Talking About Suicide

Talking with Yvonne Bergmans


“So many care providers only see people when they’re not well. They don’t get to see the other side. The gift I have, I get to see all sides.”

Yvonne Bergmans started a support group for suicide attempt survivors at St. Michael’s Hospital in Toronto more than a dozen years ago, and she has been pushing for more recognition of their voices ever since. She’s happy to report that this year, a national conference on suicidology for the first time will put a “huge focus” on attempt survivors and their stories. Her group has been featured in a documentary which can be viewed online, and some members have posed for a series of portraits and interviews. A few have collaborated with Bergmans for published academic studies. They are fascinating.

Two group members tell their story, with strong advice for professionals, in a 2007 study.  Anger, accusations and even eye-rolling don’t help in a crisis, they say. “Don’t punish me for being ill. Admit to yourself that you may not understand. Let me help you.” Even simple, practical things: Don’t lose their personal items. Keep their families informed. And this: “Call me by my name. … When I am in crisis and I feel that all is lost, I must remember that I am someone.” They remind the reader that they are educated, employed and high-functioning, but such things don’t mean a crisis can’t happen.

In a 2009 study, other group members talk about the risks and benefits of being open about their experiences. “When I naively disclosed (about suicide attempts) in my college mental health-related classes, I was shocked at classmates’ reactions, which were split between the morbidly curious and the physically repulsed,” one writes. And yet, “my clients with suicide issues or a history of attempts have appreciated the honesty,” another writes. “They tell me they can relate better to me; it gives me ‘street cred.'”

One of the support group’s first steps is to create a safe space not only for members but also for the topic of suicide and its effect on others. “We often go at it from the perspective of how to communicate your distress,” Bergmans says, “and have people hear it and not freak out.”

She also introduced me to the concept of the “prosumer,” the professional caregiver with his or her own experience with suicidality. Something to explore for later.

How did the group come about?

It came about 13 years ago when I was hired by the then-chair in suicide studies, Paul Links. Psychiatrists saw a lot of people with recurrent suicide attempts coming into the emergency department, and there was a definite gap in service for these people. There were very few places people could go. He hired me to create an intervention. I was hired in November 1998, and in February 1999 I started the first group. We started and just kept on going. It was sort of a situation where I initially was told we’d be doing a DBT (dialectical behavior therapy) program. It just didn’t work for me as a therapist, getting my tongue around the language. Clients were not terribly engaged. Together we started creating an intervention that they could engage in, and we have now had probably well over 300 clients.

Was the documentary a good representation of how the group goes?

Yeah. There were probably more men in that group than there are normally.

As the group grew, what adjustments did you make to help people open up?

It was not really an issue. Once it was safe enough to talk about suicide without getting into means and methods, and you could use the word and not have people freak out and rather ask the question “What does it mean for you?” and recognizing that it doesn’t always mean imminent death, and people coming to a place where there’s no judgment, this is your reality, and being with people who get it. That’s one of the most important pieces. People are not completely alone and adrift in the intensity and pain of experiences. So the way we approach it is in talking about suicidality. We often go at it from the perspective of how to communicate your distress and have people hear it and not freak out.

So, how do you?

We do a number of things. The first is, can you identify how safe or unsafe you feel? Can you identify what it is taking you to the place where suicidal ideation is so great where you think you can’t manage? Things like, “I called colleagues, I called friends, I tried distracting myself, and I still feel unsafe. I can’t deal on my own, I need help.” The other thing is, “I need to be in a place safe enough that I’m nowhere near the environment where this got triggered or started, I can’t be anywhere near my means, and I need someone to help me with that.” There’s a lot of work about developing a language of safety. Knowing early warning signs, knowing the tools to use. And being a teacher to the care providers you work with. We work from the perspective that everyone is a learner and teacher. They are experts by experience.

(I asked about the level of nervousness among therapists in working with suicidal people and whether it’s different in Canada.)

I’d say it’s about the same. You’re working with a person with a high potential of dying. It’s just scary. Yeah, so comfort is something we try to work on. When we do groups, I have many colleagues from various professions working with me, co-facilitating, so they develop a skill set. So they come to realize that when our clients are in good shape, they’re just a hoot and half, a human being you could meet anywhere, a cooking course or anywhere. And the difference between the acute phase and their normal lives. It’s a very different presentation. So many care providers only see people when they’re not well. They don’t get to see the other side. The gift I have, I get to see all sides.

What are their responses to seeing people on the other side?

I don’t think I’ve had any co-facilitator who hasn’t found it a useful experience, having learned something.

Is the group always a mix of people in their normal state and in crisis?

Yeah, and sometimes we get a group when all are in really rough shape. You take it as it comes every week. You certainly hope that people, even when feeling really vulnerable and fragile, they are still able to use some of the skills they were using, and whatever little energy they might have had to get themselves here. A skill called determination.

Have you lost people, or had people leave the program?

Yes, we have lost some people that I’m aware of, probably lost five by suicide. We had a few lost to various medical conditions. And there are people who said, “See you later, never see you again.” Others show up five years later. You can do two groups with us, and we’ve had some grads to come back and become peer facilitators.

How are you, doing this for so long?

It’s a gift. A real honor seeing people shift and change. As a care provider, I can walk with them on the journey, but I have to be clear I can’t do it for them. It’s a parallel process whereby I’m inviting them to participate in a safe place for themselves. I have to do the same professionally, ask others to be another set of eyes. So as a result, we always make sure to have weekly supervision with all facilitators so we can stay honest about our emotions.

What are your personal experiences with suicide? Or is it something where you know you’ll never have to deal with it?

I don’t think anyone can ever be sure they’ll never have that struggle. I think I can’t ever assume I won’t get to that place. I started this job in November, and the following August, my cousin died by suicide. It went from professional to personal.

Did you want to leave, or to work harder?

No, it just left me knowing where I needed to be at this point in time in my life.

Does the group address some of the root problems behind some suicidality, economic ones and so on?

I can certainly help get them to case managers who can help them. I do a lot of crisis management. There’s an expectation that they have a support system, because in the group, there are things they’re not going to share that have personal meaning for them because it’s a group. I can point them to directions and assume they follow up. I assume capacity and capability.

Are there cases where you turn people away?

We rarely turn away. Maybe because of a psychotic disorder. and sometimes the housing situation for people is so fragile they don’t know if they’re able to get to group, so sometimes that’s been an issue. I say that very, very rarely.

What have been the surprises? Any points of view you hadn’t considered before?

That’s really hard to answer. Because every day there’s something new. To say what stands out, I couldn’t name anything. It depends on the day and people in it. People’s persistence and resilience perpetually humble me.

Any examples?

Just the lives that people have to live, endure and survive. You just sit back and go, “Wow, have you got a lot of strength and courage.” Some people might think they have a great big black cloud over their head. A wide variety of different experiences.

Any way to make the cloud go away?

I’m not going to make it go away. I can give you an umbrella and show you how to open it!

(I asked about the openness around the topic of suicide in Canada vs. the U.S.)

Absolutely not. It’s SO not different. A stigma is a stigma.

That’s just the way it is?

Heavens, no. The AAS (American Association of Suicidology) is doing a great job giving people who have attempts, giving them a platform. We are trying to do the same in Canada. And a huge focus in our conference this fall is going to be on honoring the voices of those who’ve had the experiences.

For the first time?

It’s been an evolution. I’d say the evolution has been in the last 10 years. This year’s organizers made a very clear, a mandated part of the conference that more sessions will have first voices. And the AAS did that in their spring conference. I think it’s a general move now.

Why did it take so long?

Stigma. Fear. Prejudice.

But these are the therapists and researchers.

Yeah. Sometimes people have to get out of their own box. I’ve been jumping up and down for a loooong time. My role as a social worker and advocate, it’s been a long path. A very long path in terms of having the voices listened to without the professionals taking over in terms of the sound, shall we say. Because I think medicine has traditionally been quite hierarchical, “This is what you’ll do, what’s good for you.” Whereas social work has client-centered approaches. Nursing has jumped on the bandwagon of late.

(I asked about professionals having their own experiences but not saying so, or saying it quietly, and whether they tell her.)

I think it’s when I go to conference. There’s a small body of literature that talks about it with the “prosumer.” They’ve been able to say they have participated in both realities. And it’s an “and” as opposed to a “but.”

How does the trend move along to more openness?

I think persistently we plug along together. Raising awareness. That suicide is preventable in most cases. Recognizing that it’s very much as it used to be with cancer or HIV, these perceptions are what need to be blown out of the water. And alongside that, the resources. Right now there’s not a whole lot of resources for people struggling with suicidality. The resource allocation at the larger social level is imperative. A lot of myths-busting needs to happen!

Do you have a favorite myth?

Not really

The one about just trying to get attention, just a gesture?

Yeah, that’s where I get a frying pan … Just kidding. That’s so disrespectful. What we often have is, if a person is saying they want to die by suicide, there’s a need not being met. If you tell them it’s manipulation, you’ve missed the point.

How to make this a more comfortable subject in public?

It’s portrayed in the media in such a sensationalized way. There’s not a whole lot of understanding of the despair and compassion required. It’s everybody’s biggest fear, right? How to say, “This is a fear and we can talk about the fear.” I don’t know a whole lot of people who have made it through and can say, “This is what it is. This is how you can be helpful. This is a real struggle. And it feels like a life sentence. And it can be different.” It seems to be more deficit-focused. And if you focus on what’s wrong, you’re not going to get to what’s right.

Among the 300 or so people you’ve worked with, are any of them outspoken?

Yeah. Definitely there will be one, two, three, possibly four at the conference. And there have been a couple who have been interviewed in the Ottawa Citizen. They did a series. And the folks who responded to yourself or to Doug. That’s where there are openings.

Who else is doing what you’re doing?

There’s a group called SAFER in British Columbia. To the best of my knowledge, we’re the only game in Toronto.

What about the issue of involuntary commitment, does that come up with your group?

I can’t commit anybody. I don’t have that capacity. When I work with people, we start with the premise that we all have a right to feel safe,and a responsibility to ensure others feel safe around you. I also work with the second premise that behavior is a choice with an effect. If I’m feeling unsafe, I tell the client I feel unsafe and need help. I always work with the folks so they make their own choice. I’ll support them, meet them at the emergency department, whatever it takes. There are times I’ve had to call 911. I hate it and people get angry when I do it. But when comes to this, I’ll do it.

While they’re in the group?

Somebody calls me outside the group. If it’s in group, I’ve been known to walk with people down to the emergency department. Or to my office, figure out a strategy, talk every few hours with them, ask them to let me know how they’re doing. Sometimes going to the ER can be more traumatizing than their actual feelings.

How will people ever feel comfortable enough to come out? What else needs to happen?

Currently, if a person is brought into the hospital by police, it is on their record that they have has an interaction with police, It does not clearly state it was a contact only. As a result, if people need to have a police check done for work purposes, it comes in the report. This is traumatizing and stigmatizing, and many have lost employment opportunities because if it. Sadly, it does not get removed for five years, and then only if the person requests it. Currently, there is a coalition trying to work on changing this because it is so discriminatory.

Any other ideas in mind that you’d like to pursue if you had the resources?

I would have a Maytree. I would have a number of Maytrees. And it would have a dog, and a cat, and music therapy, and dance therapy, and art therapy, a little medication if needed. If you need meds, a doc would be on site who could do it. And no one on staff freaks out at the word “suicide” and you’re not dumped out if you have suicidal thinking. It’s pretty hard for folks to talk about it if they feel constantly under threat with no safe place to go. How can they heal and become advocates for themselves and one another?

How’s that idea going?

I have mentioned it for the past 12 years. I have invited many people to find me millions of dollars. Interestingly, everybody I’ve invited hasn’t been able to, so there you have it. That’s my biggest bugaboo, people being thrown out of programs at the thought of suicide. My biggest frustration, but hey, life happens.

What else would you like to say?

Nothing I can think of.

Who else are you? The group isn’t all you do.

You haven’t seen my workplace, have you? I started off as a youth worker, a special ed behavioral teacher, the guidance counselor at an inner-city school. Then I ended up here. Every stop prepared me for the next one.

When the word “suicide” first came up, what was your response?

I had basically called to say, “Listen, do you have any jobs for part-time casual?” and they said, “Paul has this suicide thing going on, he said it’s yet to be created.” I said, “Hmm, I’ve worked with high risk for all of my career. I’ve worked with groups. Suicide is the new factor here. Let’s go for it.”

Can the public come to the conference?

Absolutely! In October in Niagara Falls.