Ohio Counseling Conversations
Ohio Counseling Conversations
Conversation 33 - The Impact of Client Suicide on Professional Counselors
When mental health and criminal justice systems intersect, what happens to those caught in the middle? Dr. Em Ribnik, Director of the Criminal Justice Coordinating Center of Excellence at Neomed, takes us deep into this complex terrain where vulnerable individuals often find themselves navigating confusing and sometimes contradictory systems.
Drawing from over 15 years of experience in mental health and crisis services, Dr. Em shares powerful insights about how cross-system collaboration can transform outcomes for people experiencing mental health crises. She explains how Crisis Intervention Team (CIT) programs equip law enforcement with essential skills for de-escalation and appropriate response, creating pathways to treatment rather than incarceration for many individuals.
The conversation takes a profound turn as Dr. Em discusses her dissertation research on the impact of client suicide on counselor supervisors. "That person's decision does not negate all of the incredible work you did with them," she emphasizes—a message rarely shared with clinicians experiencing this traumatic loss. She reveals the staggering workforce impact, with nearly one-third of clinicians considering leaving clinical work and even the mental health field after a client suicide, and offers practical guidance for creating supportive supervision and organizational responses.
College mental health emerges as another critical focus, with Dr. Em highlighting how this developmental period coincides with the emergence of serious mental health conditions. "It's a unique, very condensed experience that you will never have the rest of your life," she explains, detailing the biological, social, and academic pressures that create perfect storms for many young adults.
Throughout, Dr. Em weaves personal experiences with professional wisdom, challenging us to break the silence around suicide through responsible, healing conversations. Her passionate call to inspire new professionals to join the mental health field despite its challenges reminds us why this work matters: behind every statistic stands a human being deserving compassionate, informed care.
Listen now to gain insights that could transform how you think about mental health crisis response, professional resilience, and the power of cross-system collaboration to save lives.
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Created by the OCA's Media, Public Relations, and Membership (MPRM) Committee & its Podcast Subcommittee
·Hosted by Marisa Cargill
·Pre-Production & Coordination by Marisa Cargill and Victoria Frazier
·Editing by Leah Wood
·Original music selections by Elijah Satoru Wood
Dr M Rybnik is the Director of the Criminal Justice Coordinating Center of Excellence at the Department of Psychiatry at Neomed, a role she has held since 2021. She has over 15 years of experience in mental health and crisis services, including serving as a clinical counselor at Kent State University at Stark and as a crisis intervention team coordinator in Portage County, and was even featured last year by ABC News on the value of crisis intervention team training for police officers to help them appropriately respond to mental health crises. At the Center of Excellence, dr M partners with criminal justice and mental health stakeholders to improve cross-systems responses for individuals in crisis and justice-involved people living with mental illness. Her leadership includes expanding CIT programs across Ohio, coordinating the Ohio Cross Systems Mapping Initiative and providing statewide training and consultation. She's an active member of the Ohio Attorney General's Task Force on Mental Illness and Criminal Justice and other statewide committees.
Speaker 1:Dr M completed her PhD in Counselor Education and Supervision in 2023. Dr M completed her PhD in counselor education and supervision in 2023. Her dissertation, the Impact of Client Suicide on Counselor Supervisors, reflects her commitment to addressing suicide intervention, postvention and the professional impact of client loss. In addition to her academic and clinical leadership, she teaches, trains and collaborates with organizations like Light After Loss to support suicide loss survivors and educate providers on the needs of those affected. With such an amazing background and a wealth of knowledge, we here at Ohio Counseling Conversations are so excited to be joined by Dr M Ribnick. Thank you so much for being here with us today. To start off, we want to know a little bit about your journey into counseling and what led you to the current role directing the Criminal Justice Coordinating Center of Excellence at Neomed.
Speaker 2:Well, first off, thank you for saying that correctly the first time A lot of people stumble over that very long title.
Speaker 2:It's a mouthful yeah, it is. It was very hard to explain it when I first got this job. So my journey in counseling I'm in my mid forties, so this started, you know, a little over 20 years ago.
Speaker 2:I really didn't think about my journey in the counseling field until I was in my PhD program and someone asked it was part of a part of our class and I had the memory of what really truly set me on this path was when I was little and I saw movie Teenage Mutant Ninja Turtles and there's a scene where there's two characters talking and they're talking about the one's anger and, you know, talking about how, you know, turned inward, this can be an enemy, how that other character is choosing to face this enemy alone, and then it ends with, as you face this, don't forget your family and don't forget me.
Speaker 2:And it was really in that moment that I connected with this idea of wanting to help others, wanting to be of service. And that's a movie I saw when I was 10, so you know, 30 some years ago, the yeah, the idea got planted that this is what I wanted to do with my life. I didn't always know what it was, you know, I couldn't, I didn't know what counseling was when I was that age right, but it was always in there.
Speaker 2:My entire career really has focused on helping others, being of service. I've almost exclusively worked in public service throughout my career. I was a hall director for a while at Kent State University and had experiences there. I did have one student have their first psychotic break while I was there. I was part of the group that responded to a really sad accident where a car full of students from all from the same floor, they had a horrible car accident and and all of them passed away. So I was tagged to come in and help support other students throughout that and that's just always been what I've wanted to do.
Speaker 2:My first job in the field was working in crisis services. So I worked in a 24 seven crisis hub. So for my county at the time we took calls 24 seven7, you know 365, but we also stopped people in person. We did community outreach going to see people in their homes, sometimes bringing them, you know, back with us to the center to talk to them more. We were doing level of care assessments, pre-hospitalization screenings and then, for those who did need to be hospitalized at a psychiatric facility, we were also coordinating those admissions. So we really walked with those clients from the moment they walked in or they were brought in, because sometimes they were brought in by police or family all the way to them heading to the psychiatric facility.
Speaker 2:So you know we would spend a lot of intense time with them. I saw people of all ages but most of my work was with those with severe and persistent mental illness and that's always been a passion of mine to help them have, you know, better lives, have them help, help them have a better experience of their life. Did that work for about five years. It's actually where I got involved with crisis intervention. Team programs was during that time. Then I worked for 10 years at Kent State University, at Stark, at their counseling services, so focused on working with college students.
Speaker 2:It was very different because it was not a residential campus. So it was a different type of community, different diversity of students who were coming through the door. Lots of individuals from lower socioeconomic status, lots of trauma, you know, walking through the door, but also still individuals of that age where they were having, you know, some early psychotic breaks, early showings of potentially more severe persistent mental illness because of, you know, that transitional age range Extraordinarily rewarding One of the things that I always tell folks that is a great part when you work at a school, whether it's a K through 12 or a college is go to graduation. It's something that we don't have out in community mental health right. We don't get to see someone we work with necessarily achieve things Like we don't necessarily get to witness them in their life. For me, it became very important to be at graduation every semester to see students that I worked with every year, you know, walk that stage knowing what they had done and the work they had done to get there.
Speaker 2:And then about a little over four years ago, closing in on four and a half years ago, I saw this current position at Northeast Ohio Medical University, so now I am the director of the Criminal Justice Coordinating Center of Excellence, housed in the Department of Psychiatry, along with two other coordinating centers. One is the Ohio Program for Campus Safety and Mental Health, so they focus on mental health awareness and suicide prevention at university and college campuses, and then the Best Center, which focuses on best practices for schizophrenia and other psychosis diagnosis treatment. So they work a lot with training clinicians with how to better work with individuals experiencing psychosis. Okay, it sounds like a lot of training clinicians with how to better work with individuals experiencing psychosis.
Speaker 1:Okay, it sounds like a lot of your work sits at that intersection of mental health and now the criminal justice system. What do you think is so critical about this collaboration, especially when we're talking about suicide prevention and postvention efforts?
Speaker 2:Sure. So the over-representation of those with mental illness in the justice system has been going on for decades, and we know that this happens because for some folks, when they are experiencing their symptoms, those can be very strong, they can take over. Symptoms can sometimes cause folks to behave in a way that they wouldn't typically behave, or for someone with severe, persistent mental illness who has very severe symptoms, you know, they may be doing things that puts them in harm's way, puts others in harm's way or just, in general, might concern people in the community, right? So there's a lot of interaction between those systems, and so what we try to do is work with communities in Ohio to bring those two systems proactively together as best as possible to look at what is that experience of individuals with mental illness in their community that come in contact with the justice system. What services are there, what tools are there to potentially deflect them to treatment as appropriately? Or, for those that need to, still, you know, go through the process of the justice system, working towards having appropriate services for them so that they are not becoming sicker while engaged with the justice system. That's really what we come down to With suicide prevention as soon as anyone has contact with the justice system.
Speaker 2:That is a risk factor. There can be loss of face. There can be a lot of loss that comes with interaction with the justice system At minimum. There can be shame that comes with interaction with the justice system at minimum there can be shame that comes with it. There can also be very concrete losses loss of job, loss of relationships, and the most concrete one is loss of freedom, even if it's temporary.
Speaker 2:Higher risk, you know, potentially for suicidal thoughts or suicidal behaviors, and that means that the staff and the personnel of the justice system also need to be informed about these to provide their own interventions for safety of folks. For example, one of the things we do is we collaborate with the attorney general's office to put on educational webinars for jail personnel and correction staff to learn about things like recognizing, you know, when someone might be at risk, making sure that they're using appropriate screening tools at booking, really working with them about what's appropriate to do when someone has a crisis at the jail, you know. So we work with them on all of those aspects. So for lots of individuals that contact with the justice system, can you know, potentially ratchet up that risk for suicide and they're around a different system than the mental health system, but it is a system that is trying to do well and trying to make sure that people are protected and alive and are receiving the care that they need in order to continue to participate in whatever process they're going to be going through.
Speaker 1:Yeah, yeah, and I know, like we heard in your bio, how you've been a leader in Ohio's crisis intervention team expansion and I guess I'm curious what are some of the most promising practices that you've seen with CIT when it comes to prevention for individuals in crisis?
Speaker 2:Sure. So in Ohio, crisis intervention team programs are organized locally. So while my center, the CJCCOE, serves as a place for consultation, technical assistance, guidance resources, mentorship, it's really the local CIT programs that lead the expansion and the growth of what happens with that in their communities. So they're primarily organized by mental health catchment board area. So we have 88 counties, we have multiple mental health boards that have two, four, sometimes even six counties under their catchment. It's really those programs that have found their own ways to enhance and expand what they're doing Related to suicide prevention.
Speaker 2:Over my tenure here, looking at it from the state level, we've seen CIT programs integrate mental health first aid into their CIT patrol officer training courses. We've seen the utilization of QPR. The utilization of QPR We've promoted QPR for first responders, which is a question, persuade, refer training that really is targeted towards how do you do that with the first responder population? They are different and also how can they help each other as peers. So we've promoted that. Some of the things that the different programs do is they're carving out time and trainings for suicide prevention, not just intervening when someone is suicidal or is making suicidal statements.
Speaker 2:Law enforcement officers understand why, because we know that that's a big part of empathy, for when you're in a crisis situation of being able to maybe not completely understand what someone's going through, but have some kind of basic knowledge as to what are all the things that could push someone to that moment of crisis, and that empathy really helps them with with responding really well to individuals in crisis to have patience, to give them space to kind of talk things out, help them kind of come out of the crisis at least enough to get to the problem solving space. Yeah.
Speaker 1:To deescalate.
Speaker 2:Yeah, to get them kind of past the peak of the crisis. So we're seeing a lot of education, integrating this information into training courses. But beyond that, as I mentioned, as a program locally, they're also working with other criminal justice and mental health partners. We have CIT programs that are sharing information about their contacts right out in their community with mental health providers, sharing information about their contacts right out in their community with mental health providers, so mental health providers can do an outreach to folks that had contact with law enforcement who didn't need to go through a crisis. You know services, but so they're getting follow up. We're seeing policies and procedures starting to be developed that are focused on suicide prevention and, as I mentioned before, we're also seeing jails taking a higher interest in suicide prevention within correctional facilities, which in and of itself is kind of a standalone issue, as kind of a microcosm issue within suicide prevention on the justice side of things.
Speaker 1:With September being Suicide Prevention Awareness Month, what does it mean to you to have meaningful suicide prevention? What does that look like at a systems level, especially for maybe those who are justice involved or with mental health concerns?
Speaker 2:To me, meaningful suicide prevention is taking it past a screening, taking it past an assessment and looking at what are the community-based and environmentally-based things that contribute to someone hitting that point of crisis. I mean we're talking about affordable housing, you know, affordable food, ability to keep jobs, ability to pay for what their children need. I mean there's these other things that are happening around someone that the communities can work on to improve. And while prevention is hard right, because there's not it's hard to draw a direct line between, well, we did this thing and it prevented this other thing. It's very hard to do that in the prevention world, but what we can do is put into place as much preventative efforts as we can, because you never know what's going to be the prevention effort for that one person that it clicks with. For some, for one person it may be having access to a food pantry. For another person it's being able to get their psychiatric medications. For someone else it's being able to work with a family advocate to regain custody of their children. It's so diverse.
Speaker 2:But when I think about suicide prevention while as a clinician, I think about the work that I've done one-on-one with clients, you know, with assessment, interventions and prevention, and you know the education and the awareness piece, but I also view it in a larger sense of there's things outside of the clinician's office that impacts, you know, if someone is going to be in a crisis. So I think of that in that wider lens of what what going on in communities can be improved to really support people when right, when you think of you know good old Maslow's triangle if you don't have those foundational things, it's really hard to really do do much of anything. And those foundational things are often community-based services, human and community service supports. Those are the things that we need happening out in communities as a part of suicide prevention.
Speaker 1:Yeah, yeah, definitely. We had a different episode on harm reduction and I feel like it's those things too right Like that. It's just like meeting people's really basic fundamental needs helps create a more tolerable environment. Even if we can't get to like a higher place than tolerable, like it is something where we can, at least we have the ability to then keep working, absolutely yeah. So your dissertation is sort of focused on the impact of clients, who not sort of it did focus on the impact of client suicide on counselor supervisors. What have you learned about how suicide affects the counseling profession and what kinds of supports are needed for them after you know, in the aftermath of that?
Speaker 2:Sure, so this is going to be a long answer, so I love long answers, kind of buckle in for a few minutes.
Speaker 2:Yes, so when thinking of what was learned, part of my my literature research was focused on in general, what is the impact of client suicide on all types of mental health clinicians still focusing on counselors and then later on supervisors and the reality is that it's grief. It's grief and loss. It's very comparable. But then we as clinicians have this added layer of perceived responsibility I'll use that phrasing and this perceived responsibility comes from how the rest of the world views our positions.
Speaker 2:You know, in society we're the helpers. We're there to help people make quote unquote better decisions. You know improve their life. You know make changes. Hopefully those are positive changes and I think we also get that message a lot in our graduate programs and in our training of you know we are responsible to our clients not for our clients, but to our clients very muddy, as we will naturally feel a sense of responsibility that can be exacerbated if our peers view it as our fault or our responsibility. I know as a, as a clinician, survivor of suicide loss myself, one of the first things I thought was I shouldn't do this. This shows I shouldn't do this, I shouldn't be a clinician and I would overhear. You know other clinicians say things like I can't believe that they didn't know how to handle that situation in counseling.
Speaker 2:So, other people were talking about it, having not ever worked with that person or been a part of their situation that person or been a part of their situation, so it's a lot of grief. It gets complicated very quickly for clinicians. I think for clinicians too, and similarly for doctors and other folks within the health field that are held to confidentiality standards, there's a very natural isolation that happens. These are not things that you can talk to your best friend about these are not things you can talk to your family about.
Speaker 2:I was in a situation where a family member knew about one of the suicides and was talking to me about it and making statements.
Speaker 2:We'll go with that they had no idea that I was the last clinician to see this person. Yeah, so there's I think there's an added layer. I mean, being a suicide loss survivor is isolating in and of itself. When your job as a layer of isolation, it becomes really difficult. There's a lot of questioning should, questioning of skills, questioning of competency, and everybody responds to that in different ways, just as everyone responds to grief and loss and trauma in different ways. So one of the things that we also know is being a clinician survivor of suicide loss is also a workforce issue. In 2016, ohio did a study they had a task force about this and our Ohio Department of Mental Health and Addiction Services did a study of Ohio mental health clinicians and the impact of client suicide on them, and what they found was, you know, blaming themselves, questioning of competency, questioning of skills. But what really stood out to me in that and I think this is something we don't always consider when we talk about suicide loss within our own field is about a third of those individuals left the field. Many of them considered early retirement. Many of them moved out of clinical work. Some of them left the field completely.
Speaker 2:When I was doing my dissertation, there were two participants. Now my participants were supervisors. I had two participants who had supervisees that completely left the field after a client suicide for different reasons, but left the field because of the client, you know, in the aftermath of a client suicide. So this has significant impact. It doesn't matter if you are someone like me who worked in crisis and walked through the door with an expectation that someone was probably going to either die from natural causes, which is very common with those who are severely, persistently mentally ill and homeless. Those two things going together really shortened someone's life. But I also knew that someone completing suicide was also very highly probable. I walked into that field knowing that in my mid-20s- Logically, knowing it one thing, experiencing it quite different.
Speaker 2:And I'm a seven-time suicide loss survivor in different identities of my life, so it doesn't matter if you go through four, five, six, seven, if you go through one. They are impactful in their own ways, and so that was one piece of the learning was the impact. It is becoming more prevalent. I was just in a training earlier today with a researcher doing similar work to mine and we promised to keep in touch, where you know she's looking at data for another country where they're starting to estimate that up to 50% of their mental health clinicians will have a client complete suicide during the course of their professional career. So it's out there and it's happening.
Speaker 2:The other thing I learned was we need to think about how we are talking about suicide with our graduate students, yes, and our folks that are learning and getting ready to enter the field and to work on it. Because we have mental health clinicians, we have our own stigma about it because of that helper role that we're supposed to have and the perceptions of that that we hold for ourselves and that others hold for us, and I think we need to take a hard look at are we really talking about client suicide beyond? How do you do an assessment? How do you identify it? How do you make a safety plan? How do you make a safety plan? How do you involve crisis services?
Speaker 2:We need to kind of step back and look at the humanity of it and the reality of this is a loss. It may be someone who a clinician only talks to once during intake. That's still someone they interacted with that they could have a loss and grief reaction to. It. Could be something that they knew for years loss and grief reaction to it, the opposite, and it could be something that they knew for years, right, right. So I think we as a, as a field, need to take on a little bit more responsibility for having very open, transparent conversations about what is this really like? What is the possibility of this happening at some point during your career? If you work in crisis, that possibility is probably going to go up. If you, if you work on the substance use and chemical dependency side client, the probability of a client death, not necessarily a suicide, also goes up. So there's there's just some realities I think we need to talk about, and talk about them in a way that are accessible. I don't I don't think suicide is scary. I talk about it often.
Speaker 2:I talk about all client death often, but one of my goals with my research and when I give presentations about client suicide what we could be doing in supervision and you know the impact of any kind of client death is helping it to become accessible so people are willing to think about it.
Speaker 2:As human beings we're not great thinking about death. It tends to be the big thing. We deny for as long as possible, and that feeds into our work, because we're all humans doing the work. But I think we have a lot of opportunities to change course on that. The other thing I learned was supervisors aren't really getting a lot of education about the impact of client suicide. There's not a lot of information or research happening about how to navigate supervision after a client suicide and how can we best support clinicians. One of the standouts and it came up on naturally on its own. It wasn't a question I asked, but one of the other things that I learned was the impact of how a clinician's organization reacted to the client had huge impact on how they navigated it, kind of what happened with supervision.
Speaker 2:unfortunately, most of it was negative, yeah, but that had huge implications for how clinicians and supervisees and their supervisors kind of moved forward was did the organization have supportive policies? Did they have an EAP to connect them to another clinician who can work with them? On that? Clinicians were not good clients. There's a professional clinician who works with clinicians as clients, so did they have an EAP who helped them with a case review?
Speaker 1:What was?
Speaker 2:the attitude kind of given towards the clinician. So there was a lot of exploring and discussing. Not only the supervisees you know own individual reaction, the supervisor's reaction also had a high impact on them. If the supervisor kind of freaked out or got real anxious, that was seen by the supervisee and impacted them. But then also up to how did they perceive the organization reacted to?
Speaker 1:what happened. And that speaks to that earlier statement you made about like specifically like just building more conversations around it so that we can normalize it but also create a supportive space where this isn't like a right it. We're all going to feel that initial reaction, but like the clinician, who, who is surviving the loss, like is hearing those you know like reactions too, and so like it might already be on their mind, but if the system that they're operating in is doing more of that, it's sort of like I don't know, just enforcing that belief that maybe they have.
Speaker 2:Yeah, and it's very common for clinicians who've lost a client to suicide to perceive that others are blaming them, to perceive that their peers are looking at them negatively, even to perceive that their supervisor disappointed or upset with them as well, as then it starts to go outward, you know, a perceived a perception that the family blames them, or that a spouse blames them, or maybe it was something more high profile. And how is the media treating that story? Yeah, how is, you know, the individual being portrayed? You know, in the media all of that can, can enhance this feeling of being isolated, feeling like you don't belong in the counseling field anymore. And I can attest to and the thing that I say to clinicians who are survivors of client suicide, and I will say this over and over and over again because it was never said to me- was.
Speaker 1:That person's decision does not negate all of the incredible work you did with them.
Speaker 2:Yeah, that's a conversation we need to be having among our supervisees our supervisors and our graduate students.
Speaker 1:Yeah, wow, powerful and to your point, that you made of, like what we're learning is a lot of clinicians and their graduate programs are being trained in like risk assessment and maybe preventative stuff to be aware of, but like the postvention part is very much overlooked. I mean I can speak to my own personal experiences like yeah, I mean I never heard the word postvention in my graduate program for context. So tell us like how do you define post and why do you feel like it's such an essential part of the conversation?
Speaker 2:Sure. So postvention is a very broad term. It really it relates to activities, interventions and supports that happen to any individual that is the survivor of a suicide loss. So, as you can imagine, that can encompass a lot of things. So from a societal side, that can be things like having appropriate legal counsel to navigate potentially probate court or other things that come up after somebody dies, especially if they die unexpectedly or significantly sooner than one would think. That can also be very concrete things.
Speaker 2:Postvention can be a hazmat cleanup crew that has some training on being appropriate and providing support while they are going to take care of something that family shouldn't be seen or should be protected from right. So there's some very logistical things with postvention. But it's also family support, it is work support. It is a loss, obviously that causes grief and trauma. One of the things that we often forget, even as clinicians, is when someone completes suicide, it is highly likely that they're doing it at their house or somewhere on their property and it is most likely that a family member is the one who discovers them. So they are going to continue to live there, at least for a while, with that new context for their surroundings. So postvention can be even understanding that when we talk about postvention on a clinical standpoint, it's really looking at providing support, providing resources, but also having the awareness to work with an individual on their grief, on their loss, and recognizing it as traumatic loss and treating it clinically as traumatic loss and understanding that the unique aspects of loss and trauma that come with being a survivor of suicide loss it is different from other types of losses Very, yeah. So being knowledgeable about that and being able to work with a client or a family, you know, kind of through that, I think for us as clinicians it's also important to remember that we may not be the first stop on their journey.
Speaker 2:Going to therapy was not the first stop on my journey. I gave a presentation with a close friend of mine about our two different journeys with suicide loss and she's very good and talks about how she went into therapy mostly immediately and I will give my presentation and the joke is have you heard about me going to therapy yet? No, it's still coming. This was really into my journey before I even considered doing that. So I think for postvention too, from the clinical sense, is to remember that we may not be somebody's first stop. We're probably going to be later on in the process.
Speaker 2:How important peer support is for those who've experienced suicide loss. To connect with other people, other family members, other parents who have had a similar loss is very powerful and for many of us we cannot always join with them in those experiences in the same way that a peer can. That's okay and that's probably a good thing. That's okay and that's probably a good thing, and as clinicians we should be supporting that and making sure that our clients are aware of those other resources and different kinds of supports. That therapy might not be the direct healing journey for them. It may be a variety of things that happen Right.
Speaker 1:Yeah, yeah. What do you feel like are some ways supervisors, or even like counselor ed programs can do, like, or what can they do to better prepare and support counselors in training, especially like that might experience this type of loss?
Speaker 2:Sure. So on the counselor education side, we'll kind of start there first, yeah, of course. When you're looking at it from the academic side, in'll kind of start there first. Yeah, of course, those screening questions in an initial assessment goes beyond safety planning, goes beyond doing risk assessments and really talks about here's not just prevalence but let's look at different populations and how this comes up. If you want to work with the severely persistently mentally ill, this is how suicide kind of fits in with that population. If you want to work with first responders and law enforcement, how does suicide fit into that population? How does it fit into chemical dependency work? How does it fit into correctional work?
Speaker 2:You know so, having some of those open conversations about you know this, this is prevalent, it's a unique thing to humanity. It isn't going away and just really opening those conversations and encouraging students to really reflect on what that means for them. One of the things that was powerful for me to realize as I grew older and matured as a person and in my career was that my professional view of suicide and my personal view of suicide can and does differ, and so those have to be reconciled on almost a daily basis. But I will own that I have different views in my professional identity and in my personal identity and that took a long time to get to, to be comfortable with that, to be comfortable saying it, you know, to not hide it in any way or pretend that that wasn't what was really happening.
Speaker 1:I'm so grateful you said it because I think it speaks to our humanity as counselors which, like I try to do often, but like sometimes we, you know that like perfectionistic thing comes in and says like we can't be the human too.
Speaker 2:Yeah, yeah and and opening those doors to having that reflection on. I encourage um academic programs to consider how, how, how do you want to help educate your, your graduate students, about death and dying? How do you want to help them reflect on their views of that and their comfort level with with pieces of that? You know, really, look at grief, trauma and traumatic loss, uh, counseling interventions, clinical work. For the academic programs that are also, you know, educating supervisors, I think they really need to take some more time in educating supervisors about here. Here's the impact of this. Here are some things you can do. The first step is what they're already doing, which is learning about it. The second step is, in supervision, talking about it before it happens. Right, right, just sharing what you're willing to share.
Speaker 2:In my dissertation, I encourage supervisors to reflect on if they feel comfortable sharing what they have gone through as a clinical survivor of suicide loss, to share that, and one of my participants talked about they made the choice to share that with their supervisee and the relief that it brought for their supervisee, how it improved their supervisory relationship and how it helped that supervisee in their healing journey after going through not exactly the same scenario, because every everyone is unique and different, but they were able to see that someone they looked up to, someone that they respected, someone that was seasoned in the field, had also gone through this, you know.
Speaker 2:So having, I think, having that openness to talk about it is very important. Having the openness to learning about it is also very important. The openness to learning about it is also very important. It's also important for individuals to come to terms with if they are not in a good place with those topics and figuring out how you're going to navigate forward from that. You know, for example, many of us in graduate school pick a population, but I will never work with that population Right, like we think. We're going to have a list and a choice.
Speaker 1:I'm like, were you following me in grad school?
Speaker 2:Everybody has like their, their list of that's the population. I'm never, I'm never going to work with.
Speaker 2:And sometimes you know individuals that are highly suicidal is on someone's list and the reality is you're going to you're individuals that are highly suicidal is on someone's list and the reality is you're going to see them. Yeah, Because they're everywhere. They're every socioeconomic status, they're in every community, they're in every school. You know individuals struggling are everywhere. That is why our entire field exists.
Speaker 2:So I think that openness to talking about it, that openness to encouraging reflection, to, like I said, it took me a long time as a person and as a professional, to to to figure out that dissonance for me between, as a professional, I feel this and as a professional, I advocate this, and on a personal side, I have a little bit different view. How can I respectfully reconcile those and express them in a way that is understood and that I feel good about? But that took a long time and I didn't necessarily have a mentor or someone, a supervisor or someone, even on the academic side, who who was guiding that. I had to do it kind of on my own. I probably could have found somebody, I didn't. So I, I, I, maybe I chose to do that myself and I know what that feels like. So I think on the academic side it's. It's really looking at suicide, like we said, is more than prevention there has to be.
Speaker 2:I think recognition that this does happen.
Speaker 1:Yeah, zoom out, but like also get specific about some of the things that are in that picture once we zoom out.
Speaker 2:Yeah, yeah, absolutely. And then for supervisors out in the community, again it's talking about it, it's bringing up, you know, even concrete things like what happens after a client completes suicide, what steps have to happen, what will be tasked on the supervisor, what will the supervisee be expected to do, what are the resources, what happens after. And talking about that before it ever happens. So it's not a surprise, it's not. You're not trying to take in or give somebody new information in the middle of a traumatic loss response.
Speaker 1:Again, I'm really grateful for your disclosure because I think it's important that we bring humanity into the profession and I know, if we're reflecting on some of your other experiences, that you spent a good amount of time helping college students and supporting them in crisis. I wonder how that shaped your understanding of suicide risk and response, especially amongst that population of younger adults.
Speaker 2:Sure. So in particular with, particular with with college students. I think what's what's challenging for college students is is that age and for, for this matter of speaking, we're going to talk about kind of your traditional age college students, so we'll go to like 20, 23, 24, is that's a, if you don't remember that time, it's a rough, it's a rough couple of years for most of us.
Speaker 1:If you saw my face, listeners my eyeballs just got giant, because I'm like oh yeah, I'm with you there.
Speaker 2:And we can all connect to that. That's a difficult time. There's a lot of change, there's a lot of transition. We ask as a community and a lot of our 18 to 22 year olds, when they go to college, we're asking them to figure out what they want to do with the rest of their life. We're taking them from a very structured environment in high school to basically no structure in college, living on their own. You know, like in a more communal environment.
Speaker 2:There's a lot of new that happens during that time and then unfortunately, biologically, that time also coincides with high risk time for the emergence of more serious mental health issues. You know the exacerbation of depression, the exacerbation of anxiety, and anxiety has taken the lead, if you will, in more recent research that really anxiety is the driving diagnosis among that age group. Depression's not far behind. Because they are clinical best friends, anxiety is kind of the lead there but also much more serious mental illness such as bipolar disorders. We start seeing first episodes. Psychosis, we start seeing first episodes, particularly for males during that time period. So there's a lot happening in that particular timeframe.
Speaker 2:For me it made me love working with them to see them start to come into their own, start to understand themselves and make decisions for themselves. Many of them, when I worked at the regional campus, were making decisions to not just better their own life but to better their family's life. Many of them came from poverty. It was not uncommon for me to meet with a student who, you know, still lived at home but didn't didn't have a bedroom. They might be sleeping on the couch so that other siblings can have, can have bedrooms, or I mean they just came from very different situations so that that age range, a lot, a lot is going on.
Speaker 2:You also get to start voting for the first time, right? I mean there's you can you could be sent off to a war conflict at that time. I mean there's you can you could be sent off to a war conflict at that time. I mean there's a lot that can happen in that four to six year period and it's it's very concentrated. So there's a lot going on for. For college students, yeah, and when you talk about, kind of your your quote unquote non-traditional college students, right, individuals that might be older, coming back to school, you know they have their own different set of circumstances because they may be coming back out of duress where, with changing job markets. They have to come back.
Speaker 2:Yeah, they have to. It's not like they're going for fun, right. They're coming back for a reason. They're in a whole different set of circumstances, with probably trying to support family and spouses themselves living independently. And then you put classes on top of that. You know that's a that's a unique experience. It's. College is a unique, very condensed experience that you will never have the rest of your life. Yeah, like you do when you when you go to college, because you have all the regular stresses of life plus classes on on top of it, right? So it's a very unique high stress time and again. The majority of us get through it with some of our bumps and scratches, and for others, that is the time when some real serious stuff starts for them.
Speaker 1:Yeah, yeah, I couldn't help but think even really with both non-traditional and traditional, but like especially with more traditional college age students that it's like not only these changes, but that, like the expectations of the people in their lives are changing, like that their parents are expecting maybe different behavior or things from them and there's a lot of pressure that comes from that. I think that still can happen with non-traditional college students, whether it's partners, family, children, et cetera, but that that entrance into this stage sometimes tweaks what your supports expect from you.
Speaker 2:I think one of the most fascinating things that happens during this timeframe and we're going to go back to the word I used earlier, which is dissonance One of the big dissonant things that happens is you have been sent to college where you are expected to be an adult, right, yes, and you're supposed to be an adult every single day. You're a big kid, you're an adult, you go do adult things. The instant you set foot back into your house, your parents expect you to be a kid again. Yeah, so that dynamic is also very unique. Yeah, so that dynamic is also very unique, and it is something that college students who don't go to live on campus experience on a daily basis. Where it's this conflictual. It's conflictual pressure, pressure to be mature, pressure to be an adult, pressure to go to college, do your chores at home and, you know, come home by this time and might still have some of those kiddish, teenage-ish expectations or restrictions placed on them as well. So that is also very, very hard.
Speaker 1:Yeah, yeah, you know, when we come back to the idea of like the risk, especially that these are times when things you know maybe are developing or emerging as we see, like these more severe symptoms, there's a lot of stigma that comes around like persistent and severe, like mental illness, but also around like suicide, and oftentimes not just stigma but silence. Yeah, and oftentimes not just stigma but silence. It can be within a family system, on a college campus, in clinical settings. How do we break that silence in?
Speaker 2:responsible and healing ways, inviting individuals that say things that I say into spaces and promoting. Promoting those voices who are willing to talk about our experiences, are willing to kind of look at some of those topics in our field that others could view as being very dark or very scary.
Speaker 1:Have the dark conversation.
Speaker 2:Yeah, have the dark conversation. If you have it with me you're gonna laugh too. So like it's okay. But I think elevating those stories, elevating those questions like what you raise, like wait a second, if this is how someone's impacted, like what should we be doing differently or what should agency organizations and their leaders be thinking about? So I think it's inviting the voices, because maybe someone isn't ready to talk about it themselves, which is fine.
Speaker 2:Hearing someone else talk about it can be very powerful, even if it doesn't change anything for their day to day. But hearing someone else talk about it and connect with someone else's story and what someone else is passionate about can, can do a lot for healing, which again is why peer support becomes such a big thing for so many different types of clients, whether that's, you know, working through a NAMI affiliate to, as a family, go and learn about family to family, peer to peer classes, or it's finding a peer support group, finding a suicide loss support group. Those all have different things that they can offer us for healing. For us as clinicians, I think it's looking at again being willing to talk about these topics if not willing to talk about them, willing to listen to this podcast as a willing to take some time and just just listen to this and reflect on it and see what you want to do with it.
Speaker 1:And so, for those of you listening, if you know someone like that's something that's this can be a resource to be shared right. Like that, that's something that sort of gives a sense of community around this experience. It's heavy, right, it's emotional and it can take its toll, as you mentioned. Like that there are people who leave or move out of like clinical roles at minimum. Can you speak to the emotional toll that this does take on professionals and you know to the degree you're comfortable, whether it be in counseling or crisis response? Like how you personally navigate the sustainability and self-care of being in these spaces?
Speaker 2:So as I mentioned, I might not be the best example of taking care of oneself and accessing appropriate resources when things first happen, but I own that as that was part of my journey. For me, part of what I share is that in that moment that a clinician finds out that one of their clients has died by suicide, until you go through it, you have no idea how you're going to react.
Speaker 2:And one of the times when I found out about one of my my clients who died by suicide, I came in to start my shift and I was. I found out and I stayed in work my whole shift and I threw myself into that shift and I threw myself into every crisis call, every pre-hospital screening. I just threw myself into everything and it was after I got home that I started having a reaction. So I had a very delayed reaction and that is often how, even years later, should I learn of that? It's still kind of a delayed reaction. There's a little bit of shock at first and then the reaction starts to happen, whether that's questioning or being genuinely sad. Like this is a person who has ended, who has ended, and then going through all the things that I mentioned before of questioning myself, questioning should I, should I really be doing this in this field? Isolate it?
Speaker 2:What I have found to be the most beneficial outside of finding a good therapist is having two very distinct groups of supports. The first group should be your peers, coworkers, supervisor, academic folks, faculty people you bonded with, other you know, if you're a graduate student, other graduate students, right, other clinicians who have gone through it, who can talk shop about it and who you can have those like I got to work through this clinically type of situations right Can kind of work through a case review or, you know, kind of do consultation with you on the fly. You know you need to have those friends of yours and supports that are other clinicians you have to. But the other group you absolutely have to have are people who have no idea what we do, that have no connection to our field whatsoever. None of my parents really work in this field and definitely not on the crisis side of things or on the justice side of things now, with my current position.
Speaker 2:And I have friends who have no connection with the mental health field and they are important because they can generally look at you and go that sucks. They can look at you and say that wasn't your fault and they don't have any of the clinical background. They have nothing but how they see you and what they think of you. So it's very, I find, and I encourage every clinician, every supervisee I've ever had which is hard when you're in graduate school but to really find those two groups and learn when you need to access the different ones. Obviously your friends and stuff like that you're not going to tell sensitive information to, but you can still share that Like you had a loss right Related to likely they're going to understand you can't talk about it that much.
Speaker 1:Right.
Speaker 2:But they can still provide you support and what's interesting is, in some ways their support can feel a little bit more pure, right? Because, like I said, they don't have the background and the statistics and the stuff that we think about.
Speaker 1:They're just there for you.
Speaker 2:You know so to me, I will always say that one of the most important things for support is to have those distinct, separate supports and access.
Speaker 1:both of them didn't have like a supervisor or peers who really understood, professional peers. I should say that if a counselor or crisis responder is listening to this episode and they're currently struggling with the weight of this work or a recent loss, what would you want them to hear or know?
Speaker 2:What I would say to them and I would ask them to write it down is what I said earlier, which is that individual's decision does not negate the good work that you did with them. It just doesn't.
Speaker 1:Hello there, my cat has joined the podcast, sorry.
Speaker 2:That's fine Good timing. We all need a little bit of animal therapy. But I would tell them, write that down, read it, say it out loud in your own voice. Hearing me say it is maybe powerful for you, but hearing it in your own voice is going to be even more powerful because it's you and that can be a first responder, a crisis worker, a clinician. It doesn't matter. That individual's choice, the decision they made, does not negate everything that you did with them.
Speaker 1:I love that We'll all be walking around with little cue cards, right, like everyone's writing, writing that down. You know, I think we've already touched on like that. This is emotional and it is heavy and it's something that you know. Challenge maybe isn't enough of a word, something that you know. Challenge maybe isn't enough of a word, right to describe it, but what gives you hope in this type of work, especially when we're talking about suicide prevention and healing across these complex systems like mental health and criminal justice.
Speaker 2:So one of the things that helped me regain hope, in particular, after the first suicide loss that I that I navigated, which and this is the first professional one there was one when I was, when I was younger, but this, this was 16 year old and this is a young kid. You know that that's a lot of layers to deal with. I was, you know, in my mid twenties I was young into my career to deal with. I was, you know, in my mid twenties, I was young, into my career. But even at that kind of youthful age and maturity in my career please read that as still being immature within my career was I sat down and I don't know what's motivated me to do this, but I sat down and I looked back at all my other cases me to do this. But I sat down and I looked back at all my other cases, all those other names, and I was able to see that, while this loss was absolutely tragic, it was very sad, there were also a very long list of other people that I had interacted with that didn't have that outcome. You know that had gotten through a crisis, we'd gotten past the period, maybe that you know they got hooked up with services, not even necessarily counseling services. Maybe they got hooked up with a resource that they needed and that alleviated their crisis.
Speaker 2:And I did that periodically through my career, because when you're early in your career and you have an experience like a client lost by suicide, you don't always have a lot of other experience to kind of weigh against that, if you will, if you will. But it is important to remember that there are a lot of other people on that other list. Even if you don't know exactly what happened with them, you know that you interacted with and didn't have this outcome. And while that might seem in some ways a little cold, because you're looking at numbers and not necessarily you know the experience, I think it can be helpful to kind of regain hope, to remember and see very concretely in front of you yes, this tragedy happened. And there are all these other times that I worked with someone and that wasn't the outcome.
Speaker 1:Yeah, yeah. I think sometimes that visual, making things visual, is helpful, even if, though, it maybe seems like, oh, this is just numbers or data. It's like, well, that's important data.
Speaker 2:That's important too, yeah, yeah, for me, continuing to pursue this work and, you know, kind of uncovering my passion and my PhD work for understanding client suicide, client loss through suicide and the impact on clinicians and what we as supervisors can do better like that also, you know, instills hope with me, because I see things we could do differently and I see people doing things differently.
Speaker 2:That, also, on the more long-term, you know, gives me a lot of hope in my current position.
Speaker 2:What gives me hope is seeing these other systems that you know if you've been, if you've worked in the field for you know a couple decades, you know these aren't always systems that agree, these aren't always systems that aligned, and the reality is we're all trying to do the same thing. And so what gives me hope is seeing, you know, the criminal justice system very actively wanting to do better for individuals with mental illness that are that are, you know, to do better for individuals with mental illness that are moving through their system, actively seeing schools want to do something different with youth Law enforcement, want to have different outcomes with people that experience a crisis or families that experience a crisis Just that desire, even though it can take a very long time to have systemic change. Seeing the individuals coming together in different communities all around the state and wanting to have different outcomes, wanting to see suicide prevention, wanting to see good care and treatment availability for those with mental illness, that gives me a lot of hope.
Speaker 1:Yeah, that is promising for those with mental illness. That gives me a lot of hope. Yeah, that is promising. So we ask this last question on every episode of our interview format podcast. So the name of our podcast is Ohio Counseling Conversations and we just like to know from our guests what important conversations do you think counseling professionals should be having with each other and or their clients in our state? It can be what we've already talked about. It can be something entirely different. I'm going to toss it back to you, dr M. What do you think?
Speaker 2:I think there's so many conversations. I think, at my core, though, I was thinking about this question leading up to today, and the first thing that popped into my mind was I think we really need to be talking about how to be inspiring for each other in our work and how to realistically support our field. How to sustain our field, how to sustain graduate students as they're entering this field. I think inspiration of individuals to work in our field, with us as our partners, as our peers, you know, shoulder to shoulder in the work out in communities.
Speaker 2:So I think we really need to have conversations about how do we want to inspire not just our field that's already out there doing the really hard work. How do we also inspire others to join us?
Speaker 1:I love that. That. That's incredible. No notes, so so, so good. No, I think that that just speaks to something that gosh I don't know that I could have put it any better, but yes, yes, I like all the snaps. Yeah, how do we get people to join us? That's incredible.
Speaker 2:And how do we show? Like I mentioned earlier about when I worked at a college, I was lucky enough to attend graduation right every semester, yeah and to see those successes. I think we need to share with each other more about those successes and we need to share the stories about and I try to do this with law enforcement when I have the opportunity to to tell stories that remind everyone that those with persistent and severe mental illness are just as human as the rest of us. They're not any different in that way. One of my favorite stories is of an individual. This happened a very long time ago and part of their symptoms was when they started to decompensate, and this sometimes happened even when they were taking their medication. We know that over time, bodies change. Medication doesn't have the same effect. This happens.
Speaker 2:But when they started to decompensate, they would experience that there were multiple worlds kind of happening at the same time, and one of the really scary worlds was a was a world of cannibals. So they would experience, you know hearing people, you know getting attacked and and so, or that they would smell people getting cooked. It was very graphic for them. So we were having this experience and they came up to the crisis center that I was working at and I was there with another worker just two of us and they come up and they knock on the door and we let them in because we know them, like, we're there, we're very familiar with, and they come in. We can see that they're upset. We asked them you know what's going on and they're telling us. You know what they're hearing, what they're smelling, what they're seeing, and in the middle of describing this to us, and they're very animated because it's very upsetting what they're experiencing. So I wanted to make sure you guys were okay. So, even in the middle of that experience, they had the insight to come to a place that they knew was safe, that they knew the people there would help to keep them safe, and they also had a caring towards you know, wanting us to be okay, making sure we weren't getting hurt, you know.
Speaker 2:So I think we need to share those stories and we need to share the stories of what we've experienced in the successes with clients, and success for a client looks different, and I think it's okay to tell those stories to our younger clinicians and our graduate students.
Speaker 2:For some clients, those successes might seem objectively kind of low, but for them it means a lot and I think those will help with that, that idea of inspiration. And you know, we, our, our field, doesn't really get the best representation out in the world on the news. Yeah, there's not an abundantly positive view of our field, and so I give. I think there's not an abundantly positive view of our field, and so I think there's real testament to be given to graduate students who may not have a lot of exposure to other you know representations and persist in coming to school and they want to work in this field. And I think we have a lot of opportunities to inspire and show the positive impact that our work has with very large amounts of people and when we need to use that information for ourselves to balance out when things don't have the outcomes we're hoping for as well.
Speaker 1:Yeah Well, this has been just a wealth of all that knowledge that you've contributed and I just want to say you're such an asset to the profession, and Ohio counselors especially. We're so grateful for you having this conversation, and I think you're inspiring people by having this conversation with us. So thank you so much, dr M. We're happy to have you.
Speaker 1:Thank you for having me much, dr M, we're happy to have you. Thank you for having me. Yeah, we hope we will have you all share this conversation with your other professional colleagues so that we can keep that inspiration and the support and conversations about the tough stuff too, going.