Talking About Suicide

Talking with Amelia Lehto


It’s always valuable to hear from someone who can see the suicide prevention world from both inside and out. Amelia Lehto is a crisis counselor who knows what suicidal thinking feels like.

Here, she explains why crisis counselors might be better trained to work with suicidal people than therapists, but she pushes back against the idea that clinicians don’t need those tools.

“It shouldn’t be absolute: ‘We don’t deal with that, send them to a crisis center,'” she says. “That’s not convenient or safe for anyone. People don’t want to be pushed off to the next guy.”

Who are you? Please introduce yourself.

My name is Amelia Lehto. I am a crisis line coordinator and specialist in suicide prevention at a crisis center in metro Detroit.

For how long?

This will be my fifth year as coordinator, but I’ve been with the agency for seven years. I started as a volunteer and worked my way into my current position.

When you joined, was your personal experience addressed?

Yes, in the screening process. For volunteers, they ask us our past history. Mine was brought up. I lost my best friend when I was 13 years old to suicide, something I’m always very open about. In that process of losing her, I had sought treatment because I was having suicidal thoughts myself dealing with the trauma of her loss, in addition to childhood sexual abuse that came up in that process of treatment and getting help and coming out with all the trauma I experienced at that young age.

How were the reactions to that?

I felt very safe in the process. I was very comfortable. I had a volunteer facilitator along with, I think, a staff member and then it was just a couple of people and myself. It came out conversationally. We were interviewing each other. It flowed very naturally out, and it didn’t seem to be a concern. I wasn’t questioned about my history because I already had been honest on my application. It’s always just been a part of who I am.

What were you doing before then?

I went to broadcasting school.

Did you pursue that?

I interned for a while locally but was a single mom at the time, and it was not financially feasible to continue. I went on to supervise at Starbucks full time, started volunteering and picked up a second job at the time.

What led you to volunteer in this area?

Six months before I started, I lost my mother to pancreatic cancer, and I was very deep in grief. I wasn’t leaving the house very often. I was not an attentive mother. My cousin who was working at a crisis center saw me over Easter holiday and told me more about her job and how it might interest me, so I pursued that into the screening process. I discovered a lot about myself in training because they asked a lot of personal history to practice, so it feels genuine when role-playing with another person. It’s a safe environment. It was really good and cathartic to put all my stuff out there to practice, with the loss of my mom, the abuse scenario. Really cathartic and healing, what I needed at the time. My mother had already encouraged me to pursue my passions, and it took her passing to find it.

What are some of the striking things you’ve learned on the job?

I was surprised. I picked a Friday night shift, and I had imagined that Friday night would be the night of crises. People were going to be overwhelmed, they were going to need help. It was the slowest shift. So my first couple of months there, I felt I had all this preparation and I was ready to take on this role. I had an amazing trainer, a former Marine, who drilled the empathy model into volunteers, really encouraged us to explore the situation and find the elephant in the room. I didn’t take on a full-on suicidal crisis call until five or six months in. A lot of calls were people who were in need of support but not in crisis, emotional support. It was incredibly valuable. I heard stories of people you don’t generally hear. It’s an honor to do that kind of work and give support. It really is incredible to have a genuine connection to another human being.

When I received that first true suicidal crisis, it was terrifying. You know, you have this sense of responsibility, and it’s ultimately not your responsibility, all you’re doing is being there for another human being. I was being a support to another person. It was a really challenging experience, and I had really great support from my supervisor. It was like a two-hour long call. They felt hopeless and helpless, but we were able to talk about what kind of plan was coming next. They ultimately decided to reach out to one of their family members. We role-played that situation and what they would say to ask for help. At the end of the two hours, they felt more comforted, and the crisis had passed. They felt more comfortable talking with their family, who was coming home shortly. You don’t usually see that 360, from crisis to resolution: “Oh, I can get through this.” They had reached out for mental health support in the past, and it had failed, but they were willing to try again. I can see myself sitting in that cubicle in that building that’s no longer there. It was a really good call.

Has it in certain ways gotten easier?

I have had the opportunity to go though multiple trainings, to connect with people like yourself, all these thought leaders in the field, taking their skills and experience and applying it to my work. My confidence has grown, but each call is its own. It’s not black and white, it’s one person in that moment, and it’s what’s gonna work for them. It’s always different, but I’m much more confident in my skills.

Are you allowed to bring up your own experience, or do you want to?

It’s not something we encourage on the job. We want to keep that kind of professional boundary, so we don’t put ourselves at risk in that moment. I think that’s something the warm line does because they have that ability, and I really appreciate that perspective, and it’s something to talk about in the future. But I think it would be uncomfortable initially. But I do have that ability in my personal life, and I do have people who have reached out to me, and I can really connect to them. So it’s different when on the job. I can see the value in both approaches. With warm lines, there is a more personal conversation. The peer on the other end may share their own experience and what their experience has been. While on the crisis lines the focus is on the caller and their experience, with the crisis worker reflecting the caller’s experience.

How do you take care of yourself in what can be quite stressful work, and what do you do if your suicidal thoughts come back?

I debrief, debrief and debrief on shifts and off of them if I had a really difficult call or experience in the community. The work by nature is stressful, demanding and so necessary that I really feel humbled doing it and honored by it. I am with people in what may be the worst moments of their lives, and I never take that for granted. It can certainly add up, though, over time. If I take on too many projects or had an especially stressful day, I can be hyper-vigilant when I leave the office. My husband can probably speak more to this than I can. My family is naturally affected by the stress that may build up, but they are also patient with me. Though they may not fully understand what my day was like, they know to love on me, and we do our best to leave it all at the door. For self-care I laugh, I love and I enjoy all the small things. I’ve been lucky enough to be able to travel, which I thoroughly enjoy. This past weekend I was at an event at a local metropark that is just beautiful, so I took the time afterwards to visit the hiking trails, enjoying my time alone.

There’s a lot of talk about the importance of peer support. How would you use that in your work, ideally?

At my center, we do have peer support on site. We’re a 24-hour crisis center. The peers are there with the person beginning to end to share their own experience. We definitely see the benefit on site. It’s something of interest for the phone side. We are interested in the warm line idea, and that’s something on the to-do list, the wish list of what we’d like to offer the community. There’s definitely a benefit there. I know many of our volunteers and staff have their own experience of one kind or another. The lived experience and attempt survivor movement led me to share more about it on a regular basis. It draws empathetic people. If not personal experience for themselves, then somebody in their lives. I would really like to see that happen for my crisis line, bringing peers to really connect with people on a personal level.

You must hear a range of voices. Do you think the lived experience movement is doing a good job of reflecting diversity, and what other problems need to be pointed out?

I think diversity is important, in general. Everybody, no matter their race, religious affiliation, their age, financial status, is immune to suicide, suicidal thoughts, critical situations, one way or another. It affects everyone. I hear from those that are well-to-do suburban white-collar settings, but I also hear from people who are from under-served areas. I don’t always know those specifics, but I have talked with a number of people who, the running theme is loss of one kind or another, whether it be financial, a relationship, their freedom, the loss or the threat of a loss. But we certainly are not an island unto ourselves, we have these shared losses, and I don’t think everyone fits in one category or another. Cultural diversity affects us all, and it is something that should be respected in regards to suicidality. We’re all in this together, we’re all human. The LGBT community, the black community, the Asian community, or elderly, you know, middle-aged men, across the board. It’s easier to break people down into groups, and that’s more easily digestible than to say everyone’s at risk, which puts fear into people.

With concerns out there about crisis lines calling the police or other emergency responders, what do you think is the best practice for keeping callers informed and putting them at ease?

Reaching out for help, no matter where to, takes an enormous amount of trust and an incredible amount of bravery. Often times, people are calling for the first time because they were recommended to call or had heard about it through the grapevine. This work isn’t black and white, there are shades of gray, and this interaction that a caller and a crisis worker enter into is intimate, but it is malleable by the caller. They are the driver in these interactions, while the crisis worker is the navigator. The caller has control and always should be treated as such. The difficulty lies with the negative interactions, those calls where the caller and the crisis worker weren’t on the same page, and the sometimes devastating effects that can have. The benefit of the crisis line is vast and diverse for each caller that reaches out. There are some great studies that have been conducted, namely by Madelyn Gould.

Too many times, we hear of the negative rather than the positive outcomes that happen. There is good work being done on crisis lines. There are staff and volunteers who are truly invested in the best outcome for the callers. For me, the most collaborative and least invasive responses work best for both parties, reducing the trauma and stress an active intervention _ police or other emergency responders called in _ can have. It takes three positive interactions for every one negative, but the failure here on the crisis line part is for that one negative; it’s unlikely a caller will reach back out for help or give feedback. It’s not one size fits all. If someone calls in and doesn’t connect with the crisis worker, I’d encourage the person to call back and speak with someone else. For those positive interactions, word of mouth is best practice. Share your experiences and encourage others to utilize crisis lines if necessary. They are safe, confidential and anonymous, and now there is crisis chat online. And for the negative interactions; please call back, give feedback. If we know better, we can do better.

Sometimes it seems people at crisis centers are better equipped to deal with suicidal people than clinicians are. Why is there still distrust around suicidal people, and how to break that down?

I’ve heard talk among clinicians who have fragilized people with suicidal thinking or people who have disclosed. And I think that those, in especially clinical roles, I don’t think they are as exposed to suicide in general on a one-to-one basis. They may have read about it, they may know how to treat some related symptoms, but suicide is not as comfortable a topic with them as with those at a crisis center because we’re trained to talk about suicide. In the heat of the moment, if you will. It’s a different skill set, a different training theory and background, and I think you hit it on the nose. The crisis centers, we talk to people in all sorts of states, and that’s to be expected. In a clinical setting, you’re treating long-term, ongoing mental health concerns or challenges in that person’s life. And people know if they call a crisis line, they can talk about suicide.

Do you think clinicians would benefit from the training you get?

We’ve had interns, volunteers, coming from varied educational backgrounds: psychology, psychiatry, you know, we had aspiring doctors volunteering with us this summer. We’ve had some GPs come and observe say, “I think we’d really benefit from this!” I don’t think that’s generally taught in the classrooms. I think all can benefit from the empathy model. We can all learn from each other, kumbaya.

Crisis centers appear to be taking on more and more of the work with suicidal clients from clinicians. Do you think that’s the right way to go?

I don’t. The training model I’m aware of in regards to suicide, the Air Force does a really great intervention and prevention program, and Henry Ford has a really cohesive and collaborative approach to suicide, and those networks always include the whole scope around the person, and everyone is included in the plan, and everyone is aware of what’s happening. We don’t know when we’re going to have a crisis. It can come on for whatever reason. Skills would be beneficial to all the people. They should have empathy model training and know how to truly listen to somebody instead of considering what they’re going to say next. Listening to others is really important. If they’re not comfortable with it, they can refer, but it shouldn’t be absolute: “We don’t deal with that, send them to a crisis center.” That’s not convenient or safe for anyone. People don’t want to be pushed off to the next guy. The basic skills can be had in the moment when the person needs it the most. It’s beneficial. And it’s much easier to build into the educational training that clinicians go through, to have on hand when needed. I think it would help them feel more confident in their skills.

How to address the liability question by clinicians?

I am an American Red Cross CPR trainer, and one of those first bits of information we share with people is the Good Samaritan law. If you’re intervening with someone having a heart attack, as long as you’re doing what you’re trained to do, what your skill set is at, you’re covered by the Good Samaritan law. I think that should be applied to somebody in a suicidal crisis. And you know, it is life and death in both cases. Again, the medical vs. the mental health model, the disparities between the two as if they’re different. The mind and body are the same. We have an organ in our head, and it runs down throughout our body. I think Good Samaritan law goes for bodies, and it should go for our brains.

How did you decide to be open about your personal experience?

Dese’Rae Stage and Leah Harris have been very vocal about their experiences. Along with my belief that human connection is really important, and sharing stories can be really valuable to others. I’m also an ASIST trainer. I learned the ASIST model, I went through the training for trainers a couple of years ago, and it reminded me how important our stories are and how important it is to be heard and have a genuine connection. It can be very helpful to share. So I’ve had the benefit of talking with different people over the years, to know how sharing my story has helped them. And hearing other people who’ve been through certain experiences has helped me. #SPSM chatting, seeing people connect on just a basic level. We all have skill sets, training, professional roles, but when you break it down, we’re all trying to live life the best we can. The best way is to be honest with each other.

I’ve definitely been apprehensive over the years. I’ve started blogs, deleted blogs for privacy reasons: “Who would want to read that?” But this past year, I’ve been much more involved. I auditioned for a show called “Listen To Your Mother,” and I shared a story about being a young mom, losing my mom, coming into that role now, and it was really incredible to come on stage and share my story with 400 to 500 people in that room, and it’s out there on YouTube. At least one of my stories is. And I have had encouraging feedback from it. And I’ve had a couple of blogs. I think storytelling is really beautiful and honest.

The big question: What can we really do to change the system?

I think getting the influential people, you know, those who have organizations, starting the conversation there is really important. The information trickles down, the conversation can start in those circles. The heads of organizations, the communications departments, those involved in social media, because social media is a powerful way to connect with people, and a personal way. Smartphones today, everyone has them in their face and accessible. I think starting those genuine conversations, sharing with networks. Sharing resources are so important. People are not always going to pick it up once it’s presented to them, but continue to reach out: “Hey, I’ve been thinking about you!” and explain why this is happening and what has happened so far.

It’s been really great, the network sharing and resource sharing, the movement, broadening the scope to all the people to so they know these things are accessible and OK to talk about. Because we’re social creatures, and we connect to others. And suicidal thinking, we self-isolate. Whether we’re in a room of people or not, we feel completely alone. And often, people don’t realize others have been through this and that it’s OK to talk about. It’s scary to talk about, but others have been through it. If you can’t talk to family or friends because of shame or embarrassment, you can talk to someone who’s been through it. The influential people, the ones with an ear, is a good place to start. Break it down into why this benefits them.

Is there another level we need to move to, to make our case?

I know people love their data and analytics. Unfortunately in the mental health and suicidology field, the funding and researchers are not able to keep current up-to-date stats. Our latest stats, because of the nature of our work, the most recent is 2011. We’re three years behind.

Do you mean nationally or at your center?

Nationally. The stats released this year through AAS were for 2011, and they’re usually two or three years behind. The researcher doing it is incredible, incredibly passionate and thoughtful, but you know, three years behind. We need more funding, we need more buy-in from our government and to have those funds allocated to the proper researching departments. Funding is so critical in this work, yet we are severely lacking.

Is there anything else you’re really passionate about that you want to see changed?

You talked about the difference between crisis centers and clinicians. Last week at #SPSM there was a roundtable, and JD Schramm, who did that awesome TED Talk (below), when he was asked about suicidal ideation and thoughts, he was like, “I’ve never really heard that terminology.” That really speaks to the general public, breaking down language barriers we might have in talking with people not familiar with mental health and really engaging those outside this community. So I think it’s breaking down barriers of language we use and making it understandable to those who aren’t clinicians and are not working directly with other peers and who maybe never sought mental health treatment before. The language we use is really important. One of my biggest soapboxes is how we say what we say matters. Those who are not as familiar with mental health or suicide are important, and it’s important to value what people are bringing to the table.

Who else are you?

I am nicknamed “the mother” on many of my crisis line shifts. I’m an eternal optimist, a mother, a wife, a lover, a friend. I love baby goats and sunshine and traveling and all sorts of things. I am more than one definition. I am 32 flavors and then some.

You cut it out! (To her 4-year-old)