Jan. 02, 2013 - Issue #898: Apocalypse Not?

The goal is to ASIST

Applied Suicide Intervention Skills Training builds confidence

"Nick, are you thinking of killing yourself? Nick, are you thinking of suicide?"

No one wants to ever have to ask someone these questions seriously. But if "yes" is the answer to both, how confident are you in carrying on this conversation, let alone inquiring in the first place?
Nick is one of three fictitious characters in a video shown at the beginning of Applied Suicide Intervention Skills Training (ASIST), a two-day workshop offered through the Canadian Mental Health Association. This isn't your decades-old health-class video; it is remade on an ongoing basis, with feedback from health-care professionals to ensure the most authentic examples of individuals in distress are being shown. The course strives to be as realistic as possible in teaching the process of holding a one-on-one intervention with a suicidal person, which includes asking the above questions out loud in a group setting.

ASIST is one of a number of courses that has been developed by the Centre for Suicide Prevention, based in Calgary. CSP was developed by practitioners in the early '80s and has continued to evolve through years of scientific research in the field of mental illness. Today, ASIST is the world-wide front-runner for suicide intervention training.

"We need to look at it as first aid, as a life skill," explains Mara Grunau, education director for CSP. "Seeing as how one in five people will experience mental health issues in their lifetime, it affects a lot of people, and we need to start looking at it differently. Mental illness is still a highly stigmatized subject; as a society, we are more comfortable than ever before in discussing depression and anxiety, but suicide is still very much stigmatized. We can reach out and help people at work or school, but in doing so we have to be able to talk about it."

Describing the purpose of the course, one instructor uses the analogy of encountering someone having a heart attack. As the average person in this situation is not a cardiologist, even the most basic first-aid skills are desperately needed in this moment of crisis, up until that person can get the professional care they need. Long-term therapy, counselling, support groups and medication, among other resources, may be needed for a suicidal person's recovery and continued well being. But when faced with someone's uncertainty for their life, proper initial response is critical.

Dixie Estrin has been teaching the ASIST workshop for several years and has observed its direct success in saving peoples' lives. No greater is the effect than on Alberta's reserve lands, as the aboriginal suicide rate in Canada is reportedly seven times higher than the national average.

"They're heavy workshops, because we're dealing with heavy loss," says Estrin of her time spent teaching ASIST at schools in northern Alberta reserves. "It's tough for staff and resource people in the community to begin with ... the principal of the school at the time called me shortly after we were there to let me know that the model we had shown did in fact come into play, and it did save lives."

Formal resources in all parts of the province do exist for those in distress, she says, but cautions that it can be a challenge to access them—especially with hospital wait times what they are—making ASIST all the more relevant.

"The more people who can do interventions, the better. The key is the value of relationship, and to be able to make that relationship," Estrin says. "Many people tend to think that by ignoring grief, it'll go away. This method of pushing away these feelings is not effective. Go through the pain, not around it."

The course, which is kept to a maximum of 30 students, is intensive, challenging and not for the faint of heart. On the second day, one of the interactive scenarios takes place on the railing of a bridge—and the person in distress is not coming down easily. Though open to the public, the majority of attendants are post-secondary students in the field of social work, or working in group homes, and for them ASIST is mandated. An alternative is safeTALK, a half-day workshop also offered through the CMHA, which teaches how to recognize the invitations and warning signs from youths aged 12 – 24 who are seriously contemplating suicide; it too is open to the public and can be taken for credit.

The model of assessing high, medium and low-risk individuals for suicide is outdated: professionals in the field today recognize that "at risk means at risk," period. When someone is in emotional pain, they often forget who they can reach out to, therefore it never hurts to ask a seemingly distressed friend, colleague, loved one or stranger where they're at, and remind them that help is always available.

Most people at risk of suicide do not want to die. This is an opportunity to gain the confidence to intervene when necessary and potentially save someone's life.

"Attitudes have changed in last few years," Grunau adds. "With the two NHL players who died by suicide, and the Amanda Todd case, people are talking more—and that's good—but we do need to continue teaching more as well. We need to slow down and look at the people around us. Really look at them and ask ourselves, 'How do we engage these people?'"

For more information on the course and suicide prevention, visit edmonton.cmha.ca and suicideinfo.ca.

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