Talking with Tom Kelly

In this era of creative business titles, there’s something pretty cool about being the manager for recovery and resiliency. That would be Tom Kelly, whose life reflects his work. He’s been through a period of homelessness, the questionable interstate shipping of mental patients known as “Greyhound therapy” and more than one suicide attempt. Now he works for a major mental health provider as one of its peers.

He’s also moved from being scared of mentioning his attempts _ what if he was the only person with the experience? _ to being absolutely open. And after he tells his story, he often finds people who reply, “Me too.”

Here, Tom talks about his transformation, his work and the question of whether peers one day will run the mental health organizations that now offer them welcome. He thinks that it will take a lot to overcome entrenched perceptions.

“In my opinion, the professionals that work in the field only see people when they are doing poorly and in need of attention, help etc.,” he says. “They do not see people when they are doing well! When they see people such as myself, they say, ‘But you’re different!’ I am no different than the person who walks in off the street today … ’cause I was that person 20 years ago!”

We spoke by Gchat:

 Tom:  hi
 me:  aha!
 Tom:  Finally
 me:  sweet. thanks for being available!

Tom:  no problem my pleasure

 me:  ok then. is it all right to use your name?
 Tom:  Yes
 me:  great
 Tom:  First and last if you wish
me:  very nice. OK, then, and we’re off …

my first question is always to please introduce yourself. who are you?

Tom:  Well my name is Tom Kelly and I work in the greater Phoenix area for a managed behavioral healthcare company.

I am their Manager for Recovery and Resiliency.  In that role it is my job to help get the voice of individuals receiving services and family members to the table.  As a person with bipolar disorder with psychotic features and as a person who has attempted suicide on more than one occasion (three serious attempts) I am able to use my lived experience to help others understand what it is like for individuals such as myself.  I am able to help coach, mentor, train and educate not only staff members but also community stakeholders and individuals receiving services and show them that recovery is real and possible for everyone … no matter where we came from.

Anything else?
me:  how did you decide to talk openly about your own experience?

 Tom:  I decided to speak openly about my experience after a series of different events that have happened throughout my life!  It was a process.  I remember having challenges with mental health issues going back to kindergarten … throughout elementary school and high school and college I suffered from depression and the resulting desire to end my life.  After going through several hospitalizations and spending some time living on the streets I ended up in Arizona where I started getting the proper treatment. I was misdiagnosed with depression at that point but I knew there were other things.  When I started to understand the swings of bipolar disorder and get the proper diagnosis and treatment my life started improving.

Tom:  When I started getting that proper treatment and my life started taking a turn for the better I thought that it was my turn to share my story to help others who may have gone through what I went through.  I didn’t disclose everything at first – it was some of the things that happened to me! I would talk about the mental health challenges but not the suicide attempts.  It was not until I met others who shared a similar experience with suicidal ideation or attempts that I was able to say … Me Too. I guess there was hesitancy because of what people would think of me if I told them I had attempted to end my life.  I’ve come to the point where I am not ashamed of anything that happened so if I can share and help one person than I’ve helped one person!

me:  Where did you bump into others who talked about their experience?

 Tom:  When I first got introduced into the Arizona behavioral health system I started going to a support group for people with depression and bipolar disorder.  I was referred to the group from I was referred to the group from my hospital social worker at Good Samaritan Hospital.  I thought I was alone, I thought that no one went through the things that I went through … but in that group I found some shared and similar experiences.  From there I started advocating in the system and would meet others throughout the state.  Eventually I began meeting people from all over the country.  It’s interesting in that I can talk to a group of individuals wherever they may be and usually without hesitation there are always one or two people who open up and share their experience.  I wish I had bumped into these people decades ago as opposed to years ago!

 me:  How to make it easier for everyone to find each other, by the way? Any ideas?
(And why has it been challenging to find them?)

Tom:  Let me tackle the “why has it been challenging to find them” first!  Stigma, discrimination and prejudice!!  People who have attempted suicide have shared with me that they were ashamed, that they felt guilty, and that they became disconnected from themselves and others!  I can understand why some choose not to talk about their experience.  I was ashamed and couldn’t even tell my family what I had tried in the past because of the “perceived” belief on how they would treat me – so I just kept it bottled up!  I think we could make it easier for people to find one another by sharing resources and information throughout the “health community”!  Primary Care Physicians should have information about mental health and suicide in their waiting rooms.  They have information about high blood pressure, heart disease and how to get better sleep.  If they had information about suicide, suicidal ideation and behavioral health issues perhaps that would help people find a connection to a professional who could connect them to the community.  Education is also important – we need to start education individuals in kindergarten!

 me:  Did you ever tell your family, eventually? And how was the response?

 Tom:  I was in a hospital in Iowa and transferred to a hospital in Canada (where I grew up) – my doctor thought being around my family would help in my recovery! My sister flew down to Iowa and we drove back to Canada.  I shared with my sister and that was well received.  I have a great baby sister!!  When I got into the Canadian hospital I was able to tell my parents about what had happened and my second suicide attempt (but no one knows about the first or third).  They response was supportive from my perspective – I still have one sister that doesn’t quite understand what I go through – but my family is understanding!

me:  What’s your advice on how to tell family members about an attempt, or about thoughts of suicide? And what’s your advice on how they should respond?

(This being a big concern out there.)

Tom:  I wish I had an answer to that question as it is a big concern!  I guess I would take a matter of fact approach and describe the signs and symptoms of what it going on in a person’s life!  Paint a picture to help the family understand and empathize what their family member may have been going through.  After painting that picture by trying to educate the family about the signs and symptoms of depression, bipolar, etc … and explaining that some people with mental health challenges sometimes attempt (and share
those statistics) …I would suggest that they disclose their attempt.  If family members could understand the underlying issues going on in a person’s life perhaps they could understand the attempt.  I can not imagine what it was like for my mother to hear that her only son tried to kill himself.  My mother could not imagine what it was like for her only son to want to end his life!  By understanding the diseases, illnesses, disorders – whatever it is we want to call them, perhaps family members could understand why someone would attempt to end their life!  How should they respond – truthfully, honestly, and openly!

 me:  I want to go back to something you mentioned, about living for a while on the streets. Can you talk a bit about how you got there and how you got away from that … or at least how you got away?

 Tom:  I was married for about six years and after my divorce I became seriously depressed and decided to end my life!  I ended up at a hotel and took an overdose – about thirty or forty pills – can’t remember what they were and I started to become sick and I wanted to die – I didn’t want to be sick (weird I know) so I called 911.  I ended up at a private psychiatric hospital.  After a few weeks of care I was transferred to the State Hospital where I spent about 18 months.  After my release from the State Hospital my home was the streets of Waterloo, IA. They basically dropped me off on the streets with no plan of action – except the address for a homeless shelter and the name of a behavioral health outpatient clinic.  Well there was no room at the shelter and I spent the next few months on the streets of Cedar Falls/Waterloo Iowa.  I ended up back at the State Hospital and once again after another year or more at the State Hospital I was offered “Greyhound” therapy.   I was given a bus ticket to Florida – I had secured a place to live with my father at his trailer in Fort Lauderdale.  I was given the name of an outpatient clinic but
didn’t follow up. Eventually I left the trailer and spent a few months on the streets of Florida!  I ended up in Arizona in August 1998.  It was here in Arizona that I finally got introduced into the public mental health system.  The public mental health system gave me the support I needed to get back onto my feet.  They helped with vocational rehabilitation, medication, therapy and most important ‘housing’!! I ended up on the streets because I didn’t have any hope, I ended up on the streets because I didn’t care … well the AZ public mental health system offered me that hope and caring at a time when I had none!

 me:  And how did you move from being helped to helping?

Tom:  When I was introduced into the Arizona mental health system I thought I was the only person who went through what I went through.  When I found out there were others I started to socialize with them and attend a few support groups!  The one I mentioned earlier!!  From that I learned about the Arizona Behavioral Health System and a friend mentioned a County Advisory Council.  I didn’t know anything about advocating or speaking on my behalf let alone the behalf of another but there was a person that my friend thought I should meet.  That is the only reason I went to that meeting.  From that meeting someone heard me share a little about my story and said they wanted me to talk to some case managers. After sharing my story with those case managers in the system on thing led to another to another. I met people who were interested in helping me (because I started to want to help myself) and from there ended up doing some contract training for the local managed care company.  I say that I am blessed for what I have gone through (the good, the bad and the ugly) because I would not be where I am unless I went through what I went through.  I’m helping or attempting to help others today because I want to give back to a system that saved my life.  I want to give back to those who helped me get to where I am today!  In all honesty though – giving back is selfish for me –  for when I give back and help others I get the opportunity to let others know that there is hope … the more hope I can give … the more hope I get back in return!

 me:  Do you think the approach in Arizona is pretty representative of the approach in all areas of the country? I suppose this is a way of backing into the question of what changes are still needed to the system at large …

Tom:  I have had the opportunity to do some work around the country and I do not believe that the Arizona approach is representative in all areas of the country.  I was discharged to homelessness in two other States (Florida and Iowa) – I was given transitional living services when I was discharged from my only hospitalization in Arizona back in 1998.  The behavioral health systems throughout the country state that recovery and peer support are some of their overarching principles … Arizona followed Georgia into the peer support world within a few months!  I think some states are strong on peer support – many need help.  In my experience where there is strong peer support, the behavioral health system is a little stronger too!  Maricopa County through Magellan Health Services offers support groups for people who have attempted suicide that are peer-run and peer-led.  There are only a handful of support groups for people who have attempted suicide across the country … there needs to be groups such as this throughout the country.  Funding is a big challenge within the behavioral health world as many programs and states are underfunded.  I think funding would help improve the system at large – I think helping develop programs and including those individuals who go through what they go through need to be part of that program development!

 me:  You mentioned “Greyhound therapy,” and that reminds me of a story about a similar case that made the news earlier this month. Any idea how widespread that practice is? And surely it’s illegal, or at least unethical?

Tom:  Getting a bus ticket from one part of the country to another is cost shifting.  But other states offer that same service!  I do not know how widespread that practice is but to me it’s unethical.  In retrospect when I was given a bus ticket from Iowa to Florida, I did have an appointment with a counselor at an agency in Florida.  I didn’t know where they were, didn’t care, didn’t really plan on meeting anyone because of the ‘mental’ state I was in but the hospital did their ‘due diligence’.  If something happened they could have said “Well we gave Mr. Kelly the name and address of the Henderson Mental Health Clinic and he had an appointment!!”

 me:  Still, it’s amazing that people are just put on a bus. Have you seen any programs that do a really good job of addressing not only mental health but the underlying economic issues?

Tom:  There is one agency in Maricopa County that really focuses on employment for the people they serve.  Throughout the country the average rate of employment for people with serious mental illness is around 10%. This one agency in Maricopa County has an employment rate of 26% for people with serious mental illness.  Help put a job into someone’s weekly list of things to do and not only does it help the individual financially it helps the system because the individual becomes a tax payer and gives back to the community!!  The programs that focus on Housing First and Employment First are those that are doing a really good job of addressing the mental health and helping to improve the underlying economic issues!!

me:  This may be an ambitious thought, but how long will it take to move from peers being part of the system to peers running, or helping to run, the system? And how long will it take for many in the system to be comfortable saying openly that they’re peers as well?

Tom:  What is the saying about a cold day in …

Tom:  There are a handful of agencies across the country that have “peers” on their executive teams.  I was in such a position for a few years with another managed behavioral health agency.  There are many agencies that are non-profit agencies which are governed by Boards of Directors.  Many of those agencies have peers that serve as Board Members. I think that the peer voice is at the table to a better extent today than it was in 10 years ago!  I think that because of the belief that peers can recover and do in fact have knowledge, skill and abilities to move forward in the employment area many of them choose to stay within the behavioral health world. There are two National Managed Behavioral Healthcare Organizations that have peers who are serving at the Executive Team Level …

Tom:  I think the other question about how comfortable people are in disclosing their lived experience is a challenge!  I see more and more when I present that someone will come to me after the presentation and open up and say “Me Too” … when I ask them if others know about their lived experience they say “I can never tell people that I’m a peer – what would they think?” … there is still a lot of stigma, prejudice and discrimination going on … one day my friend … one day!!!

me:  I’m always curious about the more striking or surprising questions and responses people get when they talk openly about this. Does anything stick with you?

 Tom:  Please elaborate a little not sure what you are looking for ….

me:  You’re open about your experience. What are some of the more surprising questions or responses you’ve had about it?

Tom:  I guess I share so much about my experience and I am an open book that I don’t get too many surprising questions.  The responses I get, to be honest, are things people don’t say or ask!  Here I am, an open book willing to let them ask me
any question they want and … nothing!

I will have to think more about this particular question … I think I can find something that is surprising … just cant think about it now
 me:  What would you love to be asked? I don’t mind being guided along here!

Tom:  Once again … I don’t really know!

Tom:  Discrimination and prejudice seem to be more prominent within the behavioral health world and suicide prevention world than in the general community … How do we really get to the heart of the matter when it comes to understanding the damage that fear, ignorance and malice does in the work we do!

Tom:  I think it’s important for people to share their experiences and not feel ashamed to tell their stories.  Every civil rights movement started with a few people who had the courage to move forward … we need to develop courage and character and support folks for sharing their stories!

 me:  Why in the world would discrimination, etc., be stronger within the very field that talks about breaking down stigma?

Tom:  That’s the million dollar question!  In my opinion the professionals that work in the field only see people when they are doing poorly and in need of attention, help etc.  They do not see people when they are doing well!  When they see people such as myself; they say – but your different!  I am no different than the person who walks in off the street today … cause I was that person 20 years ago!!  When they don’t see that recovery is real and that recovery is possible they use “dark humor” and other defense mechanisms to protect themselves from “those people”.  It is funny that there is more stigma in the very field that is trying to eradicate it!!

me:  Interesting that you mention humor … Is there any way to talk about this issue openly with humor, dark or otherwise? I’ve seen a few interesting projects, like cartoons or documentaries …

Tom:  I think that the program coming out of Vancouver, British Columbia – Stand Up for Mental Health – is an interesting program.  David Granirer who is a therapist and has some stand-up comic experience travels around the continent and trains people with serious mental illness to deliver stand-up routines.  Victoria Maxwell does a one woman show about the ups and downs of bipolar disorder at different conferences around the world (I think she has three different shows).  I heard of another gal that does a one person stage presentation on the lived experience of bipolar too … but I forget her name!

Tom:  With the proper funding and support I think developing an Improvisational Comedy Troupe would be a good idea.  That way they could react to what the audience was giving them to work with!!

me:  Those people are good to know! I’ve spoken with David before … And here’s a change of subject. Let me know if you’d rather not go here, but why does it seem like the topic of assisted suicide is completely separate from the usual mental health world?

Tom:  A topic for another discussion for sure!!  Perhaps it should be called Assisted Death …

 me:  And for that matter, there doesn’t seem to be a lot of philosophical conversations in this field …

Tom:  I think the topic of assisted suicide is separate because the person has to go through lots of different things in their decision and are they not being challenged by whatever challenges those who do die by suicide without the assistance!

Tom:  I don’t really have a stance on anything in life … I really try to be a non-judgmental person … if push comes to shove … I would support someone asking me to pull the plug if it were in their living will!!  How about you?

 me:  I think I agree. It was startling to watch my father pass away and have no inrush of nurses because he had a DNR order, but he had declared his wishes and had been very open about his long fight, in his case with cancer. I just think there’s a lot of ground for very good discussions out there.

Anyway … here comes another change of topic:
 Tom:  Sure but you only have me for another 10 minutes …

 me:  Got it. Two more questions, then. This is question I often ask, because it was something that certainly stopped me from a more serious attempt: What if suicide prevention messaging emphasized the idea that no method is foolproof? That you can wake up in far worse shape? I think many people think, “Maybe this will work” and take huge risks in their attempts …

Tom:  I believe I have seen some messaging in that people could wake up and be in far worse shape.  To me it’s kind of interesting, I didn’t think of that at all when I was in a position where I wanted to die!  I didn’t want to jump because I was afraid of heights – not because I didn’t think it was NOT going to kill me.  I know people (two friends of mine today as a matter of fact) that survived bullet shots to their head – so that was out of the question.  With me it was always medication overdose.  I just wanted to end the pain, go to sleep and die in my sleep.  I’ve heard people have ended up in worse shape from all three of those different types of attempts!  I’m blessed and lucky after putting more than 150 pills into my system that I made it out of the coma relatively mentally healthy with no brain damage (that I know of LOL).  Those that think “Maybe this will work” are at a place where they need connection to something, someone in my humble opinion.  Perhaps the messaging would touch them – in my personal situation – I would not have thought anything about messaging around that thought!!

me:  Good points, and I’m scared of heights myself! OK, I like to end with this question: Since this experience most likely doesn’t define you, at least completely, who else are you?

Tom:  I am intuitive, perceptive, fun-loving person that enjoys helping others!  I’m a friend, brother, son, athlete, dancer and all-around nice guy!!!  Do you know anyone looking for someone like me … I’m single too!!

 me:  Ha! Let’s see what happens when that’s posted for the world to see!
Thank you so much for taking the time to do this!
Tom:  Hmmm maybe I’ll need to edit that last comment!
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Talking with Samantha Nadler

Samantha Nadler once told her therapist she wouldn’t live to be 18 years old. Six years past that deadline, she now supervises a crisis program and talks openly about her experience with suicidality. She recently went home for the first time in a decade, revisiting a world where she had been seen as the hospital patient, the troubled one. Her transformation was greeted with happy surprise and even tears.

Here, she talks about the limitations of mental health coverage, the very cool rise of social media in suicide prevention and the way her work has created a buffer for her past.

“A lot of people, including myself, expected I would not survive that part of my life,” she says. “Now I’m being able to contribute in my own way _ another reason for it to be very healing.”

Tell us about yourself.

I came into this field because I wanted to get firsthand experience, and a full-time position opened. I answered phones full-time for a crisis line, and also for 211, for social services. I did that for about three years. I also was offered the opportunity to start facilitating a survivors of suicide support group, for those who lost someone to suicide. So I’ve been doing that ever since, for about three years. Then a year ago, I had the opportunity to be promoted to crisis program supervisor. I’m currently working on my master’s in social work at the University of Tennessee. And that’s everything I can think to tell you.

How did you come to be talking to me?

Sure. When I first started here, I was not open about my history because of stigma. I didn’t want to raise concerns about my stability. I did tell them here I had personal experience with suicide, but with family members, which was true. After a couple of years here, I had the opportunity through the Tennessee Suicide Prevention Network to facilitate an attempters group. This was a Suicide Anonymous group. It was a 12-step model, but we never had anyone show up, so we stopped having it. At first, my job was concerned that I may not have had enough experience. I was fairly young. I’m 24. And that’s when I had to be open about my history. That’s kind of how I came into the field.

I’m very lucky. My job has been very supportive ever since. People get something from me talking about my experience. I have some sort of professional and personal authority on the topic. Our survivors of suicide group has been helpful for me and others. I started attempting suicide when I was 12. And I have a history of eight or nine attempts, and the last was five years ago.

Why?

I grew up in a pretty dysfunctional household. A broken marriage, my parents remarried, a very difficult transition. Depression and anxiety run in my family, so I have that going for me. I came to know about suicidal ideation when I was 12. I didn’t understand it. I just didn’t want to live. Nobody had ever talked about it, that people experienced that. The first time I was hospitalized, I hadn’t even attempted, I just verbalized it. That’s how I found out it was a serious thing.

I never talked to anyone directly about my feelings. It was basically professionals talking over me. I never had a chance to know why I was feeling that way. I had multiple attempts from feeling trapped in my house. School ended up not well for me. I think I ended up cutting most of my sophomore year. I ended up with a diagnosis of bipolar, with a lot of changing medications, trying to find out what works. It was not consistent. I had no chance to find out what worked for me. I had battled depression for the majority of my life at this point. I still experience ideations, but I don’t act on them anymore.

After the last attempt, what made you decide that?My last attempt was the most lethal, with three days in the ICU. My previous attempts were all overdoses, but I didn’t necessarily need medical attention. This time I remember being told, “We’re not sure you’re going to make it.” My liver had issues. I really got to see how others were affected by my actions. Before, I was pretty isolated. I didn’t see how it affected others, the impact my death would have. I was able to see that more.

Honestly, working at my job has been very healing for me. I’ve always wanted to go into mental health and talk about suicide, I just never thought it would actually happen. So coming into this field has been very therapeutic for me. I get the chance to give back what has been given to me over the years. Also, the more I invest in the field, the more it acts as a buffer for me. I know if I were to do something like that, all the work I’ve done trying to prevent this, I would feel it be a waste. Because I would do something I’ve been advocating against for so long. And I’ve been connected with so many people. The impact, I suppose, would be greater.What made you realize you could work in this field?

There was a transition from when I lived at home in New York to being in a troubled teens program for two years in Tennessee. When I was at home, I remember saying to the therapist that I wasn’t going to live to be 18. So just merely being able to leave my house, see that I can make it out of high school, that I do have that ability to go to college, that was what kind of pushed it. I always knew I wanted to major in psychology or social work. I’ve been really enjoying it. I’m very lucky I got my job here while working on my bachelor’s. I’ve been able to have really cool experiences firsthand.

Has stigma in your field ever been a concern?

Well, not since I’ve been open professionally about it. I went through my whole adolescence being the identified patient in my family, always the one going to the hospital, having attempts. So, of course, I had that label there. But coming here _ I went from New York to Tennessee _ I was hesitant because I was afraid people would think I wasn’t fully capable. I did hold back for a while. It would be understandable to think that way. I was only a year out from an attempt. If we were to interview anyone here who recently had attempted suicide, it would raise concern for us. If the opportunity had not presented itself …

After coming out of the closet of mental illness, it’s been fantastic, actually. I’ve received nothing but support from every direction. It’s been really comforting and surprising for me. I think people understand me and my position more. My knowledge in this field is not based on just what I read in books, which has been helpful.

In your field, how many people would you say have experience, and how many have just a book background?

I met a lot of people at the AAS conference. I’ve attended ended two of those. And I connected with a lot of people who had that history. But I met a lot more who were suicide survivors. But there’s a movement now to have attempt survivors talk and be a part. I think I saw that more than four years ago. I’m someone who over the years has opened up as well. But I have to say I’ve met more survivors of suicide than attempters. I only know one other person in the Tennessee Suicide Prevention Network who has that kind of history, the only one who has opened up about it.

Have you had any unusual reactions?

From sharing my history?

Yes.

Well, usually in my survivors of suicide support group, I will sometimes mention it. I know that I have observed group members changing their tone about someone attempting. I don’t want people thinking they have to be more sensitive to my experience. I offer my knowledge about what happened when someone was in that frame of mind. I can offer that validation of whatever they think might have happened. Sometimes people in my group get relief from that.

Another setting is if I choose to share in our call center training, three times a year. I cover the suicide assessment portion. Sometimes I get questions about something they heard about suicide risk, a lot of stereotypes. So every once in a while, I have a back-and-forth with someone about a theory, and sometimes I throw out, “Well, I attempted suicide this many times, and I did not experience this.” That usually gets an interesting response, because until that point the trainees know me as a supervisor. I always get more in-depth questions about suicidality because they know someone who’s experienced that. But I haven’t really received anything wild, because I’m so involved in this field that people aren’t surprised.

Should people in the field disclose that they’ve had this experience, and should people with experience be given priority in the field?

Well, yes and no. Yes, because having that understanding definitely gives you an edge and depth of understanding that the average person doesn’t grasp. That’s why so many people say, “It’s selfish” and “How weak of them,” when it’s the opposite. But on the other hand, there are people out there who are very empathetic and, while not experienced themselves, they may have had a best friend who tried to kill themself and understand having someone in their life with that experience. That’s how I was with the survivors of suicide group, because even though I had not lost someone, I felt connected. I think people out there don’t necessarily have to be in my shoes, but if they have some exposure to it …

You have to have this kind of understanding to have the job. I think people in my shoes should be looked at more seriously for these positions instead of, “Oh geez, they might be more unstable for this job.”

Since you work inside the system, what changes would you like to see?

I definitely feel there are not enough resources for people who chronically deal with suicidal ideation. Our call center is working on starting an attempters group, and I know there aren’t many out there. Basically, the options are individual therapy or going to the hospital, and there’s nothing really in between. I feel there’s a gap in services there. For people who are feeling suicidal, without the fear of working with them. A lot of people fear because they think they’re encouraging an environment where people become more suicidal or plan suicide together, which is ridiculous. You don’t get cancer any more than the average person if you discuss it. And I don’t think people understand. Over 90 percent of people who die by suicide have a mental illness, and that speaks for what that means when someone tries to take their life.

I definitely would like to see more mental health initiatives in health care. I recently had to seek out a therapist and get anti-depressants for the first time in a while. I’m paying for the cheapest health care, but I can see no one but my primary health care doctor. I should be able to see a therapist under that plan if I needed to. I don’t go to a doctor for anything else. A therapist is expensive, and I see how people end up not getting help. I definitely feel there needs to be more services. I think a lot of people are scared to work with those with a history of suicide.

Also, I would like to see more professionals trained in how to assess for suicide. I think those working in the health field don’t really have a well-rounded understanding of how that works. For example, when I saw my doctor, the question was, “Are you suicidal?” “I have been.” She said, “You don’t have a plan, do you? Because if you do, I have to hospitalize you.” That’s not a tactful way to ask. What if I had a plan? I wouldn’t have been honest. She pretty much set me up to say “no” to her. I said to her afterwards how I heard that question and how others might hear it, and she’s like, “Yup, that’s great, thanks. Next patient.” It just demonstrates the lack of experience in assessing for suicide, and in a way that makes that person feel they can talk to you. And not being afraid to ask those questions and have a conversation, because a conversation could mean everything.

So the only person you can afford to go to under your health plan is your general practicioner?

Correct. It’s the high-deductible plan.

I’m no expert on this, but I’ve heard people talk confidently about changes coming with Obamacare, mental health parity …?

To be honest, I don’t know a whole lot about that stuff yet. This was about two months ago. I could have gone to a psychiatrist, but some were not taking clients, and if they were, it was going to be like $120 to go see them. Yeah. And there wasn’t a huge selection, either. I had tried to see my old psychiatrist, but he wasn’t taking any clients. It’s just a very complicated process.

What about alternatives to the usual system, through social media or such?

Good question. I’ve seen, like, listservs. There is a clinician survivors of suicide e-mail list through AAS, for people who work in the field and have lost someone personally or professionally. So I know they have listservs for people like that, I think because when they tried to do it in cities independently, people didn’t come because of stigma, and professionals don’t want to be seen grieving over clients. But honestly, I haven’t seen too many things for people in my shoes.

But I know people are using social media a lot for, especially, suicide prevention. I have an Instagram account, and a few weeks ago I tried looking up the suicide prevention hashtag. It’s so cool because that could pull up pictures, etc., from all over the world. One photo I found was someone saying, “There is hope,” and they listed our Nashville crisis line! Out of all the numbers, they found ours. It was so neat because, you know, I wonder how many people saw that, and what are the odds? I mean, there are lots of crisis lines. The fact they had our number, and I was able to find it, shows how social media can reach out to people they don’t necessarily intend to each out to.

I know our call center does a lot of outreach events, community fairs. What’s cool about that is if someone comes up and sees that we answer the crisis line, they say, “I had a friend and gave her this number, she made it through the night” or “I used it” or “I need this number.”

And something we recently started doing, we had Fort Campbell, they reached out to us because I have a survivors of suicide support group, and they wanted people from the group to talk to their soldiers to deter the behavior, since it’s been very high on base. They also wanted an attempter. So I went, and that was really neat, since the Army used us instead of “death by Powerpoint.” We had two or three soldiers come up after each session and say they had been feeling suicidal and hadn’t told anyone yet. It as just us talking about it. I guess the stories were impactful enough that they felt they could come forward. It really was a neat experience. We got to go back last Friday to do it again.

Did you feel any sense of not trusting you because you’re not in the military?

Well, they reached out to us. That’s the most interesting part. They were looking to reach their soldiers in a different way. We weren’t trying to train them how to assess suicide risk. We were just four people with stories. Very easygoing. We were really impressed with Fort Campbell. We spoke to about 1,000 soldiers that day.

The people who knew you when you were younger, what do they think about you now?

I have to say that’s one of the coolest things about going into this field. I recently had to go home to New York last week, and I hadn’t been there in probably 10 years. A lot people had not seen me since I was very sick. It’s funny you asked that question. A lot of people found it very cool. I ran into a teacher who was really a guardian angel for me, and she teared up seeing I was alive, I hadn’t killed myself, and things were going well. And it’s especially neat when people know what I’m doing now. A few days ago, someone posted a letter I had wrote from the hospital. She said I had come such a long way, it was neat to watch how I had come from that place to this place. I have to say that’s one of the biggest rewards. A lot of people, including myself, expected I would not survive that part of my life. Now I’m being able to contribute in my own way _ another reason for it to be very healing.

What more would you like to do?

When I grow up? I feel like I have my dream job right now. I feel what I’m doing right now is so perfect for me. I have such a supportive job and supervisors, and what a great environment: ‘”I have this idea, what do you think?” “Great!” They’re very supportive. And I want to stay at my job as long as I can. I want to be an LCSW. I want to eventually be a clinician, but I’m not sure in what capacity. I’m interested in trauma, but I’m not sure how far I want to move from suicidality. But I enjoy my niche and plan on being here for a bit.

Who else are you?

Well, I’m a wife, I’m a daughter, a friend, a sister. I’m really enjoying music. I mean, that’s everything I can think to say on that. Here in the last few years, I’ve been trying to draw that line on “I am not my mental illness” and use it for good. I’m a student and, I don’t know, enjoying life, I guess.

Talking with Jay Johnston

Jay Johnston came to my attention when he recently graduated from law school and was featured on his local news. He’s come far from his days in high school, when his depression deepened and he kept thoughts of suicide secret so no one would think he was being dramatic. Now he talks openly about his attempt and encourages others to reach out before they risk going as far as he did.

“It’s probably the only disease _ and it is a disease _ where the more someone is suffering from it, the less likely they are to seek help,” he says of suicidal thinking. “Do you agree with that?”

Here, Jay talks about his mother’s reaction, what he tells curious children and why an “overly needy” dog has turned out to be an ideal companion.

Tell us about yourself.

The first impression people get when meeting me would be my disfigurement, but that’s probably not the information you were looking for. I’m 34. I live in Portland, Oregon. I’m an Oregon native. I grew up on the coast and moved to Portland in high school. I love this town and have been here ever since. I live downtown with my basset hound Hugo the Wonderdog.

Talk about your experience.

I suffered from depression all of my childhood. I didn’t know it. That was just normal for me. The depression became acute in high school. My depression was like putting on dark sunglasses. It made bright things look dark and dark things look hopeless. I told my mom when I was 17 that I had been thinking about killing myself. Unlike me, she knew that wasn’t normal and took me immediately to the family doctor. This was the ’90s, and Prozac had just come out, and there was a lot of hubbub about the drug. The doctor put me on anti-depressants, but a very low dose. I wasn’t advised to get counseling along with the anti-depressants. If that small dosage helped, it didn’t help much. Eventually, my prescription ran out and I had a hard time getting a refill. It took weeks or months. I don’t want to give the drugs a bad name, saying they don’t work. Maybe a different dosage or counseling would have effectively treated my depression. These two certainly have been effective as an adult.

In the months before my attempt, as my misery became unbearable, I spent a lot of time trying to decide if I would be better off dead and if the people around me would be better off or even affected if I died. I began testing, something like luck or fate, to see if my pain could be extinguished. I did things like driving around sharp corners at twice the speed limit. If I died, then my pain was over. If the car stuck to the road, then I would live another day.

I was also testing myself, trying to determine if I could really go through with suicide. I did this with a shotgun I had bought for sporting purposes. I had no thoughts of suicide when I bought the gun. I would unload the gun and put pressure on the trigger while the barrel was to my head. As I did this, I asked myself if I could squeeze the trigger if the gun were loaded.

I kept all this to myself. I didn’t want to seem dramatic or be perceived as someone seeking attention. I didn’t even tell the people closest to me for this reason and because I was almost certain that they wouldn’t care.

A couple of weeks before my high school graduation, things came to a head. My car broke down, I was fighting with my mom, a girl I had been seeing was showing interest in a friend of mine, my grades were horrible, and it was iffy that I could graduate. I was in absolute misery. I paged my best friend. I didn’t want to reveal anything to him. I just wanted to get out of the house and spend time with him to get my mind off things. I paged him for hours and never heard back. That was as good a sign as any that absolutely no one cared whether I were dead or alive. I wrote goodbye letters to a few friends. They were sort of half apologies. I wrote that “This probably won’t affect you, but just in case, I’m sorry. You’ll
get over it soon, but life is too painful for me.” I didn’t write a letter to my mom, even though she was the closest person in my life. My depression had my perspective so bent that I didn’t think she would care if I died, so there was no reason to write her an apology.

I loaded the shotgun and put it to my head. I bawled my eyes out because I couldn’t find what I thought of as courage to pull the trigger. I was in excruciating pain and angry at myself for not having enough “bravery” to end my pain. In the movies, people put guns to their forehead or temple. I wanted to be sure that I was dead. I didn’t want to accidentally shoot out my eyes and then live on as a blind person, so I put the barrel under my chin. This would ensure that the blast did the job.

I don’t remember pulling the trigger. The last thing I remember is lying on my bed on my side with the shotgun cradled under my chin. I might have pulled the trigger, I might have cried myself to sleep and rolled over on the gun, I don’t know.

My friend eventually returned my calls. It turned out he had been on the highway between Portland and the coast, and he had to wait to get home to call me. This was pre-cell phone days. My mom answered the phone and brought it to my bedroom. She had been in the house when I shot myself but somehow didn’t hear the shot. She found the mess and saw that I had got off the bed and crawled to the door. The shotgun tore off the front of my face but missed my brain. I lost my jaw, part of my tongue, nearly all of my teeth, both my cheeks, my nose, one eye and most of my forehead. Despite my deliberate planning to avoid survival with lost vision, that is exactly what happened.

Then what? How did you even begin to come back from that?

“Waking up” in the hospital was a gradual process. I had to be told several times over several days where I was and why I was in the hospital. I don’t remember much, but I do know that I was communicating by writing on a clipboard. I was blind in my remaining eye and unable to speak without a mouth. One of my most vivid memories is the staunch denial that I had pulled the trigger. I insisted that I had eventually changed my mind and the gun must have gone off accidentally.

The intense and interrupted physical pain is indescribable. Perhaps even more painful was the slow realization that I was now severely mangled and had no sight. Even months later, after I regained some of my vision, I was still feeling very sorry for myself for being blind. I don’t know when my depression started lifting. Perhaps it was when I was able to regain my mobility and some independence. I was still “eating” through a tube in my stomach, but my renewed physical strength allowed me to get around, and I was undergoing blind training. I was getting a more appropriate dose of anti-depressants than when I was in high school, and I was getting counseling. Perhaps most beneficial was my new dog. My neighbors gave me their overly needy basset hound, and he turned out to be an ideal companion.

How long did the blind training last, and what did you do when the training was over?

Life at this point was interspersed with extended stays in the hospital for reconstructive surgeries. After a few years of this, I enrolled at a local college, where I took additional breaks for more surgeries. This extended my college experience, but I got through it and graduated in 2008. I had been living the life I feared, disfigured and visually impaired; however, I was much happier than in my teens. I took a year off from school and enrolled in law school here in Portland, which I wrapped up this summer.

You say you were much happier. How is that?

Anti-depressants and counseling is what has made the difference for me. It took me years to realize that normal people feel good when good things happen and bad when bad things happen. Before my depression was treated, I actually disallowed myself to be happy over good things. There were so many bad things that I shouldn’t and wouldn’t enjoy the few good ones.

Did it help having a clear goal, knowing exactly what you needed to do to help yourself?

It was the reverse. Before my depression was treated, I had no hope of achieving anything, so goals were useless. That’s why I was doing so poor in school. I had no drive whatsoever. Once I was in a healthier position, I was able to have enough confidence to make goals and work toward them.

Where do you go from this point? What would you like to do?

It’s a hard question to answer. And you’re not alone. Everyone wants to know: “You’ve graduated law school, what now?” My future’s uncertain at this point. I haven’t taken the bar exam yet. There’s a lot of directions I could go. I’ll just keep moving forward; it’s how I made it this far.

How has your mom responded through all of this?

My depression and injury have probably been more painful to my mom than me. She had seen me suffer through depression, then she had to watch me suffer through the significant physical challenges after my injury. She’s been a ton of help to me and given me endless support. It’s cost her a lot of energy and pain. Have you written about the notion of the selfishness of suicide?

A little. People mention it as a misconception, that this is done out of selfishness, but no one has said they’ve been accused of it. You?

Sometimes friends have mentioned it. Not an accusation—more of a perspective. I certainly see where they’re coming from. For example, my suicide attempt is in my past, but the pain to my mom is still in the present. But what many people don’t understand is the perspective of suicide attempters. Their perception is so altered from their depression that they don’t see their actions as impacting anyone. Someone who understands that there are people who love them and would be hurt by their suicide probably aren’t suffering from the severe depression that would drive them to suicide.

At what point does thinking turn suicidal? At what point was it for you?

I don’t know what flips the switch or if there is one. My understanding is that a person
is definitely in a suicidal mindset and in imminent danger if they have planned a method of killing themselves. This is one of the questions to ask someone if you fear that they are suicidal. For me, the turning point was probably a gradual transition. When I was firmly in a suicidal mindset it was the result of pain, perceived isolation, and hopelessness.

I couldn’t state it succinctly, but my understanding is that there’s two types of depression, situational and biochemical _ whatever the brain type is called. Situational, meaning you’ve been diagnosed with cancer and your spouse left you and you’re bankrupt all at once. In other words, you’re fundamentally healthy, but the circumstances make you miserable. The biochemical kind is related to serotonin, if I understand correctly. The person is miserable regardless of their circumstances. That’s what I had.

What ultimately drove me to attempt suicide was that underlying chemical or biological or whatever depression, and then adding on to that the situational factors, which in retrospect were minor, silly things. I mean, who doesn’t get in a fight with their parents? And bad grades aren’t the end of the world. They didn’t end up being a hindrance to me as an adult, but someone suffering from depression doesn’t have the benefit of the healthy perspective to see what is good or bad or what’s minor or what’s hopeless.

Maybe it’s getting easier to talk to others about being depressed, but I’m not so sure it’s the same when a person is suicidal.

That may be true. A number of people have revealed to me their current depression and/or a prior suicide attempt, but I can’t recall anyone confiding in me their current suicidality. The worst part about depression and suicidality, probably worse than its prevalence, is that it’s treatable but the people who need to be treated most feel the most helpless and are the least motivated to get help: “No one understands my unique position. I know you think it’s no big deal. I’m not going to seek the help because no one can help me.” It’s probably the only disease _ and it is a disease _ where the more someone is suffering from it, the less likely they are to seek help. Do you agree with that? I think now I’m different,
but it’s because I’ve already learned that my depression can be treated. Before my injury, I wouldn’t have believed that my perspective was different from anyone else or that I could be helped to feel better.

Would it help if more people came forward to talk openly about their attempts? To give others that perspective?

Certainly awareness is important. However, I think someone speaking out should be deliberate in how they do it, so as not to make other people uncomfortable. This isn’t like commenting on the weather. But certainly it’s important to increase awareness about the problem and that it’s treatable.

You’ve probably heard people say this. They’ll say that they “admit” to going to counseling, as if it’s an admission of something bad. I wonder where that came from, that embarrassment for getting counseling. It’s a curious thing because no one would be embarrassed for going to a medical doctor, unless it’s something like an STD. If you have a broken bone or some kind of heart condition, you wouldn’t whisper it or say it only in confidence.

When I was a teenager, I wasn’t embarrassed for being severely depressed. I wouldn’t have wanted to bring it up with friends at lunch, but the high school social scene is unique. If a doctor asked me, I would have told him the truth. That’s something that I was told when I’ve done things like suicide intervention training. I was told never to be afraid to ask if someone’s considering suicide, because you won’t plant that seed in a healthy mind, but at the same time, someone considering suicide would be relieved that someone cared enough to ask. Have you heard that?

Yes.

I’ve been in a situation with a friend whom I asked if they were thinking of killing themselves. It’s a big question to ask.

You asked it? How did it go?

Fortunately, I got the “Of course not,” but I also got the “I appreciate you asking.” Have you heard of the yellow ribbon program?

I’ve heard it mentioned but don’t know what it is.

They have a neat thing, these business cards with yellow ribbons on them. Basically it says on it, “I’m thinking about suicide, and I need help,” that’s the essence of the message. So you can give someone the card without explaining. Because some people probably can’t verbalize their situation. You could give it to a teacher, so as to not make a scene, or give it to your parents because you’re so scared that you couldn’t put it into words but could hand over this card. It’s a neat thing. I keep some here at the house.

You have them to distribute, or to hand out for yourself?

I ordered them for a school presentation so the teacher could have them sitting on his desk. So if someone wanted one, they could take one on the sly. But no, I don’t keep them for my own use. I am fortunate enough to have professional resources like a doctor and counselor. I could just go to them and say, “Hey I think my meds need readjusted” or “I need to talk about this.” The cards are especially for someone school-age, for example, and doesn’t know what to do.

I assume that people have asked you for advice, and I wonder if you’re of the same mind. I tell people, if you’re not making progress with a counselor, psychiatrist or whatever, get a different one. Because they’re all unique, and a therapist perfect for one person might not be right for another. And if the next one is not a good fit, try again. If that therapist doesn’t work, then stick with him or her because it’s probably the therapy, not the therapist that makes you uncomfortable. Talking about and examining emotions can put you outside your comfort zone. Maybe it’s like taking medicine: It might taste bad, but it’s worth it if you’ll be healthier.

I agree. But affording it, and finding a therapist who works with suicidal people …

In Oregon, if you’re indigent, you get on Medicaid or its equivalent. I can’t remember what the program’s called, but you can be homeless and get it, and there are county-sponsored clinics where you go and get assigned a counselor. I know when I was a young adult I couldn’t afford insurance and was in the program. I think it was like a $20 co-pay that the county-sponsored clinic charged, and the state picked up the charge. Whatever it was, it was totally free. She was as good a counselor as I’ve ever had, and she only had an MSW _ a master’s degree. The worst therapists I had were psychiatrists, MDs. Their training was to fix the problem by adjusting medication. There’s a place for that, meds made a
huge difference for me, but it doesn’t replace counseling. What I’m saying is don’t shop for the fanciest degree when choosing a therapist.

What kinds of questions do you get, including from strangers?

Sometimes people will ask, “What happened to your face?” Others will say, “Oh! I just noticed you have a prosthetic nose, what happened?” Most often, probably, it’s kids, and then their parents yell at them for asking. The kid thing, that’s tough, because what do you tell an 8-year-old? If there’s no parent there, I would say I had an accident. I’ll tell an adult; I don’t mind. For me, my injury is something of the past, and my treated depression is not an issue because it’s treated. So I’m not shy or embarrassed. Being disfigured is tough, you know, emotionally tough. It would be awfully nice to look normal, but it’s one of those things you can’t control.

Do you do public speaking?

I’ve done presentations at schools, and I’ve been on a few panels, but I’m not a motivational speaker. I don’t book myself into hotel banquet rooms, anything like that.

What have you not mentioned that you’d like to?

The only other thing off the top of my head is the message to not keep it a secret if someone tells you. If someone tells you in confidence they’re considering suicide, don’t keep it secret. It’s better to break confidence than have that person languish with depression or kill themselves.

Another thing, I think therapists and auto mechanics are similar enough to compare. You take your car to the mechanic when something is wrong, but you also do it for maintenance. Going to a counselor can improve a person’s quality of life even when there isn’t a crisis. Don’t think of it as resorting to therapy.

Finally, since this experience is in the past and isn’t the only thing that defines you, who else are you?

I love to read novels. My hobbies are woodworking and vintage radio collecting. I’m a dog owner. I’m an uncle. That probably covers the main demographics.

I’m impressed by the high number of dog owners I speak with here. It’s never cats.

Dogs are mysterious. They’re uniquely intuitive. When I lost an aunt, I was just lying in bed absolutely miserable, and the dog crawled up on the bed. He’ll usually sleep on the bed with me, but this time he wedged himself next to me for as much bodily contact as possible, as if he knew I needed the endorphins. He’s done the same thing when I’ve been sick. Dogs are just endless sources of love, always happy to see you. They’re never in a bad mood or selfish. They’re just happy to get and return your affection.