Talking About Suicide

Talking with Shari Sinwelski

 September 14, 2012

Earlier this year, I got the chance to meet Shari Sinwelski, who works for the pioneering group Didi Hirsch Mental Health Services in the Los Angeles area. They’ve started one of the very few support groups for attempt survivors, and now questions are coming in from around the country by people curious, though nervous, about starting their own. Shari runs the group and explains here how it’s been going and what she’s been hearing from people who’d like to see or set up similar efforts.

“Definitely there’s some energy out there,” she says. “I think people definitely need some place to go and are finding nowhere to go.”

Who are you, and how did you get into this line of work?

My name is Shari Sinwelski, and I work as the associate division director of the Suicide
Prevention Center at Didi Hirsch in Los Angeles. We have a crisis hotline, support groups, a suicide response team and a lot of community outreach and education, programs with a couple of emergency departments. One of the things I was specifically charged with when I began was to develop a suicide attempt survivor work group.

I got into the field kind of by accident. I’ve been working in suicide prevention for about 18
years. I started in this field when I began volunteering on a suicide hotline while getting my
undergrad degree in Florida. I kind of did it as lots of undergrads do, to get experience, but I
really liked it. After my degree, I ended up working as the director of the hotline there. I was in Florida for 12 years, then I was director of the suicide hotline in New Orleans after Hurricane Katrina and was there for several years. Then here. I’ve been here since _ let me think _ 2009.

How did this group get started?

The Suicide Prevention Center started the first suicide prevention hotline over 50 years ago and has always been a leader in the field of suicide prevention. There were several reasons we wanted to start this group. Some of the idea came from recommendations coming from the National Suicide Prevention Lifeline. In addition, we would receive calls on the hotline looking for a group for attempt survivors. Many people would report that when they would search for suicide survivor groups, the groups were always for people who lost someone to suicide, but never anything for someone who survived an attempt. We felt that a group like this would be a great way for people to know that they weren’t alone and hopefully a way to get rid of some of the shame and secrecy that often surrounds the topic of suicide. In addition, there was some funding here in California for early intervention., and some opportunities because there was money for prevention. Didi Hirsch was the first suicide hotline in the country, so it’s kind of in the forefront of suicide prevention. We wanted to try this, so we tried.

How does the group work, and what have been some of the concerns?

There aren’t a lot of options to look at for best practices. And so I contacted Lifeline and found out about other groups across the country. Ultimately, the only ones I reached were Stephanie Weber and Heidi Bryan. We also have some attempt survivors who volunteer on our hotline, and I had my own focus group with attempt survivors, getting some ideas on what they thought would be important. Also, we run a support group for people who have lost someone to suicide. In a way, we somewhat mirrored the group in some of the logistics. Not the concept so much, but the structure. We also consulted with Dr. Norman Farberow, one of the founding fathers of our agency and an expert in suicide prevention. He had experimented with a group for suicide attempters many years ago.

What we’ve got going right now, a year and a half so far, is a closed group, so people are only allowed to join at the beginning of the group. That helps with group bonding and helping people to really get to know each other. It’s eight weeks. The individual goes through a telephone intake with me so I can learn a little more about their experience, to make sure that we both feel a group environment is something they’re ready for. They have to wait a little for the next group to start, so I try to assess that they are safe and have resources in the meantime.

How do the sessions go?

It’s interesting. It’s a peer support group but not a therapy group. We meet once a week. Initially it was an hour and a half, but recently it went up to two hours because there were bigger groups and not enough time to get everything done. When we first started, I mapped out a plan of topics to cover each week. Honestly, as the facilitator, I felt pressured to have something to fall back on. But I think what I found as the group progressed was that I really needed to stay in tune with the pulse of the group. A lot of times we didn’t do anything that I had planned. In the first few weeks, we really just take some time for members to get to know each other. On the first night, we’d go over guidelines, things they can get from the group, the chance to introduce themselves
and share stories of their attempts if they were comfortable. Sometimes the first few groups can be really difficult for members, especially if they have never talked with anyone about their attempt. If it was difficult, we encourage them to stick with it and follow up with every new member afterward to make sure they are comfortable.

Every group is different. Some bond quickly, others are more reserved. Sometimes if they need more of a conversation starter, we show an NSPL video that shows stories of others who have survived a suicide attempt and they can relate, talk about stigma and other concerns. But one thing we’re finding is, a lot of times group members really just needed support to talk about what was going on in their lives. Because the topic of suicide can be scary for some people to talk about, once they find a safe place, it can be really freeing. So at the start of each group there’s some time for members to check in and talk about what was challenging about the week. That can also be challenging, because if members don’t have places in life to be open and honest about what’s going on, it could bring the group to a very low place if member after member after member is talking about what’s the
negative things that are going on in their lives. The group also has to be a reassuring place to come to. A place to find hope. And so one of the things we’ve always kind of emphasized is the concept of ambivalence. A lot of times people are dealing with depression, they may be experiencing a lot of pain, and it causes them to have thoughts of suicide. At the same time there is usually something that keeps them hanging on, some reasons for living. I do that on the intake, ask them to tell me about both sides: the concerns, the pain, but also the positive things that keep them going. We incorporate that theme into the check-in. It’s a time to talk about challenges in life, but also about what’s been positive and went well. What we’ve found is, it’s helped a lot, but sometimes members can’t find their own positives, so a lot of times members start to point out positives to each other.

We’ve also incorporated other things for fun. Like at the beginning, I found it pretty cold and sterile, so I always make sure we have refreshments, drinks and food, a more welcoming environment. At times we’ve done other things for fun, For example, last year we were meeting around Thanksgiving and a lot of people said they did not have plans; we made one of our groups a Thanksgiving potluck. I guess what I’m mostly trying to convey is, we try really hard to get feedback on the needs of the group. It’s really crucial if they’re only coming and talking about the negatives and struggles to find ways to incorporate hope as well, otherwise, people might not necessarily want to come because they’re already in a bad place.

How many people are in a group, and how any have been through so far?

Right now, we’re on the eighth group. We have had as few as three, and I think our biggest group was seven. We have right now four people in this group. I think there’s been a total of 24 people. Some people repeat for multiple group cycles. I should say we didn’t want people just popping in and out because we really felt people had to feel comfortable. Also because this is a topic that can be so scary. A lot of members are still thinking about suicide, and when people are just coming in and out of a group, people wonder why they’re not coming. It doesn’t help the consistency. But the eight weeks are kind of arbitrary. It’s not to say at the end, ‘OK, you’re done, everything’s perfect.’ It’s a way to allow people to join or come back again. What I found is some members at the end of eight weeks are still finding the group to be helpful. We have allowed group members to be in additional cycles. So of the 24 different people in the first seven cycles, some repeated.

Are any topics not allowed in the group?

No, we haven’t really come up with any topics so far that would be prohibited. On the other
hand, it is a group, so we are always checking in with the group to make sure that topics are comfortable for everyone. If something was distressing, we might ask members to refrain from those topics.

What’s the most surprising thing you’ve learned or observed there?

I can’t really think of anything that was surprising, per se. But I am always amazed by the
courage of the group members to be so open about the experiences and the desire to help each other even when they might be struggling.

What comes out in the support group that wouldn’t come out in a crisis call or counseling session?

I don’t think there are any topics that come up that wouldn’t come up in a crisis call. However, the opportunity to talk with others who have been through a similar experience is something that is different. Members can feel comfortable being completely open and honest with each other, knowing that they won’t be judged. They can also learn things from people who have walked in their shoes.

You’ve mentioned that people have been contacting you about the group. What are the concerns they bring up?

I think one of the things expressed to me is, is it helpful to people who are struggling so much personally to take on the struggles of other people. In other words, is it a good idea for people who are suicidal to all be in a group together. Not that being part of the group requires it, but it happens. They get to know about each other. They might be worried about someone they met or become friends with and may also be suicidal. It can have two different effects. A positive effect is that sometimes they then realize the seriousness of their own situation: ‘Oh my gosh, I wasn’t really thinking how my decisions and actions affect people around me.’ Other times, it’s frankly too much to handle when they’re dealing with stress, depression in their own life and now they have five, six others in the group to be worried about. It can be too much. A couple of people have left the group because of that. Of course, we worked with them to make sure they had other sources of support.

You mentioned screening. What kind of restrictions do you have, if any, or other concerns?

The most important thing is to try and assess if people have enough immediate support in their lives that they will be able to stay safe until the next group starts. We also want to make sure that people have a good understanding of what they can expect from the group. That they feel comfortable speaking in a group environment. It can be helpful if they have a counselor or therapist as well, but we don’t require it.

How you feel personally, taking on work like this?

I definitely feel more positive than negative. Overall, I feel the group has been helpful. We
survey participants before the group, and at the end, and the feedback has been for the most part overwhelmingly positive. At some times I wonder _ and I’m trying to find words to describe this _ it’s not a treatment group, yet sometimes members need more, and sometimes when they’re at such risk, it’s hard not to give them what they need. However, that can be a difficult position to be in. What I mean is that either they are not connected with a therapist or need more than what we can offer in the group. Maybe they would benefit from medication or individual therapy. Maybe their therapist is not comfortable talking about suicide, and they seek out other people. That can be really challenging.

We have been trying really hard to get feedback from participants about the group. So that we can make sure that it is effective and meeting people’s needs. They provide feedback on their experiences after the group, what they liked, what they would like to see change. We also had a focus group and invited everyone who had completed the group to come and give feedback to our quality assurance department. It was a great opportunity, participants were really grateful.

All of this requires extra time, too?

I would say so, for sure. A lot of times people in the group need an extra support between group sessions. That can take a lot of time. I’m not saying it’s impossible, but I think a strictly peer-run group might be hard. It would take a peer who’s really at a good strong point in life to handle the intensity. When we started, we had an attempt survivor as my co-facilitator. After a while, it became overwhelming. There were a lot of things going on in her life, and she decided she needed to take a break. If it were just a peer-run group, it could happen to a lot of people. I’m not saying it’s can’t be peer-run, but I think it definitely needs to be somebody in a good state of mind that’s able to take care of themselves while taking care of others.

Do you know of other groups out there?

I don’t know of any comprehensive listing of groups in the US, but I know there aren’t very
many. There a few others in California that are just getting started, one in Illinois, I think one
in Arizona and a few Suicide Anonymous groups around the country. There’s been lots of people who have contacted me wanting to start one, asking similar questions. I’ve had five or six of these conversations. And we had one group member who moved out of state, he’s trying to start one. Definitely there’s some energy out there. I think people
definitely need some place to go and are finding nowhere to go.

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