Saturday, October 24, 2009

chronic suicide ideation

As most of you know, I work in a program for adults with mental illness who want to reenter the workforce. One of the main criteria for program admission is current stability. In other words, you have to be emotionally ready to work and have enough control over your symptoms to function in a work environment. We'll support you, we'll advocate for you, we'll work with your employer, we'll help you, etc, but we aren't a placement agency, we help people find jobs in main stream employment. Of course, because no one is perfect and mental illness can be unpredictable, not all over our clients are able to find employment, and they don't all remain stable. Right now, I'm working with a client who is very not stable, and it's a little bit outside my comfort zone.

Said client is chronically suicidal. Suicide ideation is part of her daily life. However, since entering our program she has attempted suicide on three different occasions. She was not stable enough to maintain employment. So, it came time to discharge her and refer her to more appropriate services. So I did... refer her that is. She and her doctor decided that a hospital day program was a good option for her, it offers DBT and CBT skills training and would provide her with tools and a lot more support then our program can. So the client and I agreed that I would discharge her as soon as she started the program...

The program kept bumping her date of admission back, and so, two and a half months later, here we are. We meet for counselling, but I feel like we're getting no where. Every session is potentially our second last session (we'll do a last one for closing once she starts) and because her suicide ideation is so prevalent it's almost all we talk about. We have safety planned so many times that both of us could probably recite the whole thing backwards, forwards and upside down. The crisis lines have heard from her day in and day out for months. The mobile team won't see her right now because it's a "long standing issue". I was out of ideas.

So, when I saw her for the second time this week, an extra session, just to get her through till her day program starts Monday (we hope, we hope, we hope) I took a totally different approach. Rather then doing the whole ASIST thing where you explore reasons for death, reasons for life, align yourself with the side that wants to live, safety plan and contract (which I don't do anyway), I thought, we'll, this isn't changing anything, screw this. So, we talked about death. We talked about who finds her body, we talked about how long it stays in her apartment, we talked about who feeds her gerbil, we talked about her funeral, her ashes, the affect on different people in her life, and you know what, our session went a whole lot better. I wasn't frustrated (something my student noticed in our last session) and I left more room for silence and thinking. She wasn't forced to answer the same questions (with the same answer "I don't know") as usual. It certainly wasn't the answer, and it certainly didn't fix her suicide ideation, but it seemed to be a better approach.

In April I'm going to a two day workshop about working with chronic suicide ideation and it's connection to trauma. I'm super excited. I felt very unequipped in this situation, and while I did make all sorts of appropriate community referrals, the person she felt comfortable talking to was me. So I did research, I consulted coworkers and my supervisor and I kept in mind that not only do I not know everything, but I don't have to know everything.

Tuesday, October 20, 2009

second guessing

I'm second guessing myself today. I don't usually do that. In general, I'm pretty good at leaving work and work and not thinking about it once I get home. Every now and again though, there's a situation which gets under my skin. A decision I made that I'm just not sure about. Today is one of those days.

Thursday, October 15, 2009

Vacation is going amazingly well. I'm hanging out with this fine canine named Apocalypse. He's pretty awesome, but VERY hard to get a picture of as he doesn't hold still long enough.

As I mentioned in a previous post a couple months ago, my vacation is with someone I met on the internet, a fact which concerned some of my friends, but it's turned out wonderfully. At least for me, I hope she feels the same way! I've known my movie loving friend online for 5 years now and I've been planning this trip for many of them. It feels so great to finally just get to hang out in the same room, even if all we're doing is reading/reading the internet.

Vacation has been so relaxing, and I still have 2 full days left! Today we went to take in some tourist sites, but for the most part we haven't been doing much of anything, something I've been greatly enjoying. We've been to mass, church, small group and movie discussion group. Watched movies and played boardgames with her roommates. I lost horribly at the game of life tonight, but really had quite a good time of it. If you ask me, I should have won, however the money didn't agree.

I hope all of you are doing well and have fun vacations to look back on/look forward too!

Monday, October 12, 2009


I'm on vacation right now and it's wonderful! I took that picture on Friday. My friend and I sat on some rocks and just "were". It was amazing. I am soooo relaxed, and I'm finally getting healthy too. It turned out I was quite anemic, which was definitely the cause of my lack of energy and depression. I've been taking double the usual amount of iron and despite the stomach ache, I feel SO much better. Vacation is wonderful. Friends are wonderful. Walking on hills, definitely not so wonderful, but still, in this gorgeous place, it's okay.

Saturday, October 3, 2009

realities of life

I haven't posted about death in quite a while. Since switching jobs, I haven't had nearly as many encounters with death, although I will say that every time I work at the shelter, one of the first things I find out is if anyone has died. So, it surprised me yesterday, when my father told me about a client from two jobs ago who died this week, a attender of the church I attended in my first couple years of university, and more recently, someone I locked up in the drunk tank at the shelter.

Anora was a broken woman, rarely have a met someone with SO much anger and pain inside, and yet, she tried to fight, as best she could. A woman, who grew up surrounded by drugs, abuse, alcohol, gangs, neglect and suffering, full of instability, it all came with her to her adult life. Trauma doesn't disappear when you turn eighteen.

Anora was found dead in a pool of her own vomit. She didn't make it through that nights drinking and drugs. We'll never know if she intended to die that night or just went a little overboard and her tired body couldn't handle anymore.

Very honestly, and this really surprised me, I hope she wanted to die. Not because I think her life was so horrible there was no help for her, but because I hope that she was ready to go. I hope this wasn't an accident and there was still some fight left in her, I hope she didn't intend to wake up the next morning full of possibilities, I hope this was on her terms, and her time. Or perhaps, she simply gave up caring, which is the most likely scenario given what I know of her.

And so today, I mourn the lose of Anora, and I pray that people will continue to make an effort for others like her, so that not every tragic story has to end in more tragedy.