September 9, 2020

At UCF RESTORES®, we not only strongly believe in the power of peer support, we’ve witnessed it firsthand. Through REACT, our peer support training program, we’ve worked with thousands of first responders to help our front-line heroes learn how to recognize signs of emotional distress in others, offer peer-level support and effectively coordinate follow up when clinical assistance is warranted.

Though it’s never a sign of weakness to talk about what you’ve seen, unfortunately, we are still battling a universal stigma that can deter someone struggling from reaching out for support, even to their closest friends, colleagues and loved ones. But, especially amid COVID-19 – an unprecedented traumatic event that has heightened stress and challenges for people of all walks of life – talking about trauma, its effects and how we can cope is more important than ever.

In this series, “The Power of Peer Support,” UCF RESTORES’ Suicide Prevention Expert David Rozek, Ph.D., breaks down the concept, why it’s so important, its role in suicide awareness and prevention, and effective tools we can use to support one another – not only as we continue to weather the storm of this pandemic together, but long after we’ve surpassed it. The first installment in this series is specifically developed for our essential workers – the first responders, medical personnel, hospital workers and more – that have so bravely served and protected us on the front lines of the pandemic.

If you or someone you know is struggling with their mental health and would like to request an appointment or consultation with UCF RESTORES, please contact us here or by phone at (407) 823-3910.

Before we dive into the topic of peer support and how it can be learned and applied, let’s start by talking about the most common stress injuries facing our front-line workers – including first responders – that could, potentially, lead to suicidal ideation.
Our first responders and front-line workers, due to the nature of their job, are repeatedly exposed to traumatic events. They listen and respond to calls for nearly every type of emergency or accident that could take place, and the stress that comes from exposure to these events does not disappear once they’ve resolved the conflict and have left the scene or returned home from a day in the field.

Many of the situations they face are truly matters of life and death, and, even with all the training and skills our front-line heroes possess, the end result of a call is not always favorable. Following a traumatic call, there is not always “down time” for one to begin to come to grips with what they’ve just experienced; in fact, in many cases, our front-line workers’ attention is needed for another call or case right away.

This level of heightened, repeated exposure to traumatic events can lead to a feeling of being overwhelmed or helpless, and some of the most horrifying calls may stay with our front-line workers for a long time. This can have a great impact on someone’s well-being – not only at work, but at home and other areas of life, as well. If these stress-related injuries are left unattended, they have the potential to effectively take over someone’s life, greatly impacting their ability to think, relate and function, and they hold the potential to introduce suicidal ideation.

From the outside looking in, what could suicidal ideation look like from a third-party perspective? What are some of the “warning signs” that might call for action?

There is no single or exact grouping of warning signs that predict suicide, though many suicide attempts are related to some sort of vulnerable period or perceived loss and the stress that started it. (For example, the loss of a job or relationship.) That being said, there are some warning signs that we can look for, many of which our medical providers, first responders and front-line workers are trained to identify. And, perhaps most importantly, we want to have a plan in place for what to do if or when we start noticing signs of distress in others.

The most commonly thought-of warning signs are noticeable changes in mental health. Many people focus on depression, which is a good indicator and can often spark suicidal thoughts. However, newer research suggests that anxiety, trauma exposure and posttraumatic stress disorder are linked to suicidal behavior, so if we start to see people becoming more anxious or “on edge,” it would be helpful to check in with them. Changes in behavior – like an increase in substance use, trouble sleeping or “stress eating” – or mood and emotions (anger, apathy, guilt or shame) can be important indicators that we can both hear and see.

Especially in a work environment, paying attention to the effect environmental factors are having on your colleagues is important, as well. Work-related stressors – more work than normal, heightened pressure, unsafe work environments, arguments with team members and bullying – can enhance the risk of suicidal ideation or behavior.

I believe it’s really important that we approach the concept of “warning signs” more holistically. Often, we hear or send the message, “If you’re in distress – call me!” But, realistically, this is not the best model for providing effective support and working to prevent death by suicide. Rather than hoping that someone reaches out, I’d encourage everyone to take a proactive approach – reach out and listen.

Many times, people who are at risk for suicide may not show “warning signs” outwardly, but are struggling internally. We do not always know what someone is going through; taking the time to reach out to our friends and family to check in on them can be such a powerful moment (for both of you!). By initiating this contact and checking in on someone, you are showing your support and that you care. It also gives the person some time and space to talk. Take the time to listen to what is going on (about whatever they want to talk about) and really be there for them.

Now, there will be times when you notice a change in your friends or family when it comes to what’s “normal” behavior and what’s not. We’ve all had those times where we’ve noticed something different in someone close to us. Something changed and it’s reflecting in their behavior. Perhaps they’re withdrawing from us, avoiding other people or are less active than normal. Perhaps they’re just communicating with you differently or their mood seems “off.” These are additional times when we want to reach out.

Suicide prevention often focuses on not-so-subtle changes in mental health. Having knowledge of these potential changes and looking out for them is a great start, but there are many more areas in which we really want to invest in order to help prevent death by suicide. A first step to having an impact and helping prevent suicide is being supportive of your friends and family – again, reaching out and listening – even when there aren’t any noticeable warning signs, to let the people you love know you are there for them.

What do I do if someone is showing clear signs of suicidal ideation, but downplays their emotions by blaming it on stressors of the profession?

This is really common; if you face this scenario, please know you’re far from alone. The strongest piece of advice I can give is to listen. Listen to their story and validate what you hear. Let them vent to you about their experiences, even if it is “just work stuff.” Professional stressors can play a key role in suicidality and making time to talk about those is important. However, to expand the conversation, it can be helpful to discuss how the stressors your colleague is facing may be impacting other areas of life outside of work, like their home life or family relationships. And, even if the first conversation remains focused on “just work stuff,” I’d encourage people to remain diligent and intentional in following up, checking in and continuing the conversation.

If I effectively approach someone that I believe is experiencing suicidal ideation, but they don’t want to have the discussion immediately, how long should I wait to bring up the topic again?

To start, I believe it’s important to note that the conversation does not have to be labeled as one focused on suicide. The stigma surrounding mental health is still very real, and we wouldn’t want to risk someone feeling “singled out.” I’d recommend checking in on people who you know are either experiencing heightened stress or showing signs of distress and simply being there for them as support. Continue to build that relationship, reaching out to check on them, just as you would for any other friend facing a tough or stressful time.

That being said, if you are worried about an imminent threat to their safety or well-being, you should work with the person to seek professional help immediately.

What are preventative measures I can take to help a loved one who is a first responder and might be at risk of suicidal ideation? If I have a loved one who is preparing to enter the field as a front-line worker, how can I help them in preparing for potentially heightened stress and, hopefully, work to navigate around potential suicidal ideation down the road?

The greatest preventative measure you can take is to firmly establish yourself as a trusted friend that is there to listen, serve as a sounding board and be supportive. Whether your loved one is just entering the profession or has served in the field for decades, continue to reach out to them as their friend – just as you always would have – listen to their stressors and validate what they are experiencing. Even if our friends and loved ones don’t seem outwardly stressed, it’s so important that we initiate regular check-ins. Building strong social connections is incredibly key, as is making sure that the work of maintaining the relationship does not rest solely on your loved one’s shoulders.

Sometimes, as stress and pressure mounts for essential workers and first responders, the social support they provide to others in their network can start to dwindle. Please do not misinterpret this as a lack of desire to maintain the relationship. Rather, waning social support from a friend or loved one should serve as an opportunity for us to reframe, reach out and offer our support.

This final point is especially relevant right now, as essential workers and front-line personnel continue to battle the ongoing threats of the COVID-19 pandemic. If you know someone in an essential line of work, reach out to them today – whether or not they’re at risk, being reminded that you’re in their corner can go a long way in bolstering their mental health and well-being.

My spouse or partner serves as a first responder, and symptoms of challenges they’re facing are noticed by our children and others in our family. Is it “OK” for me to have separate conversations with family members about what is happening? If so, what is the best way for me to go about doing so without invading the suffering individual’s privacy? What type of language should we be using when communicating with younger children about serious mental health issues?

Finding additional support, within your trusted circle, but outside of family members within the home, can be helpful. That may take the form of reaching out to one of their friends and just letting them know your partner is “stressed” or going through a rough time, perhaps suggesting that they reach out to or call your partner. You do not need to go into details; in fact, in order to avoid breaching your partner’s privacy and risk alienating them, I recommend keeping this outreach to friends at a very high level.

When it comes to children, it’s so important that we use age-appropriate language when discussing mental health issues. It’s also important that you move forward with this conversation if your partner’s behavior has impacted the children directly.

If your child approaches you about the situation, it’s important to start with gauging their understanding of the conversation: “Dad has been feeling really sad lately. What do you know about that?” Then, you can describe what is happening at an age-appropriate level; for children at a preschool level, this may be as simple as, “Dad has been really sad lately.” For children that are slightly older, you may say, “Dad has had a really difficult couple of months. He’s been feeling really down and sad; sometimes that makes it hard for him to solve problems and make healthy choices.”

Remind your children that you are working with and supporting your partner, and remind them of how supported and loved they are. Encourage further conversation, letting them know that, should they ever want to talk about it that they are safe and welcome to do so with you.