NAMI Family

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Should we be treating suicide differently?

David Robson - BBC Future featured writer

Robin Williams’ recent death has triggered many discussions about suicide. But as David Robson discovers, scientists are finding new ways to identify those at risk – potentially opening the way for better targeted treatments.

Antidepressant suicide warnings

US warnings about the risk of suicide in young people prescribed antidepressant medication may have backfired, research suggests. Continued on page 12

NAMI Massachusetts Education and Support

Programs has a new member. Laurie Martinelli

announced the recent appointment of Tina De

Angelo to the position of Director of Family

Programs.

Ms. DeAngelo is familiar to many NAMI members as

a veteran Family-to-Family Teacher, Family Support

Group Facilitator and state trainer for Family-to-

Family Teachers. She also works behind the scenes

as the nurse for our NAMI Walk.

Tina and her husband Larry DeAngelo are from the

NAMI Metro West area and are both active members

of that affiliate. Tina has served as co-president for

the past few years, president for one year, and

continues to be a member of the board.

Ms. DeAngelo stated that her goals for the programs

include bringing the Family-to-Family to areas that

have not been able to host Family-to-Family classes.

Welcome Tina!

Larry and Tina DeAngelo

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When Robin Williams died, it reminded me of the importance and value of

the work we do here at NAMI, and that many other organizations do in

trying to improve support for those affected by mental illness.

After the news broke I alternated between feelings of sadness, anger,

astonishment, gratitude and hope. I was sad because an incredibly

talented and loving man had taken his own life, and our lives were

somehow a little diminished by his loss. I was angry at the way that he was

criticized for being a coward. I was astonished by how little people

understood about depression and suicide. I was grateful to Robin Williams

for having such a gift for making people laugh. I’m sure that he saved many

from taking the same path that he ultimately took. I was grateful for the

many people who opened up about their own experience with depression

and mental illness. I was grateful for the many people who gave us a

sensible and informed narrative to help explain how such a bright star

could be so consumed by pain, agitation and hopelessness as to die by

suicide.

I’m very hopeful that this event will finally start a useful conversation about

mental illness. A conversation focused on providing help, support and

inclusion, rather than forced treatment, background checks and the usual

litany of excuses about budget cuts. A conversation focused on the need

for early intervention, trauma informed care, better treatments and the

stigma that prevents people from getting care.

And a conversation that would explain that mental illness is everywhere. It

is not confined to those who live in shelters and walk the streets. It is not

hidden behind prison walls or inside the VA or state hospitals. People you

know and see every day may be deeply depressed, hearing voices,

terrified, agonizing over every action they take, hyper-vigilant, unable to

focus and disconnected from life. These people have jobs, spouses,

families, pets and cars. They are the class clowns, the soccer moms, the

volunteers, the caregivers, the jocks and the nerds– they are people who

excel, innovate, create and change the world. These people need the

opportunity to talk, and get help. They should be able to make their own

choices about treatment and be respected for the lives they choose to lead.

Change happens when everyone becomes involved. We need support

from those who do not have mental health issues. We need corporate

support from the Targets, Ben and Jerrys and Verizons of this world. We

need support from politicians and religious leaders. We need support from

the press. We need leaders to recognize that it is way cheaper and

humane to approach any health issues proactively than reactively.

Change will happen. Let’s speed up the process by doing what NAMI does

best – by constantly reminding the movers and shakers that there is work

that needs to be done, by educating and providing support to those

affected by mental health issues. Let’s show the world that despite and

sometimes because of our challenges, we are able to contribute, add

value, provide expertise and support to all the communities with which we

are involved.

JM – August 2014

No matter what

people tell you,

words and ideas can

change the world.

Robin Williams

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BE PART OF THE SOLUTION

Improving Lives

NAMI Wants You

We are looking for parents whose children have been diagnosed with a mental illness to help other parents As a NAMI Basics teacher you will learn the skills to provide your class participants with the tools and information they need to navigate the ‘system’ and survive the ‘emotional rollercoaster’. Your valuable lived experience as the parent of a child who has struggled with a mental health issue will help you engage with parents with whom you share a common bond. You don’t need any formal teaching qualifications, but you do need to be able to communicate effectively and be at a point in your journey where you can comfortably share your experiences as a parent with a child experiencing symptoms of mental illness. By doing this you will provide hope and support to the parents in your class. BASICS is taught over a period of six weeks for one night per week. Each class lasts 2.5 hours. You will need to commit to teaching for six weeks.

TRAIN TO TEACH NAMI BASICS! September 27th and 28th in BOSTON

OUR NEXT FREE TEACHER TRAINING is on Saturday September 27th and Sunday September 28th at NAMI Massachusetts Office located at Schrafft’s Center, Suite 1M17, 529 Main Street, Boston 02129.

Breakfast lunch and snacks will be provided and there is plenty of free parking.

For more information please contact Judi Maguire

Director of Child and Adolescent Programs, NAMI Massachusetts jmaguire@namimass.org (617) 580-8541 www.namimass.org

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What’s in a name?* *A $100 Visa Gift Card to the winner

This year, NAMI Mass received the funds to revamp and professionalize our information and referral helpline!

Since March, we have been looking at helplines nationwide and tracking down local resources for the multitude of needs of people affected by mental health issues. We’re organizing that information into a state-of-the-art database that will make finding local resources easier than ever before.

In 2015, NAMI Mass will be training peers and family members to staff our new call center. We are very excited to be expanding this much needed service that connects peers and families to the resources they need to live successful, productive and healthy lives.

We need a welcoming, positive, stigma-busting new name for our

information referral service! We want to give callers confidence that

when they pick up the phone to call NAMI Mass, the person on the other

end of the line will listen with compassion and connect them to

appropriate resources.

Do you have the perfect name that will invite people to pick up the phone and call NAMI Mass? Send any and all suggestions to Megan Wiechnik at mwiechnik@namimass. org or by snail mail to NAMI Massachusetts at the Schrafft’s Center, 529 Main Street, Suite 1M17, Boston, MA 02129. All entries must be received by 5 pm Monday, October 20, 2014. The winner will be chosen by vote of NAMI Mass staff. Multiple entries are okay. The winner will receive a $100 Visa gift card. In the event of duplicate suggestions, a winner will be drawn from these entries.

--------------------------------------------------------

Entry form

NAME: My Suggestion (s)

ADDRESS:

CITY:

STATE: ZIP:

PHONE:

EMAIL:

Send to Megan Wiechnik at mwiechnik@namimass. org or by snail mail to NAMI Massachusetts at the

Schrafft’s Center, 529 Main Street, Suite 1M17, Boston, MA 02129.

All entries must be received by 5 pm Monday, October 20, 2014.

The Resource Helpline currently operates during normal business hours (9 am to 5 pm) Monday to Friday. Please feel free to call us at 1-800-370-9085 or email at info@ namimass.org with any mental health resource related inquiries. We are here to help!

Saturday, October 18, 2014 8am to 4pm UMass Lowell Conference Center and Inn

50 Warren Street, Lowell, MA 01852

32nd Annual NAMI Massachusetts Convention

Weaving Together the Threads of Recovery Keynote Speaker: Russell Pierce

Department of Mental Health, Director, Office of Recovery and Empowerment

Workshops: Check one morning and one afternoon session: (www.namimass.org for further workshop information)

Morning Workshops 10am to 11:30am Afternoon Workshops 2:30 to 4:00pm

1) When Someone is in Crisis, Who Do I Call?/Cuando Alguien Esta en Crisis, A Quien Llamo? (Workshop in Spanish)

6) Best Practices in the Criminal Justice System for People with Mental Illness & their Families

2) The Teenage Brain: What’s Going on in There? *1CEU 7) Introducing Peer-to-Peer: A Path to Wellness

3) Craig Miller – This is How it Feels: A Memoir of Attempting Suicide & Finding Life

8) Addressing the Substance Use Crisis in Adults

4) Talking About Thinking: DBT & CBT as Two Threads in the Recovery Process * 1CEU

9) Housing First: Home is Where Recovery Lives

5) Advocacy: What are NAMI’s Legislative Priorities & How Do We Promote Them?

10) NAMI, Veterans & the Communities They Live in

*CEU available for Licensed Social Workers ONLY – Workshop Additional Cost is $15 whether you are a member or non-member.

3 ways to register—by 10/15 with payment to guarantee lunch: Mail: NAMI Mass, The Schrafft’s Center, 529 Main Street, Suite 1M17, Boston, MA 02129, Email this form to membership@namimass.org or Fax to 617.580.8673.

Lunch (choose one) Chicken Vegetarian

Registrant’s Name:____________________________________________________________Phone:_____________________________

Scholarship Contributions: Give a contribution for a scholarship, so that someone who otherwise would not be able to attend can join us.

Registration Fees: Member $40/person Non-member $50/person Low Income $15/person

Registration Fee $____________+ Scholarship Contribution $________ + CEU Cost________= Total Enclosed $________________

Paying by: enclosed check credit card (MC/VISA only)

Card #___________________________________________________________Exp. Date________+ 3 digit code on back of card_______

NAME on Card:______________________________________________Company or Affiliate:___________________________________

Billing Address:_____________________________________________________City:__________________State:___Zip:_____________

Telephone:______________________________Fax:_________________________Email:______________________________________

ASL Interpretation (check here) Accommodation can be made for the deaf and hard of hearing.

Convention Scholarship Application: For the form to apply for Scholarship or more info Email: membership@namimass.org NOTE: We try to fund all applicants; however, we will not fund requests from individuals who are not a member of an Affiliate (local

chapter). Go to www.namimass.org to join an Affiliate. Memberships start at $3.00 for limited income individuals. Refund Policy: Cancellations must be received by Tuesday, October 14. No refunds can be made for requests received after that time.

Refunds will be issued in the same form payment was made. Please allow two weeks for processing. The notice can be made by email:

membership@namimass.org

CALL 800-370-9085 with questions or Register online: http://www.namimass.org/events/convention2014

375 Maximum Seating Capacity, Register Early! Program Subject to Change

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Our NAMI Massachusetts Convention is fast approaching. We’re holding it at the

U-Mass Lowell Inn and Convention Center. It’s a great location but we only have

room for 375 attendees – so register early. Breakfast and lunch are provided. The

theme for this year is ‘Weaving Together the Threads of Recovery’

acknowledging the many programs and treatments that go together to create a

sense of mental and physical wellness. Gone are the days of following the

medical model of treating mental illness. The movement to establish a more

holistic approach is gaining ground, and will become the norm under provisions

made in the Affordable Care Act.

We are looking forward to seeing you there.

Morning Workshops: 10 – 11:30am

1. When Someone is in Crisis, Who Do I Call?/Cuando Alguien Esta En

Crisis, a Quien Llamo? - Information on how to use Emergency Service

Programs (ESPs) when in need of a crisis intervention for mental health

or substance use concerns. Informacion de como usar programas de

equipos de emergencia en la necesidad de una intervencion inmediata

para la salud mental y preocupaciones con el uso de sustancias.

1-800 Hotline/1-800 Linea de emergencia

Urgent Care Centers and Community Stabilization Programs/Centros de

Atencion Urgente y Programas Comunitarios de Estabilizacion

What services do they offer?/Que servicios ellos ofrecen?

Live testimony by parents who used ESP services./Vivo testimonio de

padres que usaron equipos de emergencia.

Presenters: Karina Carmona ESP/BEST – Clinician; Andiara (Angie) Oliveira

CSESP (Cambridge Somerville ESP Team – Family Partner)

Moderator (and part of panel): Norma Mora ESP/BEST (Boston Emergency

Services Team) – Family Partner

2. The Teenage Brain: What’s Going On in There?

Any parent of a teenager spends a lot of time wondering and worrying about what happened to their child. Lynsey Heffernan and Meri Viano will clarify what’s normal and what’s not, and why it’s happening. They will explain why changes in the teenage brain, lead to many typical adolescent behaviors, but also lead to their entry into the juvenile justice system. Lynsey and Meri will talk about how traumatized, and often mentally ill, youth get caught in, and often stuck in, the juvenile justice system.

Presenters: Lynsey Heffernan (DYS) and Meri Viano (PPAL) Moderator: Judi Maguire continued on page 8

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August 18, 2014

Hello Family to Family Teachers,

We at the NAMI Massachusetts state office are writing to bring you up-to-date on several items of

importance. For all of us, August is the end of the academic year and the start of a new program year – a

time for looking back and a time for setting- up new classes, groups and trainings as well as the annual

resolution to get more organized!

Looking back on 2013-2014, we are proud of your involvement with F2F and the successes of the thirty

classes that were offered. Last year, the NAMI Mass board initiated a one year pilot project to offer

complimentary membership to F2F grads in the fall of 2013 and spring 2014 classes. We are pleased to

report that 404 new members accepted complimentary membership, at a cost of over $11,000. During the

next fiscal year, 2015, we will be tracking the renewal rates of those members. Therefore, in accordance with

the board’s decision, the offer for complimentary membership has ended. However, we hope all teachers

will continue to urge F2F students to join NAMI – new people can join for a low- income rate of $3/year with

regular dues at $35/yr.

Another part of the F2F program that was scrutinized this year by our board was the $50 stipend program for

F2F teachers. The NAMI Mass state board had agreed to stop paying stipends this fall, 2014. However, due

to valuable input from teachers, affiliate leaders and staff, the board re-instated the stipend program. The

board certainly didn’t want to send the wrong message and we all so appreciate all you do. One of the

reasons the stipend program was scrutinized is because some F2F teachers did not cash the checks and

some returned the checks to the state office. We would like to suggest to those of you who would like to

donate your stipend check, that you consider donating your stipend to your local affiliate.

And in an attempt to be more organized, we will be using a new intake form for F2F program listing and

manual printing. Please contact the state office before you do anything, other than call your affiliate. We will

list the classes on our website and order teaching manuals for you. A more detailed procedural e-mail will

follow.

We appreciate your teaching work and realize your sacrifices and hope the benefits of helping families will

continue to enrich you this new academic year and for many more years to come. Please contact us with

comments, questions and concerns.

Sincerely,

Joyce Calogero

Director of Education and Support

617-580-8541 x 221

jcalogero@namimass.org

Mary Giliberti (NAMI National Executive

Director) and Joyce Calogero at the NAMI

Massachusetts Office.

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NAMI Massachusetts Convention continued from page 6

Morning Workshops: 10 – 11:30am

3. Craig Miller: A Lesson in Everything

Craig A. Miller, author of This is How it Feels: A memoir of attempting suicide and finding life, shares

his story of recovering after years of child abuse, mental health issues, and a suicide attempt. Craig

will discuss each phase of his lived experiences from childhood to adulthood while highlighting what

helped, what hurt, and what gave him hope. But more importantly, Craig will share the steps he took

to move forward in life, how he found purpose in his pain, and how the lessons he learned from his

life’s greatest tragedies gave him everything he needed to cope with his past and remain resilient

today.

Craig Miller is an author, speaker, and suicide attempt survivor. For years he struggled with OCD,

extreme anxiety, depression, and suicidal thoughts. After a suicide attempt at age 20, Craig became

dedicated to understanding what led him to such a decision, and more importantly how he could gain

control of himself and his life to ensure it would never happen again. He published a book in 2012

titled, This is How it Feels: a memoir of attempting suicide and finding life. Craig and his story have

been featured in the Boston Globe and The Khaljee Times as well as several other media outlets

including the documentary, A Voice At The Table and the upcoming film, by Academy-Award winning

directors, The S Word. Craig currently serves on The Executive Committee for The Massachusetts

Coalition for Suicide Prevention. He also an elected member of the Speakers Bureau for the

American Association of Suicidology and regularly speaks publicly about his story.

Presenter: Craig Miller Moderator: Julie Langbort

4. Dialectical Behavioral Therapy (DBT) & Cognitive Behavioral Therapy (CBT) as Two

Threads in the Recovery Process

Clinicians and peers present the overview of these therapies and answer your questions about

appropriateness and efficacy. Open to professionals, family members and peers.

Presenters: Dr. Matt Jerram, Scott Garvin, MSW, Eliza Williamson, NAMI member and Peer

Moderator: Joyce Calogero

5. Advocacy: How to promote NAMI’s Legislative Priorities.

Learn about NAMI Mass’ Legislative Priorities and how best to make your voice heard. You’ll get

tips on how to tell your story to your elected officials. Learn also about the grass roots connection

and why it is essential.

Panel : Joe Giannino, NAMI Government relations and Miriam Stein, NAMI Cambridge Middlesex

Moderator: Jane Martin, NAMI Cambridge Middlesex and NAMI Mass Board continued on page 9

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NAMI Massachusetts Convention continued from page 9

Afternoon workshops: 2:30 – 4pm

1. Best Practices in the Criminal Justice System for People With Mental Illness & their

Families

Hear from representatives of law enforcement, court clinicians, criminal defense attorneys and

judges about how the criminal justice system responds to people with mental illness. Learn

about best practices and programs that can be replicated throughout the Commonwealth in order

to maximize criminal justice diversion efforts of people with mental illness.

Panelists: Chief David Fallon, Somerville Police Dept.; The Honorable Kathleen Coffey, W. Roxbury

District Court; Judge Coffey runs a Mental Health Court Karen Orr, DMH Northeast Area Forensics

Director Moderator: June Binney, NAMI Mass, Director of Criminal Justice Project

2. Introducing Peer-to-Peer: A Path to Wellness

Peer to Peer is a 10-week recovery and wellness program that empowers one to establish and

maintain mental and physical wellness. Using interactive exercises, P2P gives you a menu of

tools to help in decision making, identifying triggers and recognizing the impact of emotions on

actions. Great value is placed on your experience and expertise. Judi Maguire, our first Peer to

Peer state trainer, will introduce the program and guide you through some of the exercises.

Presenters: Judi Maguire and Eliza Williamson Moderator: Julie Langbort

3. Addressing the Substance Use Crisis in Adults

Families experiencing mental illness are affected by this crisis since over half of individuals with

serious and persistent mental illness are also using substances. This workshop defines primary

treatments and available resources.

Presenters: TBA, Billy Niland, Person in recovery Moderator: Larry DeAngelo

4. Housing First: Home is Where Recovery lives.

This workshop will focus on how to find housing and keep housing for DMH clients. Currently,

DMH has over 3,000 clients using different types of rental subsidies for special needs housing.

The presenter, Joe Vallely is the statewide Housing Specialist for DMH. He supports the

development of supportable housing along with the six Area Housing staff at DMH. Joe has

oversight over a number of statewide homeless programs including the PATH program that

provides clinical outreach to more than 50 adult shelters across the state.

Presenters: Joseph Vallely, Housing Specialist, DMH,Sue White, Housing Specialist, Vinfen

Moderator: Constantine Souris, NAMI Cambridge Middlesex and NAMI Mass Board member.

5. NAMI, Veterans and the Communities They Live in

Come learn about NAMI and the programs we offer for the vet community. How families can be

more involved in VA healthcare for veterans.

Panelists: Laurel Landon, Veteran, NAMI Western Mass, Will Bielty, Veteran and NAMI Connection

facilitator, Chuck Drebing, PhD, Chief of Mental Health Services, Bedford VA Hospital

Moderator: Bruce Cowell, NAMI Veteran Outreach Coordinator

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Families for Depression Awareness

FREE WEBINARS

Bipolar Disorder Training NEW THIS FALL!

For adults with bipolar disorder, their family caregivers, and the general public

September 30, 2014 at 7pm ET. Register at http://familyaware.org

Presenter: Noreen Reilly Harrington, Ph.D.

Families for Depression Awareness is responding to the incredible demand from you—our friends and

supporters—to provide a webinar training addressing bipolar disorder in adults.

The goals of the webinar will be to guide families in:

recognizing bipolar disorder

seeking treatment for themselves or their loved ones

effectively managing bipolar disorder, once diagnosed.

The training will also cover the role of family members in helping someone with bipolar disorder and what to

do if your loved one is manic or refusing treatment.

About the presenter:

Noreen Reilly-Harrington, Ph.D., is an Assistant Professor of Psychology at Harvard Medical School and is

an internationally recognized expert in the cognitive-behavioral treatment of mood and anxiety disorders,

with a particular expertise in treating bipolar disorder.

She has co-authored several books on bipolar disorder, including "Bipolar Disorder: A Cognitive Therapy

Approach," "Living with Bipolar Disorder: A Guide for Individuals and Families," and "The Bipolar II Disorder

Workbook: Managing Recurring Depression, Hypomania, and Anxiety." In addition to serving on the staff of

the Massachusetts General Hospital (MGH) Bipolar Clinic and Research Program, she also serves on the

staff of the MGH Weight Center, with a special focus on the treatment of obesity and eating disorders in

individuals with mood disorders.

Teen Depression Training

For Parents, Teachers, School Counselors and Staff, and Youth Workers

October 30, 2014 at 7pm ET. Register at http://familyaware.org

Presenter: Nancy Rappaport, M.D.

This webinar trains caring adults to recognize depression in teens and know what to do to help.

The program covers

What is teen depression

What are behaviors of concern, including self-injury

How to talk to teens about depression

What role bullying plays in child and teen depression

How is depression treated in teens

Where to get help

How to address difficulties that may arise, such as the refusal of help

About the presenter:

Dr. Nancy Rappaport is an Associate Professor of Psychiatry at Harvard Medical School and Director of

School-Based Programs at the Cambridge Health Alliance. She is the author of In Her Wake: A Child

Psychiatrist Explores the Mystery of Her Mother's Suicide (Basic Books, September 2009) and The Behavior

Code: A Practical Guide to Understanding and Teaching the Most Challenging Students (Harvard Education

Press, April 2012), written with Jessica Minahan.

Continued on page 11

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Governor Patrick Signs Safe and Supportive Schools into Law

Massachusetts Governor Deval Patrick made history on Wednesday, August 13th 2014, as he signed the Safe and Supportive Schools provisions into law. In recognition of the link between safe and supportive school environments and the reduction of school violence, the legislature incorporated these provisions into its omnibus Act Relative to the Reduction of Gun Violence.

With the enactment of the Safe and Supportive Schools provisions, Massachusetts becomes a national leader in supporting schools and districts to create the whole-school safe and supportive environments that can serve as the foundation for all students, including those who have endured traumatic experiences, to learn and succeed. The centerpiece of the new Safe and Supportive Schools law is the statewide Safe and Supportive Schools Framework. Organized according to the six core elements of school operations contained in TLPI's Flexible Framework, this statewide framework will help schools align the many school climate-related initiatives (anti-bullying, dropout prevention, positive discipline, etc.) that are necessary for creating safe and supportive learning environments. In addition, a groundbreaking definition states that a safe and supportive school is one that supports students in four key domains —relationships with adults and peers, self-regulation of emotions and behaviors, academic and non- academic success, and physical health and wellbeing.

Families for Depression Awareness continued from page 10

FREE WEBINARS

Coping with Stress and Depression Training

For Adults, Family Caregivers, Human Resources Managers, and Employee Assistance

Program Professionals

November 20, 2014 7pm ET Register at http://familyaware.org

Presenter: Annelle B. Primm, M.D., MPH

Learn how to manage stress and identify depression in yourself and others during this 1-hour training.

This webinar covers:

What is stress and ways to reduce stress (e.g., lifestyle changes, reframing negative thinking,

positive inventory, and more)

What is mindfulness-based stress reduction

How to differentiate stress from more serious conditions, particularly anxiety and depression

What to do if you or someone you know is suffering from depression

What resources are available to you and your family

About the presenter:

Annelle B. Primm, M.D., MPH, is the Deputy Medical Director of the American Psychiatric Association

(APA). In addition, she has served as Director of the APA’s Division of Diversity and Health Equity, and

the Director of APA’s SAMHSA-funded Minority Fellowship Program, positions she has held from 2004-

2014. Prior to that, Dr. Primm was Medical Director of the Johns Hopkins Hospital Community Psychiatry

Program where she oversaw a variety of mental health services for adults. She is currently on the part-

time, volunteer faculty at the Johns Hopkins School of Medicine as an Associate Professor in the

Department of Psychiatry and Behavioral Sciences.

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Should we be treating suicide differently?

Continued from page 1

It is so easy to read meaning into the smallest things after a tragedy. In a 2006 interview, Robin Williams talked openly about his mood swings. “Do I perform sometimes in a manic style? Yes. Am I manic all the time? No. Do I get sad? Oh yeah. Does it hit me hard? Oh yeah.” He didn’t say that he’d been clinically diagnosed with a specific disorder, but his publicist has confirmed that Williams had been battling depression in the months leading up to his suicide.

Among the hundreds of tributes to Williams’ warmth and comic genius, many have pointed out that his death highlights, yet again, the many misconceptions and stigmas surrounding mental health problems. NBC News has a thoughtful piece about the “deadly stigma” surrounding this “silent epidemic” – suicide is rarely discussed, despite the fact that it is a growing issue; more people in the United States now die of suicide than in automobile accidents. Then there are people who still consider suicide a “selfish act” that can be cured with willpower. It is sad we are even having these discussions. Tony Blair’s former spin doctor, Alistair Campbell, who has himself suffered from mental health problems, best described the misunderstandings in an article for the Guardian: “If he’d had a heart attack, lost a fight with cancer or been knocked over by a car, would there be a need for a debate about what this says about the state of heart disease, or cancer care or road safety?”

Yet even once the taboos have been broken, we still have a long way to go if we are to treat suicidal feelings with the same precision as other diseases. Anti-depressant drugs and cognitive behavioural therapy seem to reduce suicidal thoughts for many people with depression – but they are not a perfect cure for every patient. Why some respond, while others don’t, has been the matter of much soul searching, but recent research is helping to shed a little light on this dark state of mind. Self-awareness

For instance, there is a growing recognition that the disease we call “depression” could be an umbrella-term covering many distinct problems, each with a different biological origin. In particular, a suicide attempt may be foreshadowed by a string of neurological changes that are not found in people with other kinds of depression. Of the most noticeable differences, patients who have tried to kill themselves seem to have less of the white-matter connections that transmit information in the dorsomedial prefrontal cortex – the part of the brain right behind your forehead’s hairline. That’s significant, since this region helps us process our self-awareness.

People who try to kill themselves seem to get stuck in ruminative, negative styles of thinking full of self-criticism – so the study’s authors wonder if the neurological changes could lie behind those destructive trains of thought, blinding people to the hope and promise of the future, and even of their sense of their own self-worth.

Continued on page 13

“If he’d (Robin Williams)

had a heart attack, lost a

fight with cancer or been

knocked over by a car,

would there be a need

for a debate about what

this says about the state

of heart disease, or

cancer care or road

safety?”

13

Should we be treating suicide differently?

Continued from page 12

People feeling suicidal thoughts also seem to have reduced connectivity in the frontal areas of the brain associated with emotional control and inhibition. Again, the consequences of this are hypothetical, but suicide is considered to be an impulsive action, so it could be that the abnormal wiring in these regions makes it harder for someone to cope with the urge for self-destruction. On top of these specific changes, the brain cells themselves seem to be wasting away across diverse regions of the brain, potentially impairing problem solving and decision making – cognitive problems that are commonly seen in people who have attempted suicide.

At the moment, it’s not clear what triggers these anatomical changes and whether they are the primary cause of the suicidal urges – it could be that they are just a side-effect of the depressed, desperate feelings that the patient is already experiencing. Most likely, the psychological symptoms and the altered brain wiring are both the result of a complex interplay between your genes and your circumstances.

Once we have picked apart the specific mechanism, this new understanding could eventually change the way we treat people with depression. Firstly, it could help identify who is most at risk for suicidal tendencies. Many suicidal patients are unlikely to tell anyone, even their doctors, about their darkest feelings – but a brain scan might reveal those characteristic anatomical changes, giving doctors an insight that they couldn’t have gained from an interview. Since neural degeneration – such as the death of neurons – has certain chemical signatures, some have suggested that blood tests could one day reveal the early signs that could precede a suicide attempt. Preliminary explorations of the technique have been positive, but much larger trials will be needed before any form of this test could be used in the clinic.

Once the patients’ particular needs have been identified, the work could then tailor treatments that best suit the particular type of depression they have. Doses of lithium, for instance, seem to replenish the grey matter in damaged areas of the suicidal brain; and studies have found that the drugs do indeed reduce the risk of a second suicide attempt, when applied to people with bipolar disorder who have already attempted to take their life once. Other drugs could have a similar function.

Kees van Heeringen at the Unit for Suicide Research in Ghent University in Belgium has proposed that upcoming, non-invasive forms of brain stimulation like transcranial magnetic stimulation (TMS) could also be of interest. Using a magnet on the scalp, TMS can boost or reduce the electrical activity in specific parts of the brain – sometimes with long-lasting effects.

Continued on page 14

Brain fibres, as seen in this MRI scan, could leave physical clues of depression (Science Photo Library)

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Should we be treating suicide differently?

Continued from page 13

It has already helped bring relief to people with other kinds of depression that had resisted treatment, and it could potentially target the regions most affected in people with suicidal feelings, curtailing their destructive urges. A better understanding of the brain changes involved – and the way it influences someone’s thinking – may even help refine the talking therapies by helping to identify the thought processes that are most severely disrupted as a consequence, says van Heeringen.

It is unlikely that any single treatment will ever be a panacea for people suffering from severe and suicidal depression. Instead, the strength of this new approach lies in the many different strands; where there was once a murky darkness, neuroscientists and psychiatrists are now beginning to see a kaleidoscope of new options. If they can be adapted to each patient’s specific circumstances, that might save an enormous number of lives from being needlessly taken from the world.

Understanding and Helping the Suicidal Individual

BE AWARE OF THE WARNING SIGNS

Are you or someone you love at risk of suicide? Get the facts and take appropriate action. Get help immediately by contacting a mental health professional or calling 1-800-273-8255 for a referral should you witness, hear, or see anyone exhibiting any one or more of the following:

Someone threatening to hurt or kill him/herself, or talking about wanting to hurt or kill him/herself.

Someone looking for ways to kill him/herself by seeking access to firearms, available pills, or other means.

Someone talking or writing about death, dying or suicide, when these actions are out of the ordinary for the person.

Seek help as soon as possible by contacting a mental health professional or calling 1-800-273-8255 (TALK) for a referral should you witness, hear, or see anyone exhibiting any one or more of the following:

Hopelessness

Rage, uncontrolled anger, seeking revenge

Acting reckless or engaging in risky activities, seemingly without thinking

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Understanding and Helping the Suicidal Individual

BE AWARE OF THE WARNING SIGNS

Continued from page 14

Feeling trapped – like there’s no way out

Increase alcohol or drug use

Withdrawing from friends, family and society

Anxiety, agitation, unable to sleep or sleeping all the time

Dramatic mood changes

No reason for living; no sense of purpose in life

WAYS TO BE HELPFUL TO SOMEONE WHO IS THREATENING SUICIDE

Be aware. Learn the warning signs

Get involved. Become available. Show interest and support

Ask if he/she is thinking about suicide

Be direct. Talk openly and freely about suicide

Be willing to listen. Allow for expression of feelings. Accept the Feelings

Be non-judgmental. Don’t debate whether suicide is right or wrong, or feelings are good or bad. Don’t lecture on the value of life.

Don’t dare him/her to do it

Don’t give advice by making decisions for someone else to tell them to behave differently

Don’t ask ‘why’. This encourages defensiveness

Offer empathy, not sympathy

Don’t act shocked. This creates distance

Don’t be sworn to secrecy. Seek support

Offer hope that alternatives are available, do not offer glib reassurance; it only proves you don’t understand.

Take action! Remove means! Get help from individuals or agencies specializing in crisis intervention and suicide prevention.

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