With nearly 40 years as a mental health nurse, including front line ER work, UNB nursing professor Stephen VanSlyke (BN’87, D-ADM’95, MN’02) is committed to addressing human suffering and reducing suicides.
He was recently tapped by the Public Health Agency of Canada as part of of a roster of suicide prevention experts that can be called upon for expert advice, and to help create a three-hour self-learning course for health-care providers titled, “Talking About Suicide: Empowering Health-Care Providers, Instilling Hope in Clients” The online course is meant to help nurses, physicians and other health-care professionals evaluate suicide risk, build trust with at-risk clients and develop short-term mitigation approaches. Produced by the Mental Health Commission of Canada and CHA Learning (HealthCareCAN), Stephen says it “helps to draw people into the reality of how suicide can affect very silently. Many people who struggle with suicidality hide their suffering, leaving no breadcrumb trail to say, I’m about to do this. It’s not like a bone sticking through the skin; rather, suicidality develops insidiously, making detection challenging.”
"Many people who struggle with suicidality hide their suffering, leaving no breadcrumb trail."
“It’s a bit like an iceberg. Sometimes the person doesn’t present with suicidality, but it’s underlying — it’s in the background.” For instance, someone seeking medical detox or help with a foot infection may also suffer from underlying depression and suicidality, points out Stephen. The course, which touches on the pervasiveness of suicidality, also addresses chronic suicidality. As he explains, for some people, suicidal thoughts are a constant presence, never totally disappearing but only fluctuating in intensity.
Understanding the deeper struggles of patients
The hidden signs of suicide vary significantly, although feeling trapped and hopeless is often present”, says Stephen, who teaches mental health challenges and clinical courses in mental health nursing at UNB. “Suffering does exist. Mental illness does exist. Some people live with depression, and other people live with catastrophic insults that leave them without a sense of hope.” He adds that the risk of suicide increases in people who have experienced intergenerational trauma, adverse childhood events or chronic illness.
The course, which includes a reference to cultural competency, addresses working with Indigenous people, many of whom have experienced historical and generational losses and/or been harmed by the mental health system, he says. As well, the course discusses working with newcomers, who may have experienced trauma before they arrived in Canada and whom also may come with a different perspective around suicide.
Because there are no obvious “red flags,” an intentional and open assessment of suicide is key, says Stephen, who worked to help develop a Certificate in Mental Health stream for undergraduate nursing students. He encourages professionals to ask a few respectful and caring questions that reach beyond the surface of a patient’s presenting issues — for instance, exploring how lack of sleep affects a patient’s daily life rather than solely treating their sleep problems. “Using empathetic communication is key when caring for patients who are marginalized, such as opioid users or the vulnerably housed,” he says, adding that “mental illness or substance use can alter a person’s ability to cope.” In his view, a simple act of kindness and caring can often help doctors and nurses understand the deeper struggles of their patients.
Stephen also points out that some people believe that asking for help creates a burden on others and is a sign of failure. Although depression and suicide are talked about more openly these days, they still remain highly stigmatized, he says. “When people die by suicide, it’s complicated to word the obituary. It’s complicated to know how to celebrate that person’s life. It’s complicated to know how to work into the school system if that person is a child.”
Building safe spaces for patients, students and providers
Not only do clinicians need to create safety for patients who experience suicidality, but instructors need to ensure that students who are learning about suicide feel emotionally safe. “People don’t come with a blank sheet of paper about suicide. We all have been touched by suicide. I have people in my family and colleagues who have experienced suicidality, and I’ve worked with people who have died by suicide.”
Instructors can create emotional safety for students by explaining what to expect in a session and then debriefing afterwards, he says. He stresses that instructors should normalize and desensitize the topic — perhaps by explaining how they themselves have been impacted by suicide.
Although “Talking About Suicide” is a self-directed course, one of the sections validates the common tensions practitioners may have about discussing suicide and presents ways to address those concerns. In addition, the course includes a section on self-care and emphasizes the importance of practitioners collaborating with others once they realize a patient is at risk. Participants are also made aware of local resources for suicidal people and toolkits for the helpers themselves.
Stephen would like course participants to come away with a greater understanding about the complexity of suicide and a recognition of the shared responsibility of health-care providers in addressing suicide and instilling hope in clients. Another goal is for healthcare professionals to appreciate that they can interrupt suicidality by performing skillful assessments and engaging compassionately with patients.
