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Rob Davies and Kristin Francis coach for hard conversations.
Shayma Salih and Emily Izzo, University of Utah Health
resilience
“I’m Really Worried About You” — How to Have a Conversation with a Colleague About Suicide
Coworkers are often the first to recognize when a peer is struggling under extreme stress. Psychiatrist Kristin Francis and psychologist Rob Davies share how to break through the discomfort and talk to your struggling colleague.
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ur work was hard before the pandemic, and now it's reached a level that nobody could have imagined. 

People rallied to get themselves through the Covid crisis. But even as the spread of the virus slows, a shadow pandemic of deteriorating mental health has emerged. Everyone is vulnerable right now, especially our frontline workers. 

Health care workers, particularly those with clinical roles, have often been taught to suppress their feelings and hide any signs of distress. Our colleagues are battling extreme stress and they’re realizing, “Oh, this took more of a toll on me than I thought.” Physicians who feel like their patients rely on them to stay strong might not ask for help until it’s too late. Physicians, nurses and other health care workers experience above average rates of distress and suicide than the general population, and exposure to trauma impacts our physical and mental well-being.

"Physicians, nurses and other health care workers experience above average rates of distress and suicide than the general population."

Coworkers are often the first people to recognize when one of their peers are struggling, long before mental health professionals like us become involved. But even when they notice something’s wrong, it can be difficult or embarrassing to initiate an honest discussion. 

We need to empower people to have these tough conversations. Asking about suicide does not increase the likelihood of suicide or put the idea in a person’s head. Peer support can help us develop strategies to combat rising suicide rates. It’s time to break through the discomfort and create a culture that makes having these hard conversations easier.

Yes, it’s awkward—and that’s okay

When we ask someone something sensitive or personal, we tend to overestimate how uncomfortable it will make that person. The truth is, we're usually way more uncomfortable about asking the question than they are about answering it. But if we can push past our embarrassment and just ask, “No really, how are you?” we might literally save a life. 

We can try to normalize that awkwardness by acknowledging it upfront. We might start with, “This is coming out really weird, I’m sorry. What I’m trying to say is that I’m worried about you.” Or maybe, “I’m not sure how to say this so I’m just going to spit it out…” 

"It’s better to take the risk and be vulnerable than to have someone suffer because you didn’t try." 

Embracing the weirdness takes some practice, and sometimes we still don’t get it right. It’s better to take the risk and be vulnerable than to have someone suffer because you didn’t try. 

Think of how you would talk to a friend or family member and model that technique. You can also try being more transparent in situations with your coworkers: "Wow, that was really tough. These cases are affecting me more and more. Anyone else noticing this about themselves?"

A little humor (or self-effacement) can lower defensiveness

Transparency, self-effacement and a little humor can always help lower defensiveness in these interactions. 

For a casual conversation, try these starters:

  • "This may feel kind of awkward but...”
  • "I'm not used to asking/saying this but...”
  • "This feels uncomfortable to me but...”
  • "Hey, I know we're not taught to really talk about our feelings so I may be wonky for a minute but...”
  • "I'm probably going to say this all wrong…" 
  • "You're the best provider I know. How do you keep it up with all this stress? People are having a hard time, I know I am.” 

Finish your starter by sharing your intention: 

  • "...I just wanted to make sure you are doing ok."
  • "...I really care about and respect you. Just wanted to check in after that bad outcome."
  • "...I'm worried about you. You seem out of sorts lately."

More serious starters could be:

  • "I've been reading about how providers have higher rates of depression and anxiety due to all the stress of Covid. I know I'm feeling it, do you?” 
  • "Hey, have you heard about providers struggling and not getting support? How can we help people in our group? Do you know anyone who’s having a hard time? How can we make this easier to talk about?
  • The old fail-safe is to ask about a patient: "Hey, I have a patient who is a provider and isn't doing well. I don't really know what to say because we're taught to suck it up. We know that isn't helpful or good for anyone...do you have any advice? Do you know anyone going through this?"

It's okay to be direct, especially if you are concerned about self-harm:

  • "Sometimes we have suicidal thoughts after a bad outcome or during a tough time. Are you having thoughts of hurting yourself, even if just fleeting?”
  • "You seem pretty miserable. This may come across as really direct but I just want to double-check: Are you also having thoughts of hurting yourself?”

If they blow you off or get defensive, that’s okay

Sometimes people just aren’t used to being asked about themselves. If they blow you off or get defensive, that’s okay. Apologize and express your concern or intent—people soften when they hear that you’re coming from a place of caring. 

After any conversation with a colleague, ask how you can support them. Sometimes stepping back from a direct conversation can be helpful, so ask if you can follow-up with them tomorrow or reach out later via text. If they're not responsive and you're worried that their well-being or patient-care could be compromised, talk to a supervisor. 

If a person responds “yes” to having suicidal thoughts

If a person responds “yes” to experiencing suicidal ideation and they are not getting the support they need, you can:

  1. Drive them to support resources such as the Emergency Room or Huntsman Mental Health Institute’s receiving center for assessment.
  2. Use one of the resources listed below to connect them to support.
  3. Share the list of resources with them and have them commit to connecting with support.

If you are concerned and don’t know what to do next, call the crisis line (1-800-273-TALK) to be walked through options. This is also a time to enlist support from other colleagues, friends and family members so you do not have to support this individual alone.

Getting over the discomfort can save a life

It’s also important for us to be honest with ourselves and others when we’re asked the question, “No really, how are you?” If we are struggling and in need of support, we need to speak up and share this information with people we trust. Many of us were taught at some point in our lives or during our training that asking for help meant that we were being a burden. We can change this norm today. We are all individuals of value who need each other to survive. Admitting you need help simply means it’s your turn for support, and when someone else is in need, they'll know you are there for them.

"If we can push ourselves to be brave, honest and a little vulnerable, we might make a difference."

Health care’s culture is tough, and we pride ourselves on not being impacted by the challenges and stressors we face every day. But we are impacted. If we can push ourselves to be brave, honest and a little vulnerable, we might make a difference. It’s powerful to know that getting over our own discomfort can save the lives of people we love.

 

Suicide Support

Crisis contacts for everyone:

Urgent resources for health care professionals: 

Feel like you need more training?

Acknowledgement: The contributors would like to thank Dr. Megan Call for providing editorial assistance and support resources for this article.

Contributors

Kristin Francis

Psychiatrist, Huntsman Mental Health Institute, University of Utah Health

Rob Davies

Licensed psychologist, GME Wellness Director, University of Utah Health

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