Hello and welcome, everyone. Thank you for joining this webinar today titled The Power of Human Connections, Improving the Treatment of Suicidality with the Insights of Lived Experience. It features our speaker today, Eduardo Vega. Next slide, please. Just the funding and disclaimer I wanted to cover here, fairly standard language, the Suicide Prevention Resource Center, which brings you this webinar today, which is based at the University of Oklahoma Health Sciences Center, is sponsored with a grant from the Substance Abuse and Mental Health Services Administration. The views, opinions, and content expressed in this webinar do not necessarily reflect the views, opinions, or policies of CMHS, SAMHSA, or HHS. Next slide, please. There are no financial relationships or conflicts of interest to report for this webinar. Next slide, please. SPRC, or the Suicide Prevention Resource Center, fulfills its goal of advancing the national strategy for suicide prevention by building capacity and infrastructure for effective suicide prevention across the country through training, consultation, and developing resources for a variety of settings from states, tribal communities, and health systems, and that reach individuals across the lifespan. SPRC also fosters key national partnerships that engage a wide range of stakeholders and also serves as the secretariat for the National Action Alliance for Suicide Prevention. Next slide, please. This webinar offers one AMA PRA Category 1 credit. Information about claiming this credit will be displayed at the conclusion of this webinar. Next slide, please. So, just a few tech tips here. If you've joined from the desktop application of GoToWebinar, you can access handouts such as the PDF of the slides for this webinar by navigating to the handouts area of the control panel, and if you use the instant join viewer, you can do the same by clicking the page symbol on your display. Next slide, please. We'll be compiling and holding questions for the Q&A period of this webinar toward the end of the session, but please feel free to submit questions throughout the presentation. You can do this by using the attendee control panel again to get to the questions area, and you can click the question mark icon if you're using the instant join viewer. So, without further ado, I'd like to turn it over to our presenter today, Eduardo Vega. Eduardo, please take it away, and you can advance to the next slide, please. Thank you, everybody. It's great to be here today. In the background here, you can see an image of the world's largest living thing, which is the giant sequoia. I live in California, and we've got them here, also known as redwoods, and the giant sequoia grows from one of the smallest of the cones produced by conifer-type trees, and that cone only opens when it's exposed to extreme heat. So, the metaphor here that I think is relevant is that without forest fires, in this case, we wouldn't have these amazing trees, and similarly, for some people, without experiences of intensity and distress, they may not grow. Personal transformative struggle, including struggles with suicidal intensity, are not aberrations in people's lives, and for some people, they're really central to the journey of their life. So, we want to ask ourselves, in this kind of alternative approach to thinking about encounters with suicide, if these things happen to people, and if they are, in fact, not just difficult times, but maybe important times, how can we support our friends, our neighbors, maybe our clients or patients in growing through their suicidal intensity without taking harmful action? That's to say, how can we support people encountering suicide, and similarly, at the same time, work in a new way to prevent death by suicide? So, at least 50 million people consider suicide around the year. It's probably significantly more than that. We do know that in the US, at least 14 million seriously consider suicide as polled nationally, and that number is expected to be an underestimate. So, next slide. So, about 5% of people do actually attempt suicide, and of course, a smaller percentage of those die. My company is Humanovations. You may know some things about me. You're welcome to look up more about my bio, which I know you may have received also. The point about Humanovations is that I'm evolved after many years of my work in the mental health services, policies, and programs with the goal of innovative solutions, creating innovative solutions that empower people across the world and reduce the global burden of mental health and suicide, and Humanovations is a company driven by what we'll call lived expertise. That might be a new concept to you, but that's to say, driven by the experience of people who have been there and who also incorporate professional expertise in various areas. Some of our programs and partners are listed here. Next slide, please. Why is this important to me? Well, I have worked in social services and mental health for almost 30 years, and along the course of that, I really came to develop a passion for growth-oriented approaches to recovery, and not necessarily in contrast with the mental health system because recovery has become much more of a focus within our system, but really developed a passion for connecting with people experiencing really hard times. We can just advance. Some of my experience here is listed, and I think really importantly for me is also for people to understand that I did experience suicidal intensity and survived two suicide attempts in my teenage and then college years. Those experiences, though they weren't as intense as many people's, continue to fuel my interest in being able to connect with others in this area. Next slide. As a result of this, I've been blessed to be a part of a lot of leading national initiatives and international initiatives, including the National Action Alliance for Suicide Prevention. I'm a founding member of the executive committee there and also serving on the National Suicide Prevention Lifeline Steering Committee for many years. We're going to talk today about some things that may be new for some of you, new approaches to thinking about the issue of suicide and where it lives and how we could look at it differently at the intersection of psychiatry and mental health, driven by what we've heard and what we know about people with lived experience of suicide. We're going to talk about some of these concepts, both on the programmatic level and a little bit at the big picture level. We're also going to talk about some ways that we can think about new language relating to suicide and discuss some terms that people could be using instead of some of the classical clinical terms that people, including myself, grew up using in the course of our work in mental health services. Next slide. Next slide. This is just a little meme you may have seen, but I always think it's really cheeky and really gets to the core of the experience that a lot of people have, which is that it can be difficult to talk about things that feel threatening related to suicide or even bring up the subject of suicide, even with mental health therapists or with clinicians who ostensibly would be the right people to talk to about this. Part of this is driven by a history of fear and risk aversion within the mental health profession. And also, I would suggest a lot of general social taboo. I have some papers out about this, and you can reach out for links to some discussion, which go more into the historical background of why suicide is so taboo. But the one thing that we do know and that I know personally is that individuals do not feel that they can be open even about the subject in general and could be very fearful and feel very deterred from talking about experiences related to wanting to die or serious thoughts of suicide because of what might happen and what might happen against their will and what might be not a healing experience. Next slide. So, we've put out some statistics here, and I think it's useful to just recognize across all age groups, people do consider suicide. Obviously, people who think about it, and the blue bars here is much higher as a percentage than people who make attempts and or make plans. However, the point is that if you think about this, if you look up at this slide, you're seeing 12% of people, 18 to 25, and about 5% of people in the middle adulthood area have active thoughts of suicide or think about it on an annual basis. That's a lot of people. And my point is that in the history of suicidology and in the practice of supporting people with suicidal thoughts and feelings, historically, this voice has not really been heard. So, people don't tend to talk about their suicide thoughts with others for fear of judgment, and in particular, don't tend to interface with systems often even if they are going to make an attempt. Next slide. So, here we see the general statistics. Probably many of you are familiar with them. Close to 50,000 suicide deaths. This is 2019. I do think it's useful to note that as a percentage of the total people who thought about suicide, the people who actually die is a significant minority. And about 10%, to make it easy, about 10% of people who have serious thoughts of suicide actually go on to make an attempt, and then about 5% of those die. So, really important message here is that many people have lived experience of suicide. They've experienced the feelings, the thoughts, they've been there, and they have the capacity to connect with others. Additionally, they have the capacity to give us information about what could make a difference when somebody is experiencing these tough moments and support others in new ways. So, we're going to talk about how that might shape up. Next slide. Now, here's another sort of important, I think, distinction. This is a slightly different way of looking at it, but I think one that's really important is when we map the concept of psychological distress to thoughts of suicide, it isn't necessarily the same thing. They are very closely related. So, the fact is that there are some people who don't have apparently serious psychological distress who do have thoughts of suicide, and many fewer who don't make an attempt. But we do know that most people who have, or many people who experience psychological distress do have these serious thoughts. And so, when we think about distress as a kind of overlying concept as opposed to suicidality or sort of separate from suicidal intensity, it gives us a better frame for connecting to the emotional experience that people are going through. And on the other hand, it's also useful information to know that many or the majority of people who do experience psychological distress don't actually consider suicide. So, next slide. So, the engagement of lived experience of suicide was a long time coming, and it did come about through many years of advocacy by lots of important folks preceding me. I was able to participate in the development of the National Strategy, and as you've heard, the Suicide Prevention Resource Center has the mission of helping implement that. And in it, we identified an objective around engaging suicide attempt survivors specifically in suicide prevention efforts. So, in this case, we're talking about a group of people with lived experience, a subgroup specifically of people who've been there who've attempted suicide, and the majority of them having actually had services or some kind of intervention or support before, during, and or after their attempt. So, next slide. So, in service of this objective, we formed the first ever, as far as we know, Suicide Attempt Survivor Task Force. I was co-chair of this task force, and over about two years, we met with people from all over the country who contributed to thinking about what the experiences of people with lived experience of suicide, particularly how they had been received, what kinds of treatments they'd had, and based on this, and based on their own personal lives, what are the kinds of things that this lived experience could bring to the table to help others think about changes in clinical care, in public programs, et cetera, related to folks who may be considering suicide or experiencing distress in their lives. So, out of this effort, we created the Way Forward document. It's linked down here, and you can find it. You could also just probably Google search the Way Forward suicide, and you might find it. And this document ended up being very seminal. It was the first ever product of its kind based on a national effort, and then it actually inspired some other countries to do the same. So, our core values that came out of this was that people with lived experience of suicide want to inspire hope and meaning for others, and also that they feel that dignity is central to the process, including countering the stigma and discrimination associated, and I want to be clear here, we're talking about associated with suicide itself, or a person with lived experience of suicide, as distinct from what you may have heard about general mental health or mental illness stigma. So, in addition, we really focused on, and we really came to the value of community connectedness as a protective factor. I'm going to talk a little bit more about what protective factors mean in a little bit. If we could move on, please. Thank you. So, on the sort of recommendation side, one of the core elements that came out of this is that people have experienced a lot of things that were done in the name of treatment that really felt like punishment and not care. As some of you know, it is still a practice, hopefully less so, hopefully less so, but in many places where if you are deemed to be in the middle of a suicide attempt or at serious risk of suicide attempt, and an external intervention is called for or activated, you may end up handcuffed in the back of a police car, in your transport to the emergency room. Secondarily, and I think this has been really significant, certainly was in what I've seen, people in primary medical settings, like an emergency room, who are there as a result of a suicide attempt or suicide threat, can feel very shamed, can have a lot of sort of very overt and then also microaggressive behaviors aimed at them based on people's bias and sort of some really negative views of folks who do think about or attempt suicide. So, this dehumanization, guess what, that's not really great. That's not a great experience when you're already feeling pretty down. And it has continued. And part of the inpatient system in the US is based on managing either overt or expressed suicidal ideation or what we'll call suicidal intensity. And on the other hand, a lot of that has been historically very coercive and things including restraints and seclusion, et cetera. So, the way forward call for more alternatives to this historical treatment and also alternatives driven by and engaging people who have been there, because we want to hear from others. So as an evolution of the Suicide Attempt Survivor Task Force, we developed the Activating Hope Project. This was a program that still exists, so you can still access through the National Suicide Prevention Lifeline about helping organizations associated with suicide prevention increase the engagement and active utilization of folks with lived experience in this sector or in their programs. Among the many organizations we worked with, Lines for Life Oregon was an early adopter. And it was very instructive for us in this process to recognize that although incorporation of people with lived experience of mental health conditions is not new in the U.S. and it has grown a lot, incorporating people with lived experience of suicide and suicide prevention systems and clinical care was actually really a disruptive change. And we experienced, I've seen in multiple ways, you know, the effects of this. So just pointing out here, you know, hopefully you folks are taking this on and people are championing some of these efforts. And it is important to recognize that some of these disruptive changes, you know, really challenge our roles, they challenge culture, and they require a sort of a deeper thinking than simply sort of including folks on a committee or something like that in order for us to really actively engage and thoroughly integrate the value of lived experience. Next slide. I'm looking for timing here. Okay, good. All right. Well, I'm not going to talk too much about this project. You can find out more. You can reach out to me if you want to find out more about it. The point is, next slide, that while we did, in the course of doing this change-based intervention for Lines of Life, we found that folks really developed across the agency, felt more empowered, felt freer. And many people came out to talk about personal experience of suicide that they never felt they could before. So creating this welcoming environment enabled many things to happen. This was featured and actually drew a lot of attention in their local press as well. And I think was central in helping them get some more expanded funding as well. So these areas of integration really represent new and positive change as we start to think about how do we not just humanize the experience of suicide, but really integrate that, use that in a way that can help others in their hardest times. Next slide. So how do we do this? And I would suggest that I always like to talk about seeing the situation differently. And once we see the situation differently, we can think differently. And once we think differently, we will talk differently. And once we talk differently, we will do different things. So the biggest issue, and I think one of the hardest things when you are experiencing a really tough moment associated with suicide, is the feeling that people are unwilling or unable to hear you and be with you. We all know that feeling heard is crucial. And in any sort of service capacity, you're doing good work if the person that you're working with feels heard by you, if they feel validated by you. Because of the history of suicide, and also, frankly, because of a lot of internalized fear around the issue within mental health services, within individuals, and within our culture, it is difficult for people to feel like they can be seen and heard, that they could express really clearly feelings of wanting to die, thoughts about wanting to try it, et cetera. Because we know, and I'm saying we in the sense of people who are experiencing suicidal intensity, that that can produce a lot of negative reactions in other folks, or at least intense reactions. So as we all know, if you are a counselor, hopefully you're aware that what we're bringing to the table as supporters or counselors is our presence. And we are not blank slates. So we do react to issues. We have emotional reactions ourselves. And if I'm communicating with my colleague or my peer, and they're telling me something I don't want to hear or I'm afraid of, or that makes me think I might have to do something I don't want to do, then I'm going to have that internal reaction, and that's going to get in the way of me seeing them, me really truly hearing them. Our Growing Through program, and I'm going to introduce some of the concepts here, is kind of really about shifting that so that we can get closer to that. And people who are living with this stress, who are experiencing despair, can feel heard, can talk about it. And when we see these folks, and when we think about this aspect, which has been recognized and which much of my work has sort of focused on, that these tough moments are maybe central to people's change and central to people's growth. Then we can start talking differently, and then we can support people in these really difficult times and really enable them to feel seen and heard. Next slide. So this kind of goes to the essence of human connection. And I have a little version of a sort of stress continuum thing. Obviously you may have seen many of these in the past, but what I want to do is kind of just place suicide kind of into this normalized emotional stress context. So if we think about the left-hand side as relaxing on the beach, people bringing you treats and not doing anything, we know that that's a pretty relaxed place. Most of the time, we're more over kind of in the early green-yellow area where we're experiencing some stress in life. We need that to get us motivated to show up and produce. And then stress can get more intense, right? So on a basic level, whether it's daily stress they are exposed to or a result of sort of traumatic activation on some level or some underlying condition, whatever the case is, we experience discomfort. Stress becomes discomfort, becomes intense and distracting. From that, we might also move into a place of distress. Obviously distress just means bad stress, but in this case, as we use it in the more general context, distress is a sense of having being really intensely drawn or distracted or feeling physiologically, physically really bad, maybe having panic, shortness of breath, all of that physiological response. Next slide. Okay. So beyond distress, individuals experience disability. And I want to clarify here that we're talking about an experience of disability, which is not the same as identifying with having a disability or being a person who is disabled. So you might identify, as I do, as a person who lives with a psychiatric disability. That's a different thing. The point is that having an experience of disability is something anybody could do any day. You might just be too stressed to get to that meeting. You might be feeling so much discomfort or despair that you can't get out of bed today. I'm using these terms to really get away from sort of our psychopathological language. Just talk in sort of everyday terms about what the experience is of intensity and how it can lead to what we call suicidal intensity. So disability, distress, discomfort, all of these things. And then into the fourth D of despair comes up, where an individual feels there's no escape from their situation. Maybe there's no solutions at hand. There's not really much of a future. And when you're feeling that despair, whether it comes as a result of an immediate situation or something that has frustrated you for years, we want to seek relief. We want to seek relief from despair, from distress, from disability. Sometimes we seek relief in thoughts of death. Next slide. So this is like a slightly different way of thinking about things for a lot of people. I'm going to talk more about the seeking relief concept in a minute. But from a growth recovery perspective, we can also look at the five Ps in contrast to the five Ds. Now there has not been enough talk in general, I believe, and I would hope that some of you might help us advance a conversation around protective factors for suicide. There are hundreds of papers and studies on risk factors of different sorts and trying to map risk factors to actual risk prediction, this sort of thing. And that's kind of where the science of suicidology has really focused on. However, the really important thing that has kind of started to emerge more, but that has been sort of in the background is looking at protective factors. So we know some of the things that may enhance people's risk of considering or attempting or dying by suicide. But we also know what makes a difference and why people don't move from those places of despair to taking action on their thoughts of death. Sense of purpose is something that any of us can help someone support and explore in their lives. Prospects for the future. The presence of other folks are in themselves protective factors. So I just kind of lay these out in the five Ps. There's many ways of looking at protective factors and I encourage you to sort of research the literature because it gives, it's one of the things that folks with lived experience have really talked about a lot was like, not just what would negative happen, but what makes a difference? What made us or them go from a place of like thinking death was the only option to I'm going to get through this, I'm going to persevere through this. And what kinds of things can we, whether we're clinicians, whether we're community members, be bringing to the table, be highlighting and be thinking about with folks when they're experiencing intensity to help them grow through the moments without taking lethal action. Next slide. In our courses, and one of the things that we've really focused on, and I want to point out that we've done these trainings, these growing through trainings with everybody from community members that have no experience to clinicians who have been in the field for many years, psychiatrists recently in one of our training who have started to use growth recovery language as an alternative to the psychiatric language and to some of the medicalizing terms that you may have heard or that are kind of predominant in our field. We really encourage people to use a person first approach to folks experiencing suicidal thoughts and feelings to move away from criminalizing and pathologizing language. And because I'm not entirely sure what the background is here, but I want to just kind of clarify for folks as a really concrete example, the most criminalizing language related to suicide that is still being used every day is the word commit suicide or the phrase commit suicide. It's still a big part of our language. However, as we know, commit is associated with committing crimes, committing adultery. So it's a highly criminalizing and shaming association. If we can break that association, we're already doing good work. And I would suggest that for folks who don't know, a lot of work has been done with the media as an example. So if you see a media story, a news story, or read a newspaper article these days, very good chance they're not going to use the word commit at all. A lot of great work was done by various organizations, including SPRC to get media to stop using that word commit suicide. So the point is we want to humanize people's experience, be with them, be willing to say, this is what you're going through is tough. It doesn't make you bad. And also, and I think that this is kind of one of the core messages, that it's not really that unusual. There's a thought that at least 10% of the population think about the suicide generally, not serious thoughts, in any given year. And 50% of people in life do actually have some thoughts of suicide or some encounter with suicidal intensity themselves over the course of their lifespan. So this is not a rare condition, but it is one that people are still nervous about. So how do we get around that? We start to look at the role that encounters with difficulty, with crisis, with suicide play in people's growth, and start to use language that's really descriptive or phenomenological. That's therefore like the four, the five Ds, we're experiencing distress, we're experiencing despair. And the mental health field and psychopathology has all sorts of language, all sorts of language for this. And some of it has emerged into the popular culture as well. But we want to sort of get back to using everyday language that's not placed in this clinical pathology, partly because that language can create confusion, and also because it can reinforce power differentials that don't help when somebody, when you want to connect with somebody. We want to really connect with somebody, want to use language that supports them. Obviously, their identities and identities folks choose for themselves are really important. But we also don't want to be labeling folks. So as an example, we focus on process, we focus on growth, rather than giving labels, we can have a different type of conversation. So next slide, we're going to start look at what could these, what are the different types of words we could be using as an example. So I want to start with crisis, because this is an interesting one that our field has been talking about quite a lot, which is, you know, enhancement of crisis services. I'm all for that, in general. I'm sorry, Ebony, maybe you can just like click over a few times. Few more. Yeah. Well, and I'll just talk through some of these. So crisis is an odd term, because sometimes it's hard to determine who's making a call, so to speak. So how do I know if I'm in crisis, right? You will, however, hear things like people will say, you know, if a clinic is closed after hours, if you are in crisis, call the Suicide Prevention Lifeline or call 911. However, if I'm the caller, that propels me into a question of like, well, am I in crisis? And who makes that determination? And how is that determination made? So crisis is a useful term. But on the experiential side, what we really think experience, the experience is really one of distress, one of maybe struggle, or an intensity, as we call it. And in a way of thinking about this, it could be a transformative struggle, it could be not just a bad moment, but a central moment that you're going to get through that's going to make your life better and get help you get to the next step in the life you want to live. Triggering, this is a word that has kind of come about and associated with with some trauma informed work. So I don't deny the value of that. Triggering has some negative connotations, actually, and in fact, recently, I've been working with victims of mass shooting. Obviously, since it's associated with weaponry, it's not really a great term to use. And also it kind of conveys the idea that I am or we have no agency when we're triggered, that something happens to us. So activating is a more empowering term. We spoke of committing suicide. Act out is a term I hope that if you're in the field right now that you're not here quite so much as I used to. I started working in the 90s in mental health, and it was pretty common to hear this term used to express basically any time somebody was doing something that seemed weird or that people didn't like. But it's a very shaming and demeaning term. So usually what's happening there is people are expressing what's inside them. Their emotions are coming out in various different ways. We call that ex-behavior, but what if we just think about it as people are expressing the intensity they're experiencing right there? Next slide. And you can do the same thing rather than nectar. So suicidality and suicidal ideation, we like to really help encourage people to use the term suicidal intensity in its place. You can find some papers by me and some other folks on this. Very glad to hear that actually that some national systems have already started to use suicidal intensity. And the reason that that's really great is because I think intensity goes to, it could be various things. It could be emotions. It could be thoughts. It also reflects the fact that there's an experience of somewhat discomfort. So think of suicidal intensity. Good thing if you have to do note-taking where people put SI, suicidal intensity still fits with SI, but it's different from suicidal ideation. And I'm going to talk about that a little bit more in a second. Hopelessness. Hopelessness is a kind of, it feels like a dead state. If we think of what's happening with folks as dynamic, even when it feels really bad, and people who will be there will tell you, it is this feeling. It's not, the feeling of hopelessness is a desire for something else. Because we feel hopelessness because we don't feel meaning, because we don't feel purpose. We don't know a way to get there. So thinking about these processes enables us to have more empowering conversations with folks. Same thing, mentally ill is a term I hope folks don't use too much as a label. But the experience of mental health conditions, as an example, sometimes is framed in terms of suffering from. So somebody might say, this person is suffering from bipolar disorder. Well, that may be the case if they express it that way. But a lot of us prefer to say, we're living with a mental health condition. Sometimes that feels like suffering. If it feels like suffering, then let me tell you that it's suffering. Don't assume that whatever I'm going through is suffering, and sort of using that labeling format. Next slide. So you can have these slides, and I encourage you to think about these terms. And hopefully, some will really resonate with you. Also, if you have questions, sorry, next slide. If you have questions, I'd love to hear from you. Are we having trouble advancing the slides? Ah, maybe. Okay. All right. I encourage you to just consider some of these things. They might be really different for you. They might be challenging the way you think about things. Here's a big one, suicidal ideation. Well, when I was first working as a counselor in community crisis programs, I remember they always just said, just ask the person if they're having suicidal ideation. Okay. And then you had suicide SI plus. Well, think about it for a second. The question of whether or not I should live, whether I should live through this, whether I should stay alive when I might kill myself as an example. That is not psychopathology. That is one of the essential human questions. And it goes back to all throughout history as this matter of existential debate. From a humanistic perspective, it might be considered to be the core humanistic question, the core existential question, because humans are the only animals, the only beings that intentionally take their own lives and have the capacity to do that. If you want to geek out on the animal analogs for suicide, I wrote a paper on that. Glad to talk about it. But the point is suicidal thoughts and thoughts are not a psychiatric symptom. They're a question. The question of whether I should live, what I should live for, whether I should live through this, whether I can endure this is an important question. If we think about it that way, and we're not afraid of engaging in that question, we can really connect in new ways. Psychic, you may have heard this term depending. I think it's gone out of fashion, but I'm still trying to be a humanizing term. It's a little psycho nerdy, so we just encourage people to talk about despair or anguish, use those terms. Now, suicidal behavior. I think that one of the things that I have learned, or it's certainly true for me, but that also I've derived from conversations with hundreds of people who've experienced suicidal intensity and many different types of research projects, is that most people, I would suggest 90%, who are experiencing suicidal intensity and having thoughts, making plans to kill themselves, or taking actions in that direction, including self-harm actions, are not wanting to not exist. They're not necessarily wanting to experience death, but they're seeking relief. If you ask anybody who went through it, if you ask anybody who's been there, they will tell you, I just needed relief. I had to get out. I need some way of getting past this distress and this despair. Death represents that kind of relief, even the thoughts of it. People probably, you might have heard this, but it is true in my experience and in that experience of many people that just thinking about the possibility that I could die, I could kill myself next week, it provides relief for people to think about that, even assuming they never do it. If we consider that suicidal actions, suicidal behavior, suicidal intentions are part of this, and we look at what's happening there, we say, this intensity, this despair is so intense. It's so terrible. You're just needing some kind of relief. Death feels like, thoughts of suicide feel like they could be providing relief. It enables us to come alongside in a completely different way. In our courses, and I do want to clarify that since I talk about the experience of suicide as this kind of global experience, it is really useful to be able to distinguish seeking relief from taking lethal action or taking harmful action. We can have meaningful and powerful and empowering conversations with folks in the midst of suicidal intensity, where we parse those things out, talk about the desire for relief, and also help people not take harmful actions, not act on their thoughts related to lethal action. Next slide. Next slide. I pose these to you as a way of helping you think about how we can talk about the lived experience of suicide differently. The other thing that I'm really encouraging, and we're seeing more happen, is the implementation of these kinds of approaches in peer support for people experiencing suicidal intensity. This is emerging around the country. You can find out more about it in various places. Obviously, welcome to contact me. It's really growing. Next slide. We're seeing people bring their lived experience into behavioral health care in multiple different ways, including mobile crisis, what's called peer respite, peer support groups related to suicidal intensity, et cetera. Next slide. Also, you're starting to see people who have themselves lived experience be able to feel like they can use that and disclose that in the context of some classical suicide prevention services, notably things like Lifeline, like suicide prevention hotlines, et cetera. It's still really growing. We've got a lot to do in terms of training and empowering that model. As you can see, peer support plays a role in many places. Next slide. We can see that the one area that we feel like is really growing in terms of, particularly among youth, is this experience of distress as an opportunity to bring more of a lived experience, more of a peer support model forward. Next slide. We can just skip to the next. Thank you. Here, I'm hopeful that you guys will encourage and think if you're in a systems capacity, if you're working in some systems design or advocacy capacity or in a policy that we might bring and how we might bring lived experience and peer support into these different parts of the behavioral health care system. Next slide. I'm glad to be here or refer you to other folks who might think about what are the aspects of doing this, how do we do it, et cetera. Next slide. I really want to thank you for your time today. I'll finish with this quote here. My lived experience with crisis and suicide was incredibly painful. I would never give it up because it made me who I am today. I like who I am today. That's true of Terry. That's true of me as well. Many, many folks out there will tell you that. Let's engage with suicidal intensity. Let's engage with thoughts and feelings related to suicide in a humanizing way, reframe our approach to this really powerful and important experience with a clear view to preventing death by engaging and connecting in new ways. Thank you. Thanks very much, Eduardo. Let me turn my camera back on here. All right. I think actually if we could go one slide back, I just wanted to touch on some questions or if we could get to the Q&A here. Anyways, in the meantime, thank you, Eduardo, very much for sharing your experience. The way you proposed and outlined how to see, speak, and think differently about suicide in terms of intensity and growth and change for an individual is just, I think, really innovative. As you said, probably maybe very new for a lot of folks. I also really like the straightforward reframing of how to think of growth and recovery, alternative framing, and the language we use. I guess I'll share one connection I saw is that particularly with the idea of hopelessness being something that should be reframed as seeking meaning, I thought that really lined up with your previous comment about some of the Ps of protective factors, particularly purpose and prospects. That seems so straightforward and intuitive that those would be together. I wonder, as you've trained and worked with organizations, what are some of the biggest challenges to incorporating some of this thinking into clinical practice, into the way you interact with your peers and those you would care for that you've heard just from being in this space in the field? Yeah, I think a lot of people really resonate with the approach and the humanizing angle. The biggest problem that people I've worked with encounter relates to the systems-level approach. So as an example, you might be working in a clinic, and the policy is if somebody talks about suicide, you have to talk to your supervisor, or you have to do a risk assessment right away. A risk assessment isn't necessarily a bad thing. They can be done in ways that are less, I guess, imposing. But it also shifts the conversation. If it comes up and there's a conflict in what you would want to do and what your policy is, then it puts individuals in a tough position. Same thing with some of the language. Sometimes people's note-taking and stuff like that is expected to follow a certain format, and they're expected to respond or report on these things using a more classic language related to SISA, that kind of thing. Great. Thanks. I wanted to just share a comment that one of our participants made, talking about them working in a community health center, and their experience with suicidal feelings or intensity, let's say, has really brought value and mutuality to their work with peers. I think that's a good segue, too, and a link to the comments you were making about peers. But a question that I've seen in a few different ways, speaking of systems, is I think it is certainly an area that continues to grow and be spelled out about how to best organize in this space at a systems level. But I feel like the immediate thought tends to be, OK, well, we need to go and hire someone with lived experience, or we need to get a role for a peer support service person or persons. And I don't know that that's the case. And I think there are probably people at organizations that may not be in a space where they feel like they could reveal that. And you may already have that expertise. I wonder what your comment might be about that, or what your experience has been like that working with organizations. Is that something that you see a lot, too, that people just aren't looking at maybe the pool of light right in front of them? I like the way you put that. So, yes. And in fact, the Activating Hope project really, really zeroed in on that quite a lot, which is specifically helping people feel like maybe they could talk about these things. If you're in mental health, there's a good chance that you've been affected by mental health in your life. Everybody knows this. And same thing. Suicide is not an uncommon experience. I've worked with organizations where it was pretty clear to us, because we also did an anonymous survey, that people did not feel like it would be a good idea and that they should not share that. And there's all sorts of reasons that that is both perceivable and also perhaps true. So, thinking about your personal disclosure and thinking about how we encourage other folks to disclose in the way that makes sense for them is a really important process. And there's some work done on that. But it also highlights, kind of your question highlights, like the distinction between sort of an equity and inclusion approach, which is we just want to get people in here, versus we really want to bring the value of this. We really want to like, you know, enable you. We want to derive the value that you can bring as someone who has been there into the picture. So, yeah. And that's why I talked about sort of the culture change aspect. And, but I, you know, I'd be glad to talk with you or other folks about sort of approaches, some approaches that have been developed to this. Thank you. And one thing I wanted to go back to as well, just with respect to this, I think it was that you'd framed it as an area that we need to move into maybe, or that is definitely of current need, is a particular place in the system for peer mutual supports in the distress and subacute area among that spectrum, like levels of care, let's say. I wonder if you might say a little bit more about why that seems to be a really good match, since we have some time to go into that a little bit more. Well, one of the things that I think people will recognize on a sort of philosophical level, but it's kind of hard to understand on an individual level, is how shame, there's the role that shame and isolation play. And when you're feeling really, or you're feeling like having a lot of thoughts of suicide, you're feeling a lot of despair. And if you're, and if you are considering suicide or thinking about it a lot, you know that most people don't want to have that conversation. And even your therapist, and even your psychiatrist, they don't want to have that conversation. And they may not feel prepared for it. So, fortunately, there are some trainings now, like collaborative assessment and management of suicidology, and some others that help clinicians to have these positive conversations around suicide. But the fact is that it feels very isolating. And willy-nilly, as clinicians, people providing psychiatric care, et cetera, can be compassionate, but they might not necessarily bring the same thing to the table in the sense of being able to say, I've been there, right? Like being able to hear that, that was something we could never, was never permitted for a long time. And I remember like in my personal journey, like I had recently survived a temp, I didn't tell anybody, but I met a guy and I saw that he had scars on his wrists from having made a, you know, having sliced his wrist. And I knew right away I wanted to be friends with this guy, like, because I knew he had been there. We didn't necessarily talk about our suicidal intensity, but the point is, when, because we feel a lot of times we get to that place of despair and suicidal intensity because we do feel alone. And then the experience of suicidal thoughts and feelings, they can make us feel more alone when we're given to feel that there's something wrong with us, that nobody else is thinking or talking about these things. And into that, someone who has been there can bring a new light and can say, you know, um, I've been there, uh, and, uh, and you can get through this. So. Thanks. So I think to go back to your, the five D's and five P's for what you said there, you know, for anyone who is experiencing the intensity and some of those five D's that individual there, the, that's the, the presence piece, I think from what I'm understanding, what you were saying before that immediately having someone in this space, the presence piece can counter and can balance against some of the D's there. And I think that's, that's just immediately what I thought of when you said that, but, um, well, thank you very much for answering these questions. I see we're just at about time and I just wanted to go a few slides ahead, um, to acknowledge how folks can, uh, claim credit, uh, Ebony, if you don't mind advancing the slides there so you can go to learning center, um, to claim these credits. And, uh, you know, there's just some brief instructions there. You must submit the evaluation of course, and then move on from there. But, um, I think, you know, for today's webinar, Edward, I want to thank you so much for your time and for your expertise, um, and sharing a bit about your experience as well during the webinar today. Um, it's really been a pleasure and, uh, I think we'll, we'll end our time for today. And, uh, I mean, we can just go on to the very last slides if we have some more and, uh, we'll end here, but thank you very much again. And thanks all to our audience as well. Thank you for the opportunity, Adam. It's been a great, great opportunity. I look forward to more work with you guys at SPRC and, uh, anybody here, you know, who's, who's on, uh, hope that you'll feel free to reach out and connect if you have thoughts or questions. Thanks. Take care, everyone.

Power of Human Connections

Improving Treatment of Suicidality

Insights of Lived Experience

Reframing Suicide

Alternative Language and Concepts

Distress vs Crisis

Peer Support in Behavioral Health Care

Suicide Prevention Efforts

Humanizing Approach

Preventing Death by Suicide