Talking About Suicide

Talking with Katie Ayotte

 May 11, 2012

Katie Ayotte’s story is a striking mix of what resources are becoming possible for suicide attempt survivors and the disconnects that remain. At least two fascinating twists lie ahead as she talks about becoming a peer leader of a rare attempt survivors support group in the U.S.

Katie also expresses a major problem of suicide more clearly than I’ve been able to do myself. “When you live in a society where you can’t mention the word ‘suicide,’ or live in fear of saying the word ‘suicide’ and there being some negative consequences _ as long as you live in that kind of world, you’re not going to be able to prevent it.,” she says.

Who are you?

I’m Google-able. I’m a person with a Serious Mental Illness, though I consider it Seriously More Interesting. I’ve had a serious mental illness since I was very young. My first suicide attempt was when I was 12. I now speak out about suicide and work to reduce the stigma and shame around it.

Your first attempt was when you were 12. How old are you?

I’m 50.

And now you speak out about suicide. How did the change come about?

It came about with my last attempt, about three years ago as of July. I sit on the board for Magellan, a half-community, half-Magellan governance board. I’m the Adult Recipient of Care representative. I represent the adults who receive care within the behavioral health care system. I’ve been on the board since 2008. During one of our board meetings … Now, no one on the board knew I was struggling with depression, they would have considered me “high-functioning.” I didn’t allow them to see me depressed or down. I had lost my job in 2009, a job I really felt at home with. But certain circumstances came about and I quit on the advice of my doctor so my health would get better. I was struggling quite a bit. Around mid-July I attempted suicide. I was at the board meeting and David Covington had mentioned they were starting a programatic suicide deterrent task force committee.

I had voiced to David that I’d like to be on the steering committee. He told me when it would meet the first time. Little did he know when I asked that three weeks prior I had attempted to end my own life. So I went in without a thought of telling anybody what I had been through. It was probably the furthest from my mind. David started the conversation around suicide, what survivors look like, how he saw it to be able to prevent suicide. There was a lot of talk in the room, and I found it very frustrating, hearing a lot of stereotypes, stigma, fear. And I asked David if I could _ there were probably about 30 people _ if I could have the microphone. He said, “Sure.” And for whatever reason, I felt it necessary to share that three weeks prior I had tried to kill myself. I told them the story of my job, how I had felt hopeless and helpless and a burden on my family because I wasn’t bringing in income. I briefly told how I attempted and what stopped me from completing. Needless to say, the room got very quiet. I had wanted to put a human face to it, so they were not talking about “those people,” that I was one of them. And from there it moved forward. I had a small article written about me in a local magazine called “Together AZ.” That went well. And from there, David Covington asked me if I was willing to do an interview with Ed McMahon, a local talk show host.

Ed McMahon?

Well, it’s not THE talk show host. Or Pat McMahon? It’s on YouTube. Anyway, a local TV show. I just felt the need, the importance that somebody put a face to it. People would look at me and go, “I never would have thought that you would be one of those people.” I had a lot of people say that. I think that just fueled my desire even more. I did a campaign for Magellan, “One in Four,” on depression and a campaign called “Extraordinary People” where I shared my attempt.

What happened next?

I just started getting asked more and more to share my story. I found it to be very powerful to tell it and change people’s point of view.

What were people’s reactions, especially at that meeting? What were the first things they said?

Things like, “Oh my God, I’m sorry. We didn’t know.” “I had no idea.” Typical reactions. “Is there anything we can do to help?”

And what was your response?

You know, it was somewhat comforting that they cared enough to say something. But part of me was like, they were saying these things because they were uncomfortable with the story around suicide that I’d just shared.

Were most, if not all, of them mental health workers?

Most of them were, from various fields.

Shouldn’t they be used to hearing from people about suicide?

You would think so. I guess they weren’t prepared for someone to be so open. Suicide is still a word with a lot of stigma.

Have you noticed any change in reactions since you started speaking out?

People reach out and get to know me better. They’re more interested in getting to know me, they aren’t cut off by my suicide attempt, which is good. Unfortunately, now we’re starting up a suicide attempt survivors’ group and we have to work within the behavioral health system, and there are a lot of guidelines we have to work within. We run into a lot of stigma.

From whom?

Anyone from doctors to case managers. It’s a really interesting experience. I forget what a bubble I live in, my little world where I can talk openly about suicide and not think twice about it. But just the thought of getting a bunch of people who’ve had suicidal thoughts makes people uncomfortable. The fear of the contagion effect. Actually, it’s the opposite. If someone is able to talk, it reduces the risk.

Do you have any examples of people’s reactions? Things people said that made you want to smack yourself in the forehead and think, “I can’t believe they said that”?

I had a personal experience with a doctor that made me want to smack HIM in the forehead. My regular doctor, who had build a trusting relationship, had retired. So I’ve had a string of temporary doctors. This last one, who shall remain nameless, I went in to see him because my anxieties were high. He was taking down my history and asked what I did. I told him about my work. And he just locked onto the word “suicide.” “When was your last attempt? How many times have you attempted? How? When was your most serious attempt?” I was dumbfounded. Instead of focusing on what I had come there for, he locked on the suicide bit. I told him, “You know, I’m in a good place, I have my supports _ Hello, look at what I’m doing.” He had the nerve, when handing me my scrip for Klonopin, he held it for just that extra second before releasing it, looked at me and said, “Now, you’re not going to overdose on this, are you?”

Now I understand what people say when they refer themselves to the group, when they don’t want their doctors or case managers to know. I got it. When I tell different doctors what I do for a living, they get that look like, “Is that a good idea?” You can tell it makes them uncomfortable.

Have you found a way to put them at ease?

I try. I try to explain about the group, that I have a safety plan in place, that I have people around me who love me. I can go to my husband or my mother if I have suicidal thoughts. My mother lives with my husband and I. If I come in, sit on the floor and put my head on my mother’s knees and say, “One of those days,” she knows I’m having suicidal thoughts. The same with my husband. And an open conversation can be had around it.

They know what to do? And it works?

Yeah. It’s mostly listening, letting me get the thoughts out. They’re not trying to fix anything.

It sounds awfully simple.

Yeah. It does. And that’s what we try to provide in the group, a safe place where they can get it out and feel better. Instead of trying to stifle those thoughts or figuring out how to work out those thoughts ourselves, on our own, when they run wild on us.

And this work is a good idea for you?

Without a doubt, it is. Even if I’m having a bad day, I can tell the group. I’m a peer. Just like they are. I want them to realize they have the same power I have.

What about taking on their emotions? Isn’t the group intense?

So far, it hasn’t been. It has the potential to be, which is why I have supports in place. I have a co-facilitator, a supervisor, who is a clinician, in place. If there are challenges, there are people I can go to. Going through the phases of talking about it has made me very open about talking about suicide now. I feel it’s easy to go to somebody and say, “You know, I’m feeling challenges from suicidal thoughts.” With the group, I want them to understand I’m not perfect.

Tell me about the group. How many people do you have? What are they like?

We have seven members. It’s a very diverse group. Right now we have two men, two transgender and three ladies. They’re all primarily in the serious mental health behavioral system, where we get referrals from. Most are on disability. There’s one that works, and one does a lot of volunteer work. Three or four are actually participating in several groups or classes.

How does the group go? Have they loosened up at all since it started?

Yes. A normal group starts with the check-in: How’s your day, what’s worked and what’s not worked for you the past couple of weeks. Myself or the other facilitator brings a discussion topic unless a topic has already started during the check-in. We feel the group right now is very nurturing of each other. It’s loosened up quite a bit. It’s really interesting to see the group dynamics change from just two or three members. It was a little tight. It felt almost restricted. They weren’t as open.

What are you all learning from them? What’s been surprising?

What we’re learning is that this type of group is needed. People really are open to talking about suicidal thoughts. It goes against most of the stigmas out there. We’ve been surprised that most of the referrals have been self-referrals. So it’s been enlightening. When they find out the group exists, they want to be part of it. In general, I’m amazed at the compassion they have for each other, the support when one of them is having a challenge.

You mentioned having some restrictions with the group’s setup. What kind of guidelines are there?

As far as who can be in the group, I wish the guidelines weren’t there. I wish the group was open the public in general. It probably would have a better turnout. Because it’s funded by Magellan, we have to keep it within their guidelines. People in the group have to be Title 19, which is … I don’t know how to explain it in terms for someone not living in Arizona. Criteria such as having a serious mental illness, attempting suicide or having suicidal ideations, and you have to meet certain financial criteria. What that means is, you have to fall below a certain _ I hate using the word “poverty level” _ but a certain low-income category. Which makes them eligible for more services. Certain people like myself fall just above and have less available to us.

So if you weren’t the facilitator, would you be able to join the group?

No. Absolutely not. Because I don’t fall within the criteria. I’m only in because I’ve been involved since the very beginning.

How do you grow more of these groups?

Well, we keep getting out there, saying the word “suicide,” don’t shy away from using the word. We go out to the clinics, go to advisory board councils, talk about the group. We’re getting ready to do another round.

What about getting these kinds of groups to spread at the national level?

I guess just by getting people used to the word “suicide,” having people be OK with someone saying, “I’m having thoughts of suicide” or “I attempted it.” It’s got to be a cultural change. There won’t be one until we have more people with a voice ready and able to share their stories.

How do you know when you’re ready to share?

I believe that’s an individual and circumstantial process. I was in a certain circumstance when I felt it was important for me to speak out. One thing I can say is, someone who decides to speak out publicly really needs to make sure they have supports in place. That way, if something does trigger you, you have someone who gets what a bad day feels like.

(I asked about the concerns that led me to start the blog, described in “About the Blog.”)

Well, yeah. Of course there’s a concern that someone will do something that’s going to permanently affect their lives in a way they weren’t expecting. I can’t even imagine, having come so close to a completed suicide, finding that you’ve paralyzed yourself. There’s always a concern that someone will take a step too far, end up hurting themselves in a manner they didn’t expect. I know there’s a lot of times I worry about the people in the group _ we’re lucky, no one has attempted since they’ve been in the group _ how would I react if somebody attempted and became permanently disabled because of it? There are people who take these risks. I know in my last attempt, it was impulsive. I got halfway through a bottle of Klonopin and decided this was not what I wanted to do. I was in a panic. Was I too late? What happens now? Had I gone too far? I proceeded to make myself throw up as much as I could to keep myself from suffering permanent damage. I was fearful of saying something to my husband or my mother. Both were home and had no idea. This was before we had open conversation.

I hope this wasn’t the same bottle of Klonopin that the doctor handed you.

Yes, it was.

What! Do you find any humor in that, irony or something?

Yeah. He had no idea. The fact is that, the way he said it _ “You’re not going to overdose on ME, are you?” OK, I know whose ass you’re covering!

Yeah, I know others have had experiences like me who say, “Oh no, this is not what I meant to do.” And I bet some end up in worse-case scenarios, end up killing themselves or being disabled one way or another.

What can be done about that? There’s suicide prevention, crisis lines, lethal means restriction work

That’s a hard one. You’ve got all those things, but when you live in a society where you can’t mention the word “suicide,” or live in fear of saying the word “suicide” and there being some negative consequences _ as long as you live in that kind of world, you’re not going to be able to prevent it.

That sounds like a good ending. One more question: Who else are you, outside this issue?

I’m a wife, a mother, a daughter, a friend. I mean, I have a wonderful husband and mother who are just so supportive and caring. I have a wonderful daughter and two absolutely amazing granddaughters. I’m just really blessed to have parts of my family close to me. I come from an abusive background. Coming from an abusive home, I never would have thought I would have the closeness I do. I feel incredibly blessed. Like with my mom living with us. She’s 75. I always told my husband it’s a package deal. You get me, you get her.

After hearing this, I feel I should ask the question many people might ask: Why would you want to leave all of that?

As much joy as I have, there have been times when the emotional pain has been as much or greater. The pain and depression just get so overwhelming, and I just lose the ability to fight.

Anything else?