Suicide rates have been steadily increasing in recent years, according to the Centers for Disease Control and Prevention. Stigma and lack of access to mental health services prevent many people from receiving the help they need, according to this episode’s guest, psychologist, professor and 2014 APA President Nadine J. Kaslow, PhD, ABPP. She talks about what psychologists are doing to enhance the services available to people who are struggling with thoughts of suicide.
Nadine J. Kaslow, PhD, ABPP, is the American Psychological Association’s 2014 president; a professor, Emory University School of Medicine department of psychiatry and behavioral sciences; chief psychologist, Grady Health System; vice chair of the department of psychiatry and behavioral sciences; and director of the postdoctoral fellowship program in professional psychology at Emory University School of Medicine. She serves as editor of the Journal of Family Psychology. She has more than 280 publications on the assessment and treatment of family violence (intimate partner violence, child maltreatment), assessment and treatment of depression and suicide in youth and adults, post-traumatic stress disorder and its treatment, couples and family therapy, women’s mental health and pediatric psychology.
Audrey Hamilton: Suicide rates have been steadily increasing in recent years, according to the Centers for Disease Control and Prevention. Still, stigma and lack of access to mental health services prevent many people from receiving the help they need. In this episode, psychologist and professor Nadine Kaslow talks about what psychologists are doing to enhance the services available to people who are struggling with thoughts of suicide.
I’m Audrey Hamilton and this is “Speaking of Psychology.”
We’re speaking with Dr. Nadine Kaslow, 2014 president of the American Psychological Association. A tenured professor at Emory University’s School of Medicine, Dr. Kaslow is also a practicing clinical psychologist. She is here to talk with us today about suicide prevention and how psychologists are developing new and innovative ways to help those who are suffering. Thank you for joining us, Dr. Kaslow.
Nadine Kaslow: I’m delighted to be here.
Audrey Hamilton: Suicide prevention is an issue you feel very strongly about and it has been a focus of your work throughout your career. Tell us why you have chosen to spend your time helping those who feel they have nowhere else to turn?
Nadine Kaslow: I think my interest in suicide and preventing suicide began when I was in high school and one of my closest friend’s mother died by suicide. And I saw the profound impact that this had on her children, her husband and the community at large and the pain and suffering that everyone else experienced. And I believe it was then that I wanted to do something about it.
Then, when I became – well, when I was in graduate school, actually, at the end of my post-doc, a patient of mine who I was extremely attached to, died by suicide and it was very, very difficult for me. It was extremely difficult for me personally as well as professionally.
I realized, however, that she chose to die by suicide because she was in so much pain in her life. She was in such psychic pain and she was hearing voices and having visual hallucinations as well and she was tormented and tortured and profoundly depressed. And she couldn’t tolerate living anymore. And so I really wanted to, after that, help people both who are in so much pain try to reduce their pain in other ways, as well as help families and friends and community cope after someone died by suicide.
Audrey Hamilton: What are psychologists doing to enhance the services available to people who are struggling with thoughts of suicide? I understand there’s an app you and your team have developed called ReliefLink. Can you tell us about that as well?
Nadine Kaslow: Let me talk a little bit about what psychologists are doing. Increasingly, psychologists are developing evidence-based treatments for suicidal persons, people with suicidal ideation or suicide attempts and developing evidence-based treatments for youth, for adults and for older adults, as well as for individuals from different ethnic racial groups. So that’s one thing psychologists are doing.
The second thing that many psychologists are involved with are the Garrett Lee Smith grants. And these grants are given to colleges and universities and tribal communities as well as to states to develop major suicide prevention efforts. And I believe that these grants have really helped facilitate infrastructures in different settings and have really made a difference and psychologists are often leaders on these grants.
In terms of developing apps that can be useful adjuncts or used as a primary tool for individuals who are suicidal, the Substance Abuse and Mental Health Services Administration (SAMHSA) put out an app challenge last year and asked for people to submit apps related to suicide prevention. We were extremely fortunate that our app was the winner of the first place prize and the app helps talk to people – or connect people with services, has safety planning on there, has various activities that people can do when they’re feeling suicidal and allows people to develop very individualized plans as well as get help anywhere they are in the United States.
Audrey Hamilton: How can digital technology work in conjunction with one-on-one therapy? Has there been research in this area?
Nadine Kaslow: There’s growing research on digital technology and there’s media-related interventions right now and these are growing, especially for people with medical difficulties. But, it is very clear that people in the younger generations really turn to the media, to social media, as a way to get all sorts of assistance. I really think it’s important for therapists to encourage people who might be interested to download apps on their smartphones or on their tablets and to use them as they see fit in a way that integrates them with the treatment. Sometimes, for example, you might encourage a patient or a client to use these apps to rate their mood daily or their suicidal ideation daily and agree with them that if it gets above a certain level, here’s what the safety plan would be. And here’s when you might contact your therapist, here’s when you might need to call 911 or go to the emergency room. So I think they can be integrated in very creative ways.
I also think that a lot of adolescents and young adults can teach us ways to effectively integrate them, especially how to communicate with them via these tools. I believe that psychology and psychologists have begun to very seriously consider how to integrate social media and other forms of technology into their work. But, I also think that we have a number of other steps that we need to consider before we have a really good plan for doing this in a very effective way.
Audrey Hamilton: You mention young people and they are very focused on social media and digital technology. There have been some high-profiled cases in the media where a young person has committed suicide after being cyberbullied or harassed online. Is suicide increasing among young people? How do we direct prevention efforts toward these youth?
Nadine Kaslow: So there’s some suggestion that suicide rates are increasing among certain subgroups of young people. I also think that we’re hearing more and more about suicides of young people and so sometimes it’s a little difficult to tell what’s an actual increase versus what’s better reporting and surveillance. But, there are definitely concerns that young people are very effective by what goes on via social media and things like cyberbullying have clearly been associated with some young people’s death by suicide.
It’s tricky to direct prevention efforts to this, but I think we need activities in the schools and programs in the schools related to this and related to talking about things like cyberbullying and cyber-harassment and the link between that and suicidal thoughts and actions, as well as aggressive thoughts and actions. So, school-based programming is important.
I also think such programming needs to exist in other places in the community, whether those be religious organizations or other places that young people go for community activities.
In addition, the media can be extremely helpful to us here in terms of talking about this, but also blogging about this, having programs that talk about this on channels that kids listen to. So, I think there’s a number of different ways we can engage more actively in preventive efforts.
Also, I think that parents and schools and other settings need to take things like cyberbullying very, very seriously because it has extremely negative effects on young people.
Audrey Hamilton: What are the barriers to getting care for suicidal youth and their families?
Nadine Kaslow: One of the first barriers is the stigma about getting psychological services. Many people and many communities would rather do anything else than get psychological services because they’re worried about the stigma associated with that. So, they don’t want to see the school counselor or the school psychologist because they don’t want the other kids to know that there’s something wrong with them and they feel like they’re going to be labeled. So, stigma is one major barrier.
A second major barrier is that there are not a sufficient number of psychologists and other mental health professionals who are really comfortable with working with people who are suicidal, especially those who are extremely suicidal. So I think we need more training to help improve therapists’ ability to effectively work with young people and others who are suicidal.
I think the third issue is that we don’t have enough evidence-based services that we have available to us to offer for suicidal people and we need to develop more of these.
Audrey Hamilton: What about suicide prevention in minority populations? Why does this deserve special attention, in your opinion?
Nadine Kaslow: So, I’ve devoted the last 20 years of my career to suicide prevention in the African-American community. Although rates of suicide are lower in the African-American community than in other communities, there are different challenges and different issues that need to be attended to. And so I think it’s critical that we develop services that are culturally informed – that are culturally competent, as well, because we need to have services that really speak to people.
So, we need to know, for example, in some communities like the Native American community, there’s often very high rates of substance abuse linked to suicidal behavior and so their programming really needs to target those linkages and we know that it’s critically important that those programs be done in a way that’s very attune to the cultural issues and the communal nature of their communities. And so I think that people from different races and ethnic backgrounds – people from different sexual orientations, genders, etc., ages, all need treatments that are very, very tailored to them. I don’t think it’s a one-size fits all opportunity.
Audrey Hamilton: Thank you so much, Dr. Kaslow, for joining us.
Nadine Kaslow: You’re most welcome. Thank you.
Audrey Hamilton: For more information on suicide prevention and Dr. Kaslow, visit our website. With the American Psychological Association’s “Speaking of Psychology,” I’m Audrey Hamilton.