Episode two: Self harm and suicide ideation with Man Anchor
While all the EPIC Conversation topics are challenging, self-harm and suicide ideation are often the greatest worries parents have for their teenager.
According to research conducted by the Australian Institute of Health and Welfare, suicide and self-inflicted injuries are the leading disease burden for males aged 15 to 19, and the fourth highest for females of the same age.
EPIC invited Steven Gamble from Man Anchor to shed some light on this topic. Man Anchor is a northern beaches based organisation that aims to help people have a simple conversation that could save someone’s life.
Roberta’s top take outs from this conversation:
Normalise the conversation around mental health
Show empathy and be non-judgemental
Check your own emotions before having this conversation.
Madeleine’s top take outs from this conversation:
The 3 D’s: delay, distract and decide to do something different
Health is health, physical and mental
Ask the question, ‘Are you thinking about suicide?’
Q1: EPIC wants to remove stigma around families in crisis. Can you please tell us about Man Anchor and the stigmas that you are trying to address?
S: Yes, Man Anchor is an organisation that I founded back in May of 2017, with a hope of being able to empower men (originally) with the tools to be able to support themselves, but also to be able to support the people around them. But over the years, we've turned to an organisation that actually works with more females now than we do males. The youngest participant is the age of eight and our most senior participant, which is a bit of a guess, is in their mid 90s, around 95, so we have a wide demographic of participants from all over our beautiful country from metro areas to regional areas. And Man Anchor was started because of my own inability to be able to support someone through times of crisis and illness. And I wanted to have the tools and I didn't want anyone else to be in the same position I was. Our role at Man iAnchor is to really build that literacy level, which has a positive effect on knocking down stigma and negative attitudes. We've got a saying here at Man Anchor, health is health, and that it doesn't matter regardless of physical health or mental health, if someone needs support. If someone is unwell. You know, we need to lean in and we need to be able to create support and live healthy ourself. And that mantra, I find it really helps to normalise health problems, including mental health problems.
Q2. Steve, you're very passionate about helping, and that comes across in your presentations. What do you love most about Man Anchor?
Oh, God, I think I'm the luckiest guy. Every day I get to support individuals growing and understanding how they can support other people. But, you know, what I also do is create opportunity with the education programmes that we do, as I said earlier that we normalise mental health. And for a lot of people that come into our programmes, they may have had lived experience of either their experience of supporting a family member or a friend or a colleague, or the lived experience of their own mental health challenges. And I'll never forget a few weeks ago, I was sitting on the couch eating popcorn, the whole family was out. And I was watching my murder mystery shows and my phone rang. And it was a guy that was from a workshop I ran on the south coast, maybe a month before. And he said to me, Steve, I'm sorry to ring you on a Sunday evening. But I just wanted to thank you because, you know, I walked out of that workshop feeling normal for the first time in my whole life feeling like I didn't have to have excuses for, you know, the person I am and the challenges that I have. And for me being able to do that wonderful thing. I'm not your average facilitator, when it comes to mental health. There's a lot more cool people out there. But I want people to be able to lean in and feel empowered to be able to use the tools. And so if I can make people feel comfortable with talking about it and living through it Well, I think that's a pretty cool job to have, isn't it?
Q3. In your experience when do parents or carers usually become aware of their teenagers mental health struggles?
S: Well, look, for most of us, that's when we start to notice behavioural changes. But if we look at mental health on a wider spectrum, what is a mental problem? A mental problem is when you start to notice subtle or major changes in someone's thoughts, feelings, physical well being or behaviours that start to impact the way that that individual gets on with life. Okay, it starts to impact the way that that person holds meaningful relationships and communicates with friends and family. So for a lot of young people, it's those behavioural shifts and those emotional shifts that we start to see, depending on what the disorder is. And, you know, when we look at adolescence, the median age and onset for anxiety is around 15, eating disorders around 18. And depression is in that early 20 mark, but you know, there's a lot of people that experience it early on In life. So, depending on the disorder, it's that shift where we start to see the individual stop doing those things they usually love doing, stop communicating the way that they usually communicate, and for most parents, that's the first indication that something's going on.
Q4. So based on those indications, is it possible to identify what drives the young person to contemplate self harm or suicide?
S: Okay, well, look, when it comes to suicide, and non-suicidal self injury, they are not mental health problems. They're crises associated with mental health problems. So usually, there's an overarching mental health problem that is bringing that emotional distress to that individual for them to either contemplate or have those suicidal thoughts, or carry out non-suicidal self injury. So usually there is that underlying mental health problem which we need to address.
Q5. So self harm, or non-suicidal self injury; would that be the first sign that a teenager might be considering suicide? Or are they connected or unrelated?
S: They are connected, but they don't go hand in hand every time so non-suicidal self injury is a maladaptive coping mechanism that we see in a lot of young people; young people have limited coping strategies. So to cope emotional distress, unfortunately, non-suicidal self injury becomes a way of relieving that emotional pain. And then we have suicidal thoughts, which is when the overwhelming pain and distress that a young person or adult might feel and they feel they can't cope with life as it is. Now, you know, in some cases, non-suicidal self injury can be a precursor to someone taking further steps to cross that line and attempt suicide, or it can be a protective factor where someone participates in non-suicidal self injury, to support themselves not going down that route of having thoughts of suicide or acting on suicidal thoughts. So it becomes definitely a risk factor. And if I was to be supporting a young person participating in non-suicidal self injury, I would definitely ask the suicide question, just so that we can, you know, be assured that this is not the case. And if we do it with empathy, without judgement, often we'll get the honest answer. So, yeah, it can be sometimes a risk factor, but also it can be a bit of a protective factor as well.
Q6. So that leads nicely into the next question, which is about having a conversation. You've just said ‘ask the question directly’. If a parent is concerned about their teenager in relation to self harm or suicide, how can they approach this conversation?
S: Yeah, look, it's probably the most difficult conversation that you'll ever have in your life. And I can't even count how many parents that I've had come through our workshops, and share their experience of having to have those bigger conversations. The first thing I'm going to say, if anyone's listening to this podcast, and they have done things differently, you don't know what you don't know. Okay? We're all learning and sometimes a little bit of education goes a long way. One of the things what I would do is, first of all, check yourself, okay. If you've got feelings, that if you've got a feeling in your gut, that something might be going on, or you're seeing signs that something's going on first thing, what I do would be check yourself, make sure that you have your own emotions, in check. Because what we want to do is lean into this conversation, provide a safe space for the young person we're supporting, and allow them to feel comfortable and connected with us. If we go in, like a bull out of the gate, you know, all we're going to do is create barriers, we are going to push people away, but if we can come in calm, collected, with understanding, with empathy, without judgement, and if we can come in with keeping the young person's feelings and emotions at front of our mind, that sets the conversation up really, really well. First thing I would do is identify if the person is having thoughts of suicide, or is participating in non-suicidal self injury. And how do we do that? We ask it in a clear, unambiguous, direct way. The question could be ‘Hi Steve. I'm wondering If you're having thoughts of suicide?’, ‘Steve, are you having thoughts of suicide?’ Clear, unambiguous? There's no judgement in those questions. Unlike, ‘You're not thinking about doing something silly?’, ‘You haven't done something silly, like harm yourself, have you?’. There's absolutely no judgement. It's straight direct. ‘Are we talking about suicide here?’ ‘Steve, I've been seeing this, this and this. I'm concerned. Are you having thoughts of suicide?’ ‘Have you been to participating in non-suicidal self injury?’, ‘Are you thinking about harming yourself?’ I think that's the clearest way we can do it. Straight, direct, unambiguous, it seems rough, seems straight to the point. But when we're talking about big situations like this, it's better that we are direct. If we are direct, and we're not wishy washy around it, what we do is get an opportunity to say, ‘Hey, I'm ready to talk about this. And I'm sharing this with you right now. So I'd really love you to share your feelings and emotions with me.” One of the things that I would do is be open to the understanding that a person who is participating in non-suicidal self injury, or having thoughts of suicide can sit with a lot of guilt for having those thoughts and feelings. So if we're able to really remove that judgement and sit with that empathy, it can make a big, big difference how we build connection. ‘You know, having thoughts of suicide is really, really common, but we don't need to act on them. Okay, so how can I best support you now?’ And that probably leads on to how do we support the young person? What we need to do is look at ways of delaying and distracting. There's a wonderful saying that we use; the three Ds - delay, distract, decide to do something different. The three Ds are a wonderful way that we can implement coping strategies and really deregulate those thoughts around non-suicidal self injury or youth suicide. You know, on average, anywhere between five to 10 minutes, is that urge to harm. So if we can delay, distract, decide to do something different with the young person in our world, well, that can relieve them from that urge to harm themselves. It can, you know, put that breaker into that thought process of suicide just for that moment, provide a little bit of clarity. And it helps us build connection because when we're working together, one of the things to ask is ‘What can we do together to help you and support you right now? What have you done in the past that you think would be helpful right now, and we can do it together. Now, if we can lean in and ask questions like that, I think it's really, really helpful. I had a wonderful mother. She had three teenage sons. And we spoke about the three Ds. And she said, you know, what Steve? You know what I do? I've got a fruit bowl on the end of our bench top in the kitchen. And in that fruit bowl, we have it full of coconuts. She said, in the backyard, we have a hammer. If any of my boys are really overwhelmed or distressed I say to them, go get yourself a coconut. They go into the kitchen, they pick up a coconut, they walk out in the backyard, pick up a hammer, and they smash the coconut. I don't know how much coconuts cost, but it may be an option.
Q7. So a lot of parents might think that talking about things would make it worse. But it sounds like if you've got a few strategies about how to start the conversation you're well on your way. So what would you say when talking could make things worse?
I think if you come in and you show disgust, or you show judgement, you know, it'd be really difficult to walk into a room, a child's bedroom and see that they're participating in non-suicidal self injury or pick up a workbook or a diary with talk of thoughts about suicide. But if we go in too hard, all we're going to do is create a barrier between us. If we can come in softly, try to understand the pain that the young person is feeling it helps build connection. So when that young person is feeling that way, they feel more proactive in reaching out to mum, dad, carer or that support network that they have. You know, I think it's all about how you come into the conversation. How I use it, the conversation on how you check your own emotions is really, really key. God, I'm a dad of three boys and two are 10 year old boys, and I'm not perfect. You know, if I see them kick a ball and smash the window in the house, you know, I have to really check myself. Sometimes I do a great job. And sometimes I don't. You know, we can do do-overs, and we can repeat, we can come back. But if we can be mindful; stop, take a deep breath, take that minute of mindfulness, and then continue on, it really does help because really the core that we want to be able to is to build connection with the other person. So their support network is there. So they have the ability to reach out and feel that they have that safety. So when those thoughts and feelings of harming themselves, or those thoughts and feelings of suicide, come to them, you know, if they think, hey, I can turn to this person because I know they're not going to be upset, I know, they're not going to judge me, I know that they're going to hear me, you know, God that sets it up for a hell of a lot better place than that person being alone.
Q9. You've given us lots of really great ideas and recommendations for the families on how to support and how to have conversations, but are there any other tips you have for the family supporting themselves and the parents supporting themselves through this really challenging time?
Look, education, psycho education is really, really important, you know, depending on whatever the mental illness is, being able to understand the mental illness, and ways that you can support that young person with adaptive coping strategies is really important. So, you know, even yesterday, I was talking to a parent, where they've built a relationship with the young person in their world that, you know, every three or four sessions they go in and sit with the psychologist and the young person, and kind of bounce off things that they've learned and, so they can be there to check in, you know, that's not ideal for every situation. But to be able to have a literacy level around the disorder that the young person is going through, being able to work through safety plans with the young person and understand those coping strategies. Also, understanding those subtle or major signs that something may be going left of centre, and the person may be becoming unwell, especially with things like psychosis, which we see a lot of young people living with, but often getting misdiagnosed or not picked up on, you know, anxiety and depression, sometimes a little bit easy to see. But little things like psychosis can be a little bit harder for parents to identify. So having a better understanding, building your internal literacy level, around the different disorders that are out there, the disorder that the young person that you're living with is navigating, and adaptive coping strategies, I think that's the best thing you can do. Each of the different disorders has a wide range of resources out there, depending on what area you live in, I would really just jump on a Google search and find what's in your local area and be aware of it, you know, here on the northern beaches where I live, we've got wonderful resources. With Avalon Youth Hub, Headspace, we have Burdekin as well. So we've a wide range of youth programmes here that can support. Just developing a really strong understanding for yourself can remove some of that fear so that we can lean in a little bit more. Sometimes parents just need that little bit of education as well, just so they can be present.
Q10. We've covered a lot today. And I'm sure that there are questions that you wished we'd asked. Is there anything else that you'd like parents or carers of teens to know?
Just to know that the sooner that we pick up something, with any young person, the sooner we can get them help them, the sooner they'll be well, again. You know, for most Australians, mental health problems are only a short period of their life. And then with treatment and support they can go on and live really healthy and happy lives. I like to use the analogy of health itself because it helps us bring back to physical health where we have prevention, early intervention and treatment. And if we were to think about physical health, if we were able to identify ways that we can support ourselves and our family with preventative stuff we're already ahead of the game, early intervention by identifying those early signs and symptoms, and then acting on them in a timely manner. What it does, it reduces the severity of the illness, it reduces the time of treatment and the intensity of treatment. And in return reduces the time between that young person being unwell and being well again, and I think that's really important. And sometimes we sit back and we wait, well, maybe it's a stage. But if we can build that proactive approach, and then the empathetic approach to the young person's problems and listening, you know, what we do is create opportunity for that person to be well, sooner. And you know, as a parent, that's what I want. So, yeah, prevention, early intervention, treatment, think of mental health like a hamstring. If you had a bad hamstring, we kept running on it, or letting the young person run on it, it's only going to get worse. But if we get them in to see their physio, or their psychologist, the sooner they're going to be well again. So I think that's a simple analogy we can do, but don't forget the health itself.
EPIC. Thank you, Steve. And thanks for creating Man Anchor. It's an amazing organisation and the passion that you have is really incredible, and we appreciate the support. The EPIC team has participated in you're Communicating with Care course and most of us have done the Youth Mental Health First Aid training as well which is great for us and great for our skills that we can pass on to other parents that we meet through our peer support journey. So we're really grateful for that and thank you for your support of teens and their families.
S. Well, I'm here if anyone needs support. They call me mental Santa Claus. So if anyone needs any help from mental Santa Claus, and all that good stuff I'll be here to support the EPIC team and everyone in the EPIC community. Thank you.
Do you have suggestions, comments, questions relating to today’s conversation or have ideas for future episodes? We would love to hear from you. Send EPIC an email at contact@empoweringparentsincrisis.com
Are you a care giver to a young person. Sign up for our EPIC Updates emails
Contact Man Anchor via its website - https://www.mananchor.com.au/
Do you have suggestions, comments, questions relating to today’s conversation or have ideas for future episodes. We would love to hear from you. Send EPIC an email
Are you a care giver to a young person. Sign up for our EPIC Updates emails
