Structured peer support for recovery from suicidality – it works

When I tell people that suicidal thoughts begin as a way to save your life, they recoil in disbelief. How could thinking about suicide preserve your life? The real truth is no one starts off thinking about actually killing themselves. Even though it might seem so even to the suicidal person, when asked, the patients I have surveyed reveal similar histories. When finding themselves in a no-win, non-alterable situation usually early in life, they have to find a way to withstand it in order to live through it. Bearing adverse situations requires mind over matter and one begins to think of “not being here” in order to survive untenable life conditions.

My suicidal patients over the last 14 years have described the first time they remember wanting “not to be here”. Each one also described having to endure a long-term abusive or neglectful environment in which they had no control. If they could not remove the problem adversely affecting their lives, then it is ingenious to devise a way in their mind to live through it by symbolically removing themselves from the danger. When a mind can eliminate anguish, a feeling of control is established. Thus, imagining “not being here” equals the only means of control over the situation at that time.

Interestingly, when I realized this I could not put my own self into this scenario, even though I knew I could trace my suicidality from 8 years old. Yet after I wrote my book about my childhood and my 24 years of suicidal ideation and attempts, my readers were the ones to inform me they directly related to similar childhoods also insufficiently nurturing (and in most cases, much worse than mine).

I realized that my patients and I shared a daunting suicidality that protruded into our dreams and invaded our desperately few quiet moments. But I had been delivered from active suicidal ideation. At age 32, I finally told my best friend what I was dealing with and she took it upon herself to form an intimate and confidential coalition of my friends who became dedicated to keeping me alive until I could learn to keep myself alive. Between my own strides in mental health therapy and their specifically planned efforts, we all succeeded.

At that point in my life I knew I had to change courses. Prompted by a new career devoted to mental health and chemical dependency counseling and in research for my Masters in Counseling, I looked further into the identified thought progression of wanting “not to be here”. Continuing to work with suicidal patients, I learned that the initial thoughts of wanting “not to be here” were endorphinergic. That is to say, as long as the thoughts of freedom from pain and despair could be generated, they produced pain-killing, mood-elevating neurochemicals and hope-filled feelings.

But it wasn’t long before those thoughts alone were not sufficient to bring the relief that they did originally. The need to create more permanent feelings of relief innocently and subconsciously started and perpetuated the ever-heightening suicidal ideation which then led to attempts of increasing lethality.

Each of my patients noted the same progression beginning with adverse childhood experiences. No one started off thinking about killing themselves.  All felt better when initially thinking about “not being here”. All learned early in life about suicide’s ability to end someone’s troubles. Usually suicide had been explained simplistically as a way to be free of pain or to be “happy and in peace with Jesus”. Each patient was nonplussed by the entire process which had inexplicably morphed into anguish. Each felt they must be mentally ill because they could not understand where the thoughts came from or how to get rid of them.

I realized that our suicidal thoughts were not our fault. They were deeply and unconsciously engrained neural pathways that had innocently developed over time and had become default thought patterns engaging full force whenever we were presented with difficult situations. All of this happened totally without any volition on our part. Unfortunately, when you have an efficient unconscious go-to thought process available, there is no need to develop problem-solving skills. This explained why all of my patients stated they felt like they were helpless, hopeless and…crazy.

I wondered if the kind of focused, problem-solving peer support that initiated my recovery could help my patients. I dissected and analyzed what my team of friends did for me and replicated that in a protocol for suicide prevention. I poured over neuroscience research and found evidence that my psychobiology of suicide theory could be viable. I explain the origins of suicidality with neuroplasticity research underpinning it and present it in my book, “Just Because You’re Suicidal Doesn’t Mean You’re Crazy: The Psychobiology of Suicide” (2012). Particular cognitive behavioral and neuroscientific principles are part of the support members’ education. With the knowledge of exactly how to help the suicidal person they become goal-directed and confidently move forward.

Shortly after publication, a reader called me to let me know that the JSP3© (Jensen Suicide Prevention Peer Protocol©) has saved her life. She had been inexplicably tortured for decades with suicidal thoughts and attempts. For the first time in her life she felt like she was in the driver’s seat, no longer a pawn to her out of control and heretofore overwhelming suicidal thoughts.

I continue to work pro bono forming individual suicide prevention support teams for anyone who wants to start leading their life free from active suicidality. Discovering that this enduring neural pathway does not go away on its own, I learned it can, however, be atrophied through lack of use. I’ve realized that any thought now that resembles a suicidal thought is a message that I have to solve a problem currently undermining my peace.

In my ongoing research, I discovered that most of my patients had been discharged from one or more psychiatric hospital wards without any outpatient support (as I was also). They were commonly dismissed with only a tenuous referral for a follow-up counseling appointment. Research reveals that the likelihood of suicide is at its greatest in the first few weeks following discharge from the hospital. It seemed no one was doing anything to prevent that from becoming the possible eventuality.

I’ve been working to inform psychiatric nurses, hospital social workers and emergency room social workers about a way to build protection into the discharge plan of suicidal inpatients. I’ve described my three hour session orienting, educating and coordinating the JSP3© members with the suicidal person as the one in the driver’s seat of the team. The JSP3© team provides the daily support while a licensed therapist resolves the underlying trauma that initiated the helplessness, hopelessness and the need “not to be here”.

There is ample evidence that peer support for most populations is very successful in suicide prevention. Unfortunately, in general, hospital management hasn’t been eager to institute a new program which requires significant staff time and effort. In addition, I have addressed many battalions, squadrons and commanding officers at Joint Base Lewis McChord where there have been an unprecedented number of military personnel suicides. It saddens and frustrates me to have been unsuccessful in convincing either the Veterans Administration or the Department of Defense hospitals to institute a peer support safety net before they discharge the individuals treated for suicidality.

In the meantime I hope that continuing to teach professional education classes in Treatment of Suicidality will bring some pressure to bear on both civilian and military hospital administrations. The therapists who receive training in the JSP3© protocol have been excited about its success and have begun the process for their suicidal clients. Hopefully the hospitals will follow suit and realize that if nothing else they can reduce their liability by providing this safety net for their patients.

The Jensen Suicide Prevention Peer Protocol© is a structured way to keep the suicidal person alive until they can retrain their brain and establish new meaning in life. It’s simple and it’s saving lives every day. However, when I was fighting to stay alive every day for 24 years, I never dreamt that it would be my friends who would give me the platform to transform my life. I spent decades in stigma, silence, and shame dogged by self-destructive thoughts I could not understand. I did not know how to live. Eventually I told the right people and they began a cascade of new beginnings – a new way of helping a suicidal person and a new way for the suicidal person to help themselves. I’m still in touch with my entire support team. We talk and have lunch regularly, still solving problems for each other. We’ve shared births, deaths, cancer, disaster, plane crashes, weddings, divorces, and continuous triumph. What we began together became an enduring reciprocal coalition. I would never believe at any time during those troublesome and desperately confusing suicidal years that I would be telling this story today – or that the same wonderful people who supported me then still support me now.

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