Reading about Sue Martin

“When I began writing about my experiences I tried, in every way, to avoid telling that one part of my story, that I am blind as the result of a suicide attempt. It just didn’t work. It was like denying that I have a right arm.”

I’ve just come across the blog of Sue Martin, who is posting online the story of her attempt and of her life over the more than two decades since then. I’ve e-mailed her through the site and hope to hear more. Depression played a large part in her attempt, but her chapter-by-chapter story says little about what happened to those feelings as she struggled in her 20s to adjust to a life without sight. I’d also like to know how she talked with others about what happened, or whether this blog is her first public step. In one chapter, she does describe how she decided to be open with a classmate:

I found myself thinking that I had better tell Jim a bit more about myself. Specifically, I thought it best that he know about the cause of my blindness sooner rather than later. While blindness was becoming just part of who I was, I wasn’t quite there with the suicide attempt. Taking a deep breath, I began. When I came to the end of my story I waited. Holding my breath, I waited for Jim’s reaction.

“Oh,” Jim said. Then he added, ‘Okay.’ And that was all he said.

“Is that all you can say?” I asked.

“Well, yes, what else should I say?”

“You’re not horrified?” I said. And I thought, I might just fall in love with this guy. He knows what I considered, at the time, the most terrible thing about me and it was all okay.

They later married.

Talking With Daniel Alland

I came across Daniel Alland when he wrote a blog post in the UK about his suicide attempt several years ago. I hadn’t spoken with anyone from over there, and I wondered whether it was somehow easier in the UK to talk about suicide. We spoke by Skype, and then I went back and re-read his blog post. I liked that he was direct about his thinking after his own attempt and how his sister’s attempt not long after that changed him: “Up until the first time my family member did this, I maintained a very cynical attitude towards suicide,” Daniel wrote. “Even with regards to my own experience. I hadn’t truly listened to what those mental health charities were telling me – I was just concentrating on ways to cope. I convinced myself it was entirely down to my drug use and general weak-mindedness, and still believed that ‘It was the coward’s way out’, ‘How can someone be so selfish? They should be ashamed’ and all the other disgustingly ignorant things you hear from the ill informed about suicide.

“But when it happened to someone I knew; someone whom I had enormous respect for; someone who was strong in character, intelligent, a real fighter; I knew that this was not the attention seeking display of selfishness and spite that I was led to believe. This was a genuine problem that, if treated with contempt and disdain, could result in a successful suicide attempt one day.”

Both Daniel and his sister have moved on from their experiences, and during our conversation, he dismissed the idea of being followed around by stigma. “Just because you suffered mental health issues doesn’t mean you’re an incompetent oaf,” he said.

Who are you?

My name’s Dan. From little old England, the south of England. I work for the Ministry of Defense, and I do a bit of writing in my spare time. That’s about me summed up.

What happened? How did you get to the point where you’re telling your story?

Right. I live in a very small town in Hampshire, and there’s a little park near where my parents live, where I grew up. Basically, a few kids just decided to hang themselves in this park in the same tree, and no one knew why. It was very, very troubling, confusing. We had no idea what drove them to it. It brought back a lot of memories, really, what I went through, me and my sister. I just thought, “This could go on indefinitely, you know.” There was a case in a Welsh town called Bridgend. An old story but quite incredible, a very small town, some 30-odd suicides in eight years or so. I just thought it seemed like an epidemic, and I wanted to write about it. I didn’t think some bloke would see it and stop it happening, but I thought if I share my experiences, “Look, I know how bad you’re feeling, you can move past it as though it never happened,” you know? They’re all choosing the most definite form of suicide, isn’t it? Hanging yourself. Not like what I and my sister did, which was to hop up on pills. So when you do that, you have time to reflect afterwards.

When did this happen?

I was 22. And I’d been sort of, like, taking quite a lot of drugs, at first recreationally, and then it kind of escalated to drug abuse, basically. It’s not something I’m proud of. I’d already sort of had a problem with depression since I was a kid, maybe something I was born with. Even my dad said he had it himself. He’s been able to keep it under control. So the years when I started abusing drugs, stuff like that, I wasn’t entirely happy with my employment, I felt stuck in a rut. So one day, I just took a lot of pills, just horrible. A similar situation for my sister, really. She was probably a similar age, a few years after. The thing is my sister, she had repeat episodes, a few times she did it. But she’s totally past it now.

Are you?

Yeah. I still have days where _ I never contemplate suicide, but I do have days where I think it wouldn’t matter if I died today. It sounds weird, but _ You think it wouldn’t actually be that bad, if you died. It’s only very occasionally.

How old are you now?

26.

You said trying to kill yourself by taking drugs gives you time to reflect. Did you?

It was about half an hour afterwards. I just thought, “Oh crap.” I started thinking about people dear to me. I had a girlfriend at the time, she was great. I was thinking about my lovely mum. Ridiculous. Instead, I jumped in the car and picked my girlfriend up from a job interview. She said, “I think I got the job. How are you?” I said, “I took a load of pills.” She said, “Right, drive to the hospital now.” The hospital in our hometown is crummy. If you want something more than, like, your fingernails clipped, you have to go to Winchester, about 30 minutes up the road. They took me in an ambulance. I left my car and it got a ticket. I got a nice parking ticket.

How could you decide to kill yourself without knowing about the lethality, or not, of what you were doing?

I took 20 painkillers without doing any research whatsoever, because it wasn’t until that moment that I knew I was going to attempt suicide. I had the pills in the drawer and I thought, “If I bosh all these with a glass of water, I’ll probably just fall into a coma and then die.” Very, very silly of me. And I would obviously not recommend anyone do it.

How did everyone respond?

It was very brief. They were like, “Why did you do it?” I said, “I don’t know.” I said, “It won’t happen again.” That was it. It wasn’t until I wrote that blog post that I’d spoken openly. I just said I was down, told them I’d been taking drugs, and they were very disappointed, but they didn’t say anything. They just said, “Don’t do it any more.” I don’t know, it’s not an easy one to talk about, really.

There’s no feeling of having to hide anything?

There were only my parents, my sister, who know I did it. I don’t think they told.

The blog you wrote for, does it have a big audience?

Quite a big audience. The chap who runs it used to be editor of Loaded magazine, the biggest in the UK. It’s weird, actually, because I wrote my blog about depression and suicide and a few weeks later, a young lady on there wrote a blog titled, “I had depression before it was cool.” Quite flippant, the blog post, hers. Mine took a slightly more serious tone.

How did people respond?

Very positively. I posted a link to my Facebook page. I was inundated with positive messages: “I had no idea.” A few took slight comfort from it because they knew the guys who did end their own lives. I just wanted to create a sense of community, everyone sort of pulling together. I don’t know what I wanted from it. I just thought it’s got to stop. Thank god there hasn’t been any subsequent suicide. There were actually four, and I write in the blog there were three. There was one I didn’t know about. I think the local newspaper got tired of reporting those suicides every week.

How would the newspaper cover it? I’m not too familiar with the media over there, just the papers like the Guardian and the Times and then the tabloids.

Funny you should say that. We have a local radio station called Andover Breeze. When they reported one of the suicides on their website, a young girl, 22, very, very sad, they wrote the copy in the most conversational style I’ve ever, ever seen. It was titled “A body’s been found.” So conversational. Ridiculous. My flatmate actually sent them an e-mail to tell them off. It seemed so insensitive, to put it so flippantly as that. I think they should cover it, but I think they should be approached sensitively and respectively. I think it’s good to talk about it, you know?

How to talk about it?

I think as far as the media goes, even the sort of most reprehensible tabloid papers like the Mail cover it quite sensibly. I think it’s actually the average man on the street who has the worst attitude towards it. A personal example: After the episode of mine, about a year later, it was my mum’s birthday, and we had family around. My aunt said, “Oh my god, you’ll never guess what happened to us today. We were driving to Tesco and I was driving up the road, about a 40 mile-per-hour road, and we saw a strange-looking chap who stood on the sidewalk looking shifty, basically a guy who’s tying to kill himself. He tried to jump in front of the car.” She slammed on her brakes and just stopped from hitting him. I said, “God, that’s tragic.” They were just like _ my little cousins were laughing about it _ what a sad case he was. And then my aunt and uncle were in agreement, “What a sad idiot, how selfish it is to jump in front of our car! If he’s going to do it, do it, just hang yourself.” I kind of thought, they didn’t for one minute try to put themselves in that chap’s shoes. They made him a figure of fun.

Did you bring up own experience?

I didn’t. I was going to do it, but it was my mum’s birthday, and I didn’t want to create a scene. Maybe if I had had a few drinks, perhaps. But I didn’t want to ruin it.

How can people make this topic more approachable, more comfortable?

Good question. Just give people like yourself more of a platform. A lot of charity adverts. You see them all the time on Sky News, other news channels, every other advert is for a charity. But it’s never a mental health charity. Interesting.

Maybe there’s a different reaction in the UK if someone talks about their experience? Maybe you guys are more open than over here in the U.S.?

It’s not, really. They just think you’re a bit nuts. It’s a shame. Maybe even more so because perhaps we’re slightly more cynical. That’s what we do. We’re very good at it. I think it could change, over time. As long as you keep giving people the platform to talk about this. Like TV, if you got TV behind it, adverts. I rarely see adverts even in newspapers regarding mental health. I think that’s the best way. Just put it out there. Because then you normalize it, don’t you. The more it’s seen in the public eye, it doesn’t become such a taboo subject.

Are you concerned about people Googling you and finding your post? Say you look for a new job and they look at your background?

Yeah, well. I couldn’t not do something like that because I thought it would hurt career opportunities. A slight shame in that, if you ask me. It’s not the right reason not to do something.

You said you work with the Ministry of Defense. There’s no concern?

Yeah, maybe, if that’s the sort of thing they sack me for, then shame on them. I’d quite happily, if I was to be sacked, or if I found out I was overlooked for a position because of that, I probably would go on a campaign and try to bring those people down. I would do something like that. Just because you suffered mental health issues doesn’t mean you’re an incompetent oaf.

In this country, one good thing, we’ve got a lot of high-profile famous people _ You know Stephen Fry? He did a brilliant two-part documentary on his bipolar disorder. And obviously he’s the hardest-working man in show biz. Really intelligent, really talented. He suffers sometimes, like, very badly with bipolar disorder. I think, well, it just goes to show people can cope and get on well in life.

Were there any resources you found useful when you were getting back on your feet?

I think the best resources are literally just friends, really. There’s a few, sort of, like, charities and websites. Time for Change is one of them. They’re more about exposing and combatting prejudice against mental health. I saw a couple of social worker-type people. They were very nice, they listen to everything you’ve got to say, but really, you’ve got to help yourself.

Is there anything you’d like to add?

I was gonna mention the first port of call: Anyone who’s ill goes to the doctor. That’s what I did. I went to see a GP, a general practitioner, just at a local clinic. And that didn’t help at all. Before you’ve even sat down, they’ve already given you a prescription for antidepressants. They hand them out like Smarties. I didn’t get on with them at all. I don’t think the best way to combat mental health is with drugs. I stopped taking them. I’d like to say the drugs didn’t work.

Did they follow up with you to check on how you were doing with the medication?

Not at all.

Finally, who else are you? I have this sort of narrow view of you so far. And the Ministry of Defense job sounds rather mysterious.

I don’t deal in the sort of exciting part of the Ministry of Defense. We just look after soldiers’ accommodation. I quite like talking to the soldiers. They’re great guys, doing a great job for us. Obviously these people, some of the sights they see, losing their friends, going off to Afghanistan, I think if these guys can cope with those kind of experiences, surely I can. Apart from that, I’ve always played in bands, stuff like that. I do writing for the Sabotage Times, album reviews for Virgin. I write a bit of fiction as well.

It’s the last thing, depression and suicide, the last thing I define myself by, to be perfectly honest. I wanted to write about it because it was the biggest story in my hometown at the time, and I thought I had to give some sort of commentary to this. But I don’t define myself by that by any means. That website, my next post for it was slagging off the rock band Muse. I don’t know, the next post may be about ice cream sundaes.

Talking with Shari Sinwelski

Earlier this year, I got the chance to meet Shari Sinwelski, who works for the pioneering group Didi Hirsch Mental Health Services in the Los Angeles area. They’ve started one of the very few support groups for attempt survivors, and now questions are coming in from around the country by people curious, though nervous, about starting their own. Shari runs the group and explains here how it’s been going and what she’s been hearing from people who’d like to see or set up similar efforts.

“Definitely there’s some energy out there,” she says. “I think people definitely need some place to go and are finding nowhere to go.”

Who are you, and how did you get into this line of work?

My name is Shari Sinwelski, and I work as the associate division director of the Suicide
Prevention Center at Didi Hirsch in Los Angeles. We have a crisis hotline, support groups, a suicide response team and a lot of community outreach and education, programs with a couple of emergency departments. One of the things I was specifically charged with when I began was to develop a suicide attempt survivor work group.

I got into the field kind of by accident. I’ve been working in suicide prevention for about 18
years. I started in this field when I began volunteering on a suicide hotline while getting my
undergrad degree in Florida. I kind of did it as lots of undergrads do, to get experience, but I
really liked it. After my degree, I ended up working as the director of the hotline there. I was in Florida for 12 years, then I was director of the suicide hotline in New Orleans after Hurricane Katrina and was there for several years. Then here. I’ve been here since _ let me think _ 2009.

How did this group get started?

The Suicide Prevention Center started the first suicide prevention hotline over 50 years ago and has always been a leader in the field of suicide prevention. There were several reasons we wanted to start this group. Some of the idea came from recommendations coming from the National Suicide Prevention Lifeline. In addition, we would receive calls on the hotline looking for a group for attempt survivors. Many people would report that when they would search for suicide survivor groups, the groups were always for people who lost someone to suicide, but never anything for someone who survived an attempt. We felt that a group like this would be a great way for people to know that they weren’t alone and hopefully a way to get rid of some of the shame and secrecy that often surrounds the topic of suicide. In addition, there was some funding here in California for early intervention., and some opportunities because there was money for prevention. Didi Hirsch was the first suicide hotline in the country, so it’s kind of in the forefront of suicide prevention. We wanted to try this, so we tried.

How does the group work, and what have been some of the concerns?

There aren’t a lot of options to look at for best practices. And so I contacted Lifeline and found out about other groups across the country. Ultimately, the only ones I reached were Stephanie Weber and Heidi Bryan. We also have some attempt survivors who volunteer on our hotline, and I had my own focus group with attempt survivors, getting some ideas on what they thought would be important. Also, we run a support group for people who have lost someone to suicide. In a way, we somewhat mirrored the group in some of the logistics. Not the concept so much, but the structure. We also consulted with Dr. Norman Farberow, one of the founding fathers of our agency and an expert in suicide prevention. He had experimented with a group for suicide attempters many years ago.

What we’ve got going right now, a year and a half so far, is a closed group, so people are only allowed to join at the beginning of the group. That helps with group bonding and helping people to really get to know each other. It’s eight weeks. The individual goes through a telephone intake with me so I can learn a little more about their experience, to make sure that we both feel a group environment is something they’re ready for. They have to wait a little for the next group to start, so I try to assess that they are safe and have resources in the meantime.

How do the sessions go?

It’s interesting. It’s a peer support group but not a therapy group. We meet once a week. Initially it was an hour and a half, but recently it went up to two hours because there were bigger groups and not enough time to get everything done. When we first started, I mapped out a plan of topics to cover each week. Honestly, as the facilitator, I felt pressured to have something to fall back on. But I think what I found as the group progressed was that I really needed to stay in tune with the pulse of the group. A lot of times we didn’t do anything that I had planned. In the first few weeks, we really just take some time for members to get to know each other. On the first night, we’d go over guidelines, things they can get from the group, the chance to introduce themselves
and share stories of their attempts if they were comfortable. Sometimes the first few groups can be really difficult for members, especially if they have never talked with anyone about their attempt. If it was difficult, we encourage them to stick with it and follow up with every new member afterward to make sure they are comfortable.

Every group is different. Some bond quickly, others are more reserved. Sometimes if they need more of a conversation starter, we show an NSPL video that shows stories of others who have survived a suicide attempt and they can relate, talk about stigma and other concerns. But one thing we’re finding is, a lot of times group members really just needed support to talk about what was going on in their lives. Because the topic of suicide can be scary for some people to talk about, once they find a safe place, it can be really freeing. So at the start of each group there’s some time for members to check in and talk about what was challenging about the week. That can also be challenging, because if members don’t have places in life to be open and honest about what’s going on, it could bring the group to a very low place if member after member after member is talking about what’s the
negative things that are going on in their lives. The group also has to be a reassuring place to come to. A place to find hope. And so one of the things we’ve always kind of emphasized is the concept of ambivalence. A lot of times people are dealing with depression, they may be experiencing a lot of pain, and it causes them to have thoughts of suicide. At the same time there is usually something that keeps them hanging on, some reasons for living. I do that on the intake, ask them to tell me about both sides: the concerns, the pain, but also the positive things that keep them going. We incorporate that theme into the check-in. It’s a time to talk about challenges in life, but also about what’s been positive and went well. What we’ve found is, it’s helped a lot, but sometimes members can’t find their own positives, so a lot of times members start to point out positives to each other.

We’ve also incorporated other things for fun. Like at the beginning, I found it pretty cold and sterile, so I always make sure we have refreshments, drinks and food, a more welcoming environment. At times we’ve done other things for fun, For example, last year we were meeting around Thanksgiving and a lot of people said they did not have plans; we made one of our groups a Thanksgiving potluck. I guess what I’m mostly trying to convey is, we try really hard to get feedback on the needs of the group. It’s really crucial if they’re only coming and talking about the negatives and struggles to find ways to incorporate hope as well, otherwise, people might not necessarily want to come because they’re already in a bad place.

How many people are in a group, and how any have been through so far?

Right now, we’re on the eighth group. We have had as few as three, and I think our biggest group was seven. We have right now four people in this group. I think there’s been a total of 24 people. Some people repeat for multiple group cycles. I should say we didn’t want people just popping in and out because we really felt people had to feel comfortable. Also because this is a topic that can be so scary. A lot of members are still thinking about suicide, and when people are just coming in and out of a group, people wonder why they’re not coming. It doesn’t help the consistency. But the eight weeks are kind of arbitrary. It’s not to say at the end, ‘OK, you’re done, everything’s perfect.’ It’s a way to allow people to join or come back again. What I found is some members at the end of eight weeks are still finding the group to be helpful. We have allowed group members to be in additional cycles. So of the 24 different people in the first seven cycles, some repeated.

Are any topics not allowed in the group?

No, we haven’t really come up with any topics so far that would be prohibited. On the other
hand, it is a group, so we are always checking in with the group to make sure that topics are comfortable for everyone. If something was distressing, we might ask members to refrain from those topics.

What’s the most surprising thing you’ve learned or observed there?

I can’t really think of anything that was surprising, per se. But I am always amazed by the
courage of the group members to be so open about the experiences and the desire to help each other even when they might be struggling.

What comes out in the support group that wouldn’t come out in a crisis call or counseling session?

I don’t think there are any topics that come up that wouldn’t come up in a crisis call. However, the opportunity to talk with others who have been through a similar experience is something that is different. Members can feel comfortable being completely open and honest with each other, knowing that they won’t be judged. They can also learn things from people who have walked in their shoes.

You’ve mentioned that people have been contacting you about the group. What are the concerns they bring up?

I think one of the things expressed to me is, is it helpful to people who are struggling so much personally to take on the struggles of other people. In other words, is it a good idea for people who are suicidal to all be in a group together. Not that being part of the group requires it, but it happens. They get to know about each other. They might be worried about someone they met or become friends with and may also be suicidal. It can have two different effects. A positive effect is that sometimes they then realize the seriousness of their own situation: ‘Oh my gosh, I wasn’t really thinking how my decisions and actions affect people around me.’ Other times, it’s frankly too much to handle when they’re dealing with stress, depression in their own life and now they have five, six others in the group to be worried about. It can be too much. A couple of people have left the group because of that. Of course, we worked with them to make sure they had other sources of support.

You mentioned screening. What kind of restrictions do you have, if any, or other concerns?

The most important thing is to try and assess if people have enough immediate support in their lives that they will be able to stay safe until the next group starts. We also want to make sure that people have a good understanding of what they can expect from the group. That they feel comfortable speaking in a group environment. It can be helpful if they have a counselor or therapist as well, but we don’t require it.

How you feel personally, taking on work like this?

I definitely feel more positive than negative. Overall, I feel the group has been helpful. We
survey participants before the group, and at the end, and the feedback has been for the most part overwhelmingly positive. At some times I wonder _ and I’m trying to find words to describe this _ it’s not a treatment group, yet sometimes members need more, and sometimes when they’re at such risk, it’s hard not to give them what they need. However, that can be a difficult position to be in. What I mean is that either they are not connected with a therapist or need more than what we can offer in the group. Maybe they would benefit from medication or individual therapy. Maybe their therapist is not comfortable talking about suicide, and they seek out other people. That can be really challenging.

We have been trying really hard to get feedback from participants about the group. So that we can make sure that it is effective and meeting people’s needs. They provide feedback on their experiences after the group, what they liked, what they would like to see change. We also had a focus group and invited everyone who had completed the group to come and give feedback to our quality assurance department. It was a great opportunity, participants were really grateful.

All of this requires extra time, too?

I would say so, for sure. A lot of times people in the group need an extra support between group sessions. That can take a lot of time. I’m not saying it’s impossible, but I think a strictly peer-run group might be hard. It would take a peer who’s really at a good strong point in life to handle the intensity. When we started, we had an attempt survivor as my co-facilitator. After a while, it became overwhelming. There were a lot of things going on in her life, and she decided she needed to take a break. If it were just a peer-run group, it could happen to a lot of people. I’m not saying it’s can’t be peer-run, but I think it definitely needs to be somebody in a good state of mind that’s able to take care of themselves while taking care of others.

Do you know of other groups out there?

I don’t know of any comprehensive listing of groups in the US, but I know there aren’t very
many. There a few others in California that are just getting started, one in Illinois, I think one
in Arizona and a few Suicide Anonymous groups around the country. There’s been lots of people who have contacted me wanting to start one, asking similar questions. I’ve had five or six of these conversations. And we had one group member who moved out of state, he’s trying to start one. Definitely there’s some energy out there. I think people
definitely need some place to go and are finding nowhere to go.

New: National Strategy for Suicide Prevention

After what must have been an enormous amount of herding bureaucratic cats, the U.S. surgeon general and the National Action Alliance for Suicide Prevention have released the 2012 National Strategy for Suicide Prevention. It’s rich in information resources and includes a small nod to suicide attempt survivors, and I picked out the most interesting parts on that subject in bold:

“Objective 10.3: Engage suicide attempt survivors in suicide prevention planning, including support services, treatment, community suicide prevention education, and the development of guidelines and protocols for suicide attempt survivor support groups.

“Making a suicide attempt is a risk factor for later death by suicide. Promoting the positive engagement of those who have attempted suicide in their own care is likely crucial in successfully reducing risk for suicide. In addition, these individuals can be powerful agents for challenging prejudice and activating hope for others. Most successful suicide prevention strategies have used multiple components, but one underutilized intervention in suicide prevention has been peer support. Appropriate peer support plays an important role in the treatment of mental and substance use disorders and holds a similar potential for helping those at risk for suicide. Guidelines and protocols are needed to support the development of such services for those who have attempted suicide, as well as technical assistance to assist with the dissemination and implementation of these tools.”

I should add that I’m now on the Action Alliance‘s newly expanded task force for attempt survivors, which spent today talking about how we can use our experiences to reach out to others and generally make sure a suicide attempt or suicidal thinking can be unhooked from such unhelpful responses as secrecy, panic, contempt, disrespect, ignorance and shame. As the new national report puts it, smartly lifting a phrase from another long-fought battle over stigma, “This culture of ‘don’t ask, don’t tell’ can foster rejection, social isolation, and even discrimination if the suicide attempt is known.”

I was happy to hear the term “peer support” several times today, and I was happy to hear from some spirited, open-minded people. I expect to add more resources to this site soon.

The new national report’s sections on attempt survivors can be found on pages 63 and 110. One of the four main goals of the report is to “change the public conversation about suicide,” and another is to make a far better accounting of suicides and suicide attempts. I believe that will improve as stigma decreases and people are more open about accepting and saying for the record that a death is actually suicide, or that an overdose, for example, is actually a suicide attempt. Better numbers will give a better idea of how to track and target suicide as a serious health issue _ and, as the report points out, “not exclusively a mental health issue.”

The report, being focused on prevention, doesn’t get into any discussion of whether suicide is ever a considered, respectable action. Among its suggestions is promoting the goal of “zero suicides,” and it takes reading the smaller print to ease the concern that people who may insist on having control over the end of their lives are going to face stigma anyway. “Part of the zero suicides strategy may be for health systems to conduct a root cause analysis (a structured process used to determine the causes of an event) of suicide attempts and deaths, and to use findings to try to continuously improve service quality by focusing on systems issues rather than individual blame,” the report says. Emphasis mine again, and it’s not meant to be cranky. This national report is aiming at a widespread issue in which every case is deeply individual and never completely understood, and it makes sense that they’re trying for the best results for the largest number of people.

I don’t mean to get too into the weeds here. I’m reading through the report as I write this and am commenting on what looks intriguing. For example, in response to what must be a more vocal protest against forced psychiatric treatment, the report suggests delivering services in the “least restrictive settings,” as well as “non-coercive approaches” to people who fear the consequences of talking about suicide.

And, jumping back a paragraph to “systems issues,” I want to note that the report identifies middle-aged men as a high-risk group for suicide and then says that “there are no resources specific to midlife adult suicide prevention.” That seems like quite a gap, especially in these unhappy economic times and as the number of suicides among military veterans grows.

Take a look at the report _ and the wealth of websites and organizations at the end _ for an idea of how it may affect you.