Increasing Suicide Prevention Awareness and Access to Mental Healthcare in Veterinary Medicine with Dr. Marie Holowaychuk PART 2

TRIGGER WARNING- This episode contains references to and information about suicide which may be upsetting to some people. The purpose of the episode is to educate and bring awareness to the stigma around mental illness and provide resources but if you are not in a position to handle this discussion, please skip this episode.

If you are concerned about a friend or colleague, or if you are having thoughts of self-harm or suicide, please call the USA National Suicide Prevention Lifeline (1-800-273-8255), Canada Suicide Prevention Service (1-833-456-4566), or just dial 911.

You may also Text HOME to 741-741 to reach a volunteer Crisis Counselor. The crisis text line is also available via Whatsapp and FB messenger.

Find out more about suicide at SAVE.org
"If you are thinking about suicide, please utilize all resources available to you. Suicide Awareness Voices of Education (SAVE) has a website that is a helpful place to start. Aside from calling a crisis line, removing access to lethal means and talking to a loved one or someone else that you trust, SAVE recommends creating a safety plan. Having a safety plan in place during a time of emotional vulnerability or in crisis is one way to help manage your thoughts and feelings and a quick way to refer yourself to help. Use the link below for a safety plan template. Share your safety plan with your doctor(s), family, friends, or anyone else in your support network. Here is a template you can use."

FREE QPR training

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Today I am again joined by Dr. Marie Holowaychuk to continue our conversation regarding suicide awareness and prevention in veterinary medicine. We cover topics ranging from how to recognize someone who might be at risk of suicide to ways you can educate yourself about how to help someone in the midst of a crisis. We also touch on the correct and safe ways to discuss the matter of suicide with your team and friends.

Bio!
Dr. Marie Holowaychuk is a board-certified small animal emergency and critical care specialist and passionate advocate for veterinary team wellbeing. She lives in Calgary and travels worldwide as a speaker, consultant, and locum. Marie has spent more than 15 years practicing emergency and critical care medicine in academic and private referral hospital settings.  Outside of veterinary practice, Marie facilitates wellness workshops and retreats for veterinary clinics or organizations and offers individual or group wellbeing sessions for veterinary team members.  Recently Marie launched her own podcast Reviving Vet Med and has a YouTube channel that features monthly Wellness Wednesday videos.    When she is not working, Marie enjoys listening to podcasts, reading, hiking,  as well as spending time with her family and friends.

For more information, please visit

Transcript

Stacey Cordivano: 0:07

Hey there, it's Dr. Stacey Cordivano. I want veterinarians to learn to be happier, healthier, wealthier and more grateful for the life that we've created. On this podcast, I will speak with outside of the box thinkers to hear new ideas on ways to improve our day to day life. Welcome to The Whole Veterinarian. Hi, everyone, I just want to start out this episode with the trigger warning. This episode contains reference to an information about suicide which may be upsetting to some people. The purpose of this episode is to educate and bring awareness to the stigma around mental illness and to provide resources to enhance a person's knowledge of risk factors and warning signs in order to help prevent suicide. If you're not in a position to handle this discussion, please go ahead and skip this episode. If you are concerned about a friend or colleague or if you yourself are having thoughts of self harm or suicide, please call the USA National Suicide Prevention Lifeline at 1-800-273-8255, the Canada suicide prevention service at 1-833-456-4566 or just dial 911. You may also text HOME to 741-741 to reach a volunteer crisis counselor. The Crisis Text Line is also available via WhatsApp and Facebook Messenger. I want to let you know that there are several online suicide intervention programs that will be mentioned. If you want to investigate them further. They are the free QPR training from the AVMA, the Ask training from vet folio, and the applied suicide intervention skills training from living works. These are great places to start if you want to dig in further, and I'll include links to these programs in the show notes. So this is part two of my discussion with Dr. Marie Holowaychuck. If you haven't listened to part one yet, you might want to go back and do that, as we cover some facts about the stigma around mental illness specifically in the veterinary medical world and how it affects access to mental health care. We also emphasize the role of leadership and encouraging an open discussion around mental wellness in our workplaces. And now in the second part, Marie and I will get into more specific recommendations such as QPR training and how to recognize if someone might be contemplating suicide. We hope to provide tactical strategies to help increase suicide prevention awareness, because that is possible. Also, I just want to clarify in case we don't officially define it, QPR training, which is also known as gatekeeper training, teaches people without professional mental health backgrounds to recognize the signs that someone might be considering suicide, to establish a dialogue and to guide the person to seek professional help. Now, you probably heard her bio last time, so I'll shorten it up a bit, but I am again honored to be joined by Dr. Marie Holowaychuck for the second of this two part episode. Marie is a board certified small animal emergency and Critical Care Specialist and is a passionate advocate for veterinary team well being. She lives in Calgary and travels worldwide as a speaker, consultant, and locum. She has authored dozens of articles and recorded a multitude of podcast interviews related to personal and professional well being. And she recently launched her own podcast called Reviving Vet Med. When Marie is not working, she enjoys spending time with her toddler, practicing yoga, hiking in the Rocky Mountains and listening to podcasts. For more information on Marie, please see the show notes where I'll link all of her contact info. For now let's get into the second part of my discussion with Dr. Marie Holowaychuck. That's actually a good segue. I want to talk about QPR training and things like helping people to recognize symptoms of mental illness or you know, even signs of risk of suicide.

Marie Holowaychuk: 4:06

Yeah, it's a really important topic. And I'm glad that you brought it up. I think it's as much as we do talk about suicide in the profession, I don't think we talk about prevention enough. And so, you know, there definitely are signs that we can watch for in ourselves and in other individuals. And there are certainly risk factors, you know, that can come into play. And this is where doing my mental health first aid training and QPR training were so important because they really cover these things in thoughtful detail. But certainly, you know, I think we can start with risk factors. I think that definitely anyone with a mental illness, especially depression, mood disorders, those do tend to put a person at much higher risk of suicide. I think the statistic is that 90% of individuals who die by suicide have mental illness and or substance use disorder, so that's huge. And it's really important to know that and to recognize mental illness impacts between one and four and one and five of adults. So if you think about the people that you work with, you are bound to be working with someone, if not yourself, who has mental illness, so just recognize that that's a risk factor. And then you know, what suicide is such a complex and multifaceted outcome from a whole myriad of different factors that can contribute. So when we think of other risk factors, we think of life circumstances, difficult or challenging, you know, whether it be financial circumstances, breakdown of a relationship loss, grief, loss of a job, diagnosis of a with a chronic health condition, or a terminal health condition, lots of different situations that can play into that. And, you know, I think the best analogy I heard was from a social worker, friend of mine, who said, you know, individuals who are, you know, living with mental illness, and at risk of suicide, you know, there are multiple things, you just imagine that they're kind of hanging on to the bottom rung of a ladder, you know, they're dangling in the error. And all of these different factors, just weigh them down bit by bit by bit by bit, until they can't hang on any longer. So to say that it's one thing, you know, I think, very often, and it pains me, in the veterinary industry that we will often say, you know, it was our clients that that pushed us over the edge, or, you know, this one situation at work, that was just awful. And I think it's a real disservice to individuals who live with mental illness and who have suicidal ideation or thoughts of suicide, to chalk it up to one thing, it really belittles the difficulty of what they're experiencing on a regular basis, and just how complex suicide is. And so I'd like us to recognize and change the narrative, and that it's a very devastating outcome to a complex situation that can't be put on one thing that said, recognizing the risk factors is important. And then of course, recognizing potential signs. So, you know, people will often have some change of behavior that is notable, whether they suddenly stopped caring for themselves, they show up to work, they're not showered, they're not taking care of their hygiene, they're suddenly talking a lot about feeling hopeless, or helpless or desperate, or, you know, very big indications of potential for suicide. Certainly individuals who speak of suicide have to be taken very, very seriously, anybody who mentions harming themselves, or what would it be like if I died, or maybe I don't need to be here anymore, you can definitely have suicidal thoughts or thoughts of suicide, without actually making a plan and moving forward with suicide. But it is very important that that those situations are taken seriously and that we open up conversation about it, because we just don't know where a person is on that spectrum of thinking of suicide and actually going through with it. And we know that thoughts of suicide are very common amongst veterinary professionals. There's some studies that indicate about one in six veterinarians has had thoughts of suicide. And I think it's important to say that not all those individuals will die by suicide, many of us have thoughts about, what would it be like if I wasn't here? What would it be like if I ended my life or whatever, but certainly taking it forward, and thinking about how you might do it? Or how you would look after things in preparation for doing it. Those are very serious indicators. So if somebody comes to work, and they're, you know, hey, if anything happens to me, could you look after my dog, or, you know, I want you to have all this stuff, you know, it's really important to me that you, you know, have these things. Those can be very serious indicators as well.

Stacey Cordivano: 9:04

And I want you to talk about QPR training what it is, but I also just in relation to that, I want you to address because this really stood out to me in the QPR training that in a situation like that, it is okay to address that with like a very direct question about plans or thoughts about that.

Marie Holowaychuk: 9:22

Absolutely. And this is the biggest reason for why they developed QPR training was not just to recognize the signs and the risk factors, but to actually open up a conversation because they know that opening up conversation and identifying people who truly are having a plan and and wanting to go through with it allows them to be able to get the help that they need to stop them from ending their life before they do. So you're absolutely right. The question needs to be very direct. And the question is essentially, Are you yhinking of hurting yourself? Are you thinking of killing yourself? Are you thinking of ending your life? I mean, there's different ways that you can phrase it. People want to phrase it in a way that will make sense to the other person or speak to the language of the other person based on maybe what they've said, or what they've shared, or what feels comfortable to them. And you may need to repeat it in different ways. You know, I just heard you say, you know, that maybe you don't want to be here anymore. Are you thinking of hurting yourself? Or, you know, ending your life? Or are you thinking of suicide can even be the question, you know, you can use the term suicide, asking the question, as difficult as it is. And as uncomfortable as it is, it can be for the person asking it can be life saving for the person on the receiving end. And I think so often, when we think about it's like I could couldn't possibly ask someone, something like that, like, that just makes me just feel so uncomfortable, or so it's so intrusive. Or what if they're not thinking that at all, and now I've just said this, and now I've made them uncomfortable, I can guarantee you that no individual being on the receiving end of that is going to be angry, or uncomfortable by your question. In fact, they are more likely. And we know this based on research, to feel relief, to feel seen, to feel heard, to feel cared about. I can remember the first time that I asked someone, if they were thinking of suicide, it was actually a friend of mine who I don't see very often she lives in a different city, I happened to be flying through that city, and was on a layover. And she had just gone through a really bad breakup. She lives with mental illness, we had connected on the phone and I said, Hey, I'm going to be you know, few are really over come come to the airport, and let's have coffee. And I saw her and she just looked so disheveled and not like her typical self. She was so down. And at one point in our conversation, she said to me, I just don't think I can do this anymore. And I just even repeating it. Now I get goosebumps, I just I said to her, like I have to ask you like, Are you thinking of hurting yourself? And she was like, no, no, she's like, I'm not there. But I appreciate you asking. She said I'm just really struggling to see my way through this. And then we talked through, you know, like, what, what she's doing, who she's connecting with, how she getting help, and that sort of thing. So again, people can have these thoughts and not be in a place where they are intending to follow through. And it can bring great relief to them to know that you know what, that you are comfortable enough to talk about this, that if they did get to the point where they were having those thoughts, or that they really didn't feel like they could cope anymore, that maybe they can even come to you. Most people don't say anything, because of all this shame and the stigma around suicide. I mean, think about how we talk about suicide. I cringe every time it's on media or the news, you know, so and so committed suicide. Well, great. Now we're talking about it as if it's a crime and they've done something wrong. And now people who are contemplating that aren't going to feel comfortable to share. It's tough.

Stacey Cordivano: 13:12

It is. And there is a situation I'm thinking of where I should have asked that direct question. And I didn't. And it's even hard thinking back to think of asking that in the moment. But I will say that the research to support the fact that that is the right thing to do is super helpful. So I think if people are listening and you know, have any interest in learning more, then the QPR training is so helpful. And you know, we had to practice saying that in the QPR training, and it was hard in practice, like it is hard, but it's really comforting to know that, you know, the research shows that that is what you are supposed to be doing. You mentioned, you know, not saying committed suicide, like as akin to committing a crime, are there other phrases or, you know, correct language that we should be using when we talk about suicide?

Marie Holowaychuk: 14:02

Yeah, so we would rather refer to a person as dying by suicide, or they died by suicide, suicide can be used as a verb, so you can you can indicate that a person suicided to me, it feels a bit awkward. So I just do tend to say they died by suicide, we typically to try to stay away from a successful or unsuccessful suicide. I'm not even sure in what speak we would, it's just not appropriate to really turn it that way. So a person had a suicide attempt is the way that we would speak about that they lived through a suicide attempt to what however you want to phrase that but that we're avoiding that terminology that can be very stigmatizing.

Stacey Cordivano: 14:46

Also, something that stood out to me which because I might have phrased it this way, potentially was, you're not actually thinking of committing suicide, right? Like that's not the appropriate way to ask that that it needs to be an empathetic statement not a judgmental statement.

Marie Holowaychuk: 15:03

really important. Yeah. Thank you for sharing that. I forgot I had forgotten about that. But you're absolutely right that. I mean, can you imagine if somebody was on the receiving end of that they're not going to feel comfortable to say no, actually, I am, you know, they're gonna they feel belittled like, oh, no, no, I wasn't thinking about that. And then deep down, they're like, Oh, great. Like, gosh, I am definitely not going to bring that up now.

Stacey Cordivano: 15:26

Right. Right, right. Oh, I wanted to ask about suicide contagion, because I know that's potentially misunderstood. And is that a real thing, especially as things circulate around veterinary medicine so quickly?

Marie Holowaychuk: 15:41

I'm really glad you brought that up. suicide contagion is definitely a real thing. It's supported by research. And it is a reason why mass media outlets like cable news and radio news. It's why they have very specific rules and regulations about how they can or can't talk about suicide, especially among adolescents. So you'll notice that there is very little coverage of adolescent suicide in the mainstream media. And it's because there's a lot of research and a lot of first hand experience, certainly, here in Canada, when we think about our indigenous communities where there are clusters of suicides. And we know that youth are very impressionable. And unfortunately, with suicide, it's not a contagious thing, like somebody catches a virus, but it can be perceived as more tangible and more doable, unfortunately, when people aren't directly exposed to it. So that is another risk factor for suicide is exposure to an individual who has died by suicide, or directly being impacted by that. And so this is something I think that we've really, I don't want to say taken for granted. That's not the right word. But we've really overlooked this in the veterinary industry. And this is where my aversion to social media campaigns and other things to spread awareness about suicide, I think can be very damaging. I think you and I both probably remember in the people listening, not too long ago, within the last year, there was a cluster of suicides in the veterinary industry, and they happened very close together. And there was a big media campaign around awareness about the suicides and you know, indication that perhaps clients were to blame. And could clients be nicer it was it was really, you know, toted as a let's be nicer to veterinarians campaign, because they're dying, trying to help patients. And because it was on social media, there was no regulation of it, there was no rule that there had to be health resources attached to this messaging that was being perpetuated. And so when you think about messages like this, if you're an individual who is living with mental illness, and you have suicidal thoughts, or are contemplating suicide, and you are exposed to this messaging, just hearing about suicide, and seeing others in the industry, who are dying by suicide can be a trigger, having stories attached to these individuals where everything in their life was perfect. And then this one thing happened. And they ended their life and we just can't understand it. And their life was so great. And it is very disempowering to these individuals who are struggling, because to them, they're looking at that and thinking, Oh, my gosh, if their life was so perfect, and they died by suicide, and I'm having these horrible thoughts every day, how can I possibly get through this, rather than really sharing the full story that is this person was living with substance use disorder, or depression, or they had had previous suicide attempts that they lived through or whatever it might be, again, the circumstances we there never is one thing that can explain it. But when we attempt to explain it in one way or another, it's not helpful. And so it is really my preference to share resources for help to empower people to have conversation to encourage people to take Mental Health First Aid training, or QPR training or other assisted suicide intervention skills training, and to really be careful about the messaging that we're sharing. Because we know based on research, that we can have geographical clusters of suicide, we can have demographic clusters of suicide, and we can have temporal clusters of suicide when we are sharing it in a way or when people are exposed to it in ways that are not healthy and without proper support.

Stacey Cordivano: 19:48

Yeah, thanks for Thanks for clarifying. Yeah, I think that's super helpful. So I guess maybe to wrap up, if someone encounters or if you feel like yourself are in the middle have an actual crisis, give us some tips.

Marie Holowaychuk: 20:04

Anybody who's in a crisis, someone says, you know, I am, I am thinking of killing myself or I plan to XYZ, whatever it might be, that is a crisis, that person needs immediate help, you can call 911, you can call your local crisis center, you can call the toll free suicide lifelines that are available, but that individual needs help right away. So that is a person where either by phone, they need to be connected with someone, or they need to go in and see someone, whether it be in the ER, or their physician, or their psychologist or therapist or psychiatrist or whomever is helping them. But they need to be directly connected to an individual who is able to provide them with immediate emergent mental health support. So that would be for an individual who identifies that they are immediately at risk. For an individual who is thinking of suicide, you know, they're having thoughts of suicide, they're feeling hopeless, or helpless, but they don't have a plan. They don't intend to go forward with that, but they are in a place of struggle. And these are thoughts that they have been having, then that is an individual that should be connected with help as well, in terms of mental health, a mental health provider, but it doesn't necessarily have to be a crisis intervention in terms of calling 911 Or taking them immediately to the ER, I would say, if you're not sure, if you're like, Ah, I don't think I can discern really, you know, what the seriousness is, or, you know, what, if I wasn't sure, always err on the side of caution, you will always be directed to the appropriate resource by the crisis person that you're speaking to, for most of those individuals, they can be helped by speaking with a mental health professional, but not necessarily needing, you know, immediate, life saving intervention, so to speak. So for me, those are, I think the two, you know, situations where help would be most imminently needed. And there's, of course, the different ways that that can be provided.

Stacey Cordivano: 22:11

Thank you. I appreciate that. So I'm so thankful that you spent all this time with us going through this, it's, I think, very beneficial. And even if one person learned something, I'm super happy about that. Where can people find out more information about you and all the work that you're putting out into the world?

Marie Holowaychuk: 22:30

Oh, thanks for asking, Stacey. So I have a website. It's MarieHolowaychuck.com. And on the website, I have my blog posts that I release every month, I have podcasts that I record as well that are basically the audio file of my Wellness Wednesday videos, you can find those on YouTube, Reviving Vet Med is my podcast that people can subscribe to as well. So lots of resources. I'm on all the major social media channels as well. So I am always happy for people to connect with me whether it's just to share something that resonated with them or to ask me a question or to check out some of my online programs share my resources I'm just I'm I feel like I'm just a vessel for sharing information.

Stacey Cordivano: 23:18

Yeah, your newsletters are Great. I'm I'm big on helpful newsletters.

Marie Holowaychuk: 23:23

That's great. That means a lot. Well, if people want to, they can subscribe to my newsletter on my website. So it's a great way to kind of keep that well being content coming as just a constant reminder of you know, what we need to do to look after ourselves to really keep going in this in this profession.

Stacey Cordivano: 23:39

I'll make sure to link all those in the show notes. And then I ask all my guests, what is one small thing that has brought you joy this past week?

Marie Holowaychuk: 23:46

Yeah. Oh, such a great question. Gratitude is enjoy is such an important emotions. It was amazing. Actually, I was just thinking of this, like intentionally and I do really try to be intentional about this, but my daughter has been teething you know, she's 17 months old and getting her teeth. It's been horrible. And last week, I know the two of us between the two of us we collectively slept horribly. And this past Sunday was just the switch back to standard time so we had that extra hour of sleep and I was like oh my god she's gonna be up at like five o'clock in the morning it's gonna be terrible. She let me sleep in well, quote unquote, sleep in till seven o'clock, the new seven o'clock time. So what would have been eight o'clock and that was just like unheard of. I felt like a million bucks. Stacey. I came downstairs. I was like, I feel great. I was hugging her. I was like, thank you so much for letting me sleep in. That I know. is small, but that was a moment of pure joy.

Stacey Cordivano: 24:50

That's amazing.

Marie Holowaychuk: 24:53

We had just such a great day. We went on walks and we both felt great. So yeah, sleep

Stacey Cordivano: 25:00

Well thank you again for your time and all the insight. I really appreciate it.

Marie Holowaychuk: 25:05

You're so welcome my pleasure.

Stacey Cordivano: 25:09

I cannot thank Dr. Marie Holowaychuck enough for sharing her knowledge and experience with us. She was so generous in these past two episodes, and I really got a better handle on some of the aspects of mental illness within our profession. Thanks to her clear and thoughtful discussion, I hope you were able to take away something new as well. This topic is not an easy one, but I do find hope in the resources and education that we can arm ourselves withn in order to help our colleagues and friends. Please dig into the references that I've added to the show notes and I will also be adding a whole section of these to the website as well in the near future. You will also find all of Marie's contact information in the show notes so please get in touch with her to check out her well being courses or other speaking opportunities. She is an absolute joy and I am so thankful to have connected with This marks the end of season three, I can't believe it. As her. always, I'm so appreciative of you spending your time with me. If you want to make sure to never miss an episode. Please subscribe or follow wherever you listen to podcasts and check me out on Instagram@thewholeveterinarian. While Marie's newsletter is much more informative than mine, you can also sign up for my monthly newsletter to make sure you never miss an episode by going to thewholeveterinarian.com/subscribe. There will be a brief inter- season break but I wish you a joyful holiday season. Please try to find the small moments of joy in the midst of all the chaos. Thanks again and I will talk to you again soon.