need, but because it’s not what they naturally think of to give. Sometimes they may not know HOW to give in certain ways, other times they can they just don’t THINK of it on their own. Being clear with others about what’s happening for us, and what we would find helpful can set them up for success in meeting those needs effectively which then sets us up for success in getting those needs met. Here’s an example – my mom, whom I adore, is an advice giver. What she offers naturally is creative brainstorming solutions to problems. Meanwhile, what I often need is someone to listen and not tell me how to fix. She can do this, she just needs to be reminded to put her fixer tendency to the side and focus on listening. When I pre-empt conversations where this is the need to let her know, we both walk away feeling better – she feels like she met my need, and I feel like I had my need met. It’s so much better than when I fail to clarify my need and she engages in fixing, to which I respond with either defensiveness or shutting down, to which she feels uncertain what went wrong and I feel unheard, devalued, and frustrated that my need wasn’t met.

4. A caution around feeling like a burden. One of the barriers I often hear to asking for support from people in our lives is this idea of not wanting to be a burden to those we care about. Here’s the thing about that – if not getting support results in suicide, I PROMISE you that the burden of guilt, and confusion, and regret felt by those left behind is far greater and far more deeply and negatively impactful for their lives on an ongoing basis than whatever burden might exist in them supporting you to remain on this earth. Please don’t delude yourself into believing that you are somehow saving them from pain or discomfort by not asking them for help – this ends up inviting a level of pain for them that is in it’s own right hard to live with. People who care about you WANT to help. They WANT to be a part of your life – good, bad and otherwise. Know that this idea of being a burden is crap and doesn’t hold water.

5. Ask for professional support. I know, counsellor is telling you to get counselling. …Or something like that. If you broke your leg, you wouldn’t expect your neighbour to fix it...would you? You would go to the hospital and seek out the right people to do the job. The same needs to be true with our psychological wellness – whether you connect with your GP, your health and wellness people at work or within your union, your workplace employee assistance provider, or with a counsellor or psychologist in your community – get support from the people who do this. We have invested in making our life’s work caring for people exactly like you, and we can offer more than your neighbour.

NOTE:** I know that some have had less-than-satisfying experiences seeking professional support – and if that is a barrier for you in getting help, know that we are going to talk about this exact topic in our upcoming series. As we wrap up this series on suicide prevention for those doing the hard work of caring for our communities on the front lines, we are bridging into a new series where we’re covering what therapy is all about, what to look for in a therapist, how to navigate barriers to getting support, and so much more. I hope you’ll join me as we jump into that series next week, and I hope you will encourage others in your life to take a listen as well.

Episode Challenge:

Take some time to check in with yourself and see what indicators and risk factors line up in your own life, and work to strategize some prevention/intervention ideas to start applying. If it’s helpful, use the Beating the Breaking Point Indicators Checklist & Triage Guide to help guide the process to self-assessing and checking in with yourself.

Additional Resources:

Rituals for remembering and honouring here.

Workplace Suicide Risk Prevention quick-reference handout here.

Beating the Breaking Point Indicators Checklist and Triage Guide here.

Community Resources for Suicide Risk Prevention for First Responders & Front Line Workers:

• BC First Responder Mental Health here.

• Ways people can help here.

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