This feature by Vibh Forsythe Cox, PhD is part 1 of 2 in a series on World Mental Health Day, focusing on the goal of suicide prevention.
World Mental Health Day was created with the goal of raising awareness, encouraging education, and promoting advocacy against stigma (Learn more here). The focus this year is suicide prevention. As someone who provides treatment and training which in large part is aimed at reducing suicide and self-harm, I felt moved to participate in this conversation.
A needed shift
With the development of Dialectical Behavior Therapy (DBT) Dr. Marsha Linehan encouraged a shift in the world of mental health treatment and our approach to treating clients who are at high risk of dying by suicide. The shift she proposed was a move away from thinking of suicidal behavior as a problem to be solved, and to think of suicidal behavior as an attempt at a solution. She identified the problem as a life of unimaginable suffering; that is, a life not being experienced as worth living. Dr. Linehan developed DBT to help us as treatment providers encourage people to see a path to creating a different life – one that they can experience as worth living. I would like to highlight that perspective on this World Mental Health day. As a global community, we have been discussing and working to ameliorate a suicide crisis. We may save more lives if we focus on the crisis of people feeling trapped in lives not being experienced as worth living.
Solving the problem of a life that doesn’t feel worth living
There are an estimated 136 million people at risk of dying by suicide if they do not find a way out of their suffering (Botanov & DuBose, 2016). Read here for a recent blog post on a call to action for increasing DBT treatment from Tony DuBose, PsyD and Yevgeny Botanov, PhD.
If we think about chronic health conditions like cancer, the best prognosis requires identifying the problem and administering treatment at the earliest stage possible. The goal being to administer treatment before the cancer cells multiply and are too many to effectively overpower. If we were to approach mental health with the same mindset, the goal would be to assess, diagnose, and treat those who suffer before their suffering becomes so intense or has continued for so long that they become too weary to keep up the fight.
Often the conversation on mental healthcare, particularly regarding suicide prevention, is focused on triage. That is, discussion and resources often focus on people who have already had a suicide attempt or are harming themselves or others. The consequences of the current crisis – that lives are not being experienced as worth living – are too grave for focus this narrow.
While it is important to make sure that there is adequate care for individuals who are currently suicidal and self-harming, it is equally important to think about how people get to that position. Often limited access to healthcare, stigma, and self- invalidation create barriers to treatment for concerns including, but not limited to, depression, anxiety disorders, posttraumatic stress disorder, eating disorders, substance use disorders, and obsessive compulsive disorder . A variety of untreated or inadequately treated diagnoses can lead people to search for relief through self-harm or suicide.
I am a behaviorist by training. I often think about the learning experience of those who are hopeless and suffering. To me, instead of a race against the clock, I conceptualize the fight to help save those at risk of dying by suicide as a race against repeated failures to change their lives.
By this I mean that every step that people take toward building a life experienced as worth living is an opportunity for one of two main learning experiences. For example: Taking steps toward treatment helped or taking steps toward treatment did not help. If someone were to make the already difficult step to seek professional intervention, a limited number of trained providers in their area, long waitlists, or financial limitations may result in the learning experience that trying to get treatment doesn’t work. Even worse, they may learn that making the effort just leads to more disappointment.
It is for this reason that we need to work together to make sure that when people reach out, they aren’t just grasping at straws, that we as the community of treatment professionals can give them something useful to grasp.
Click here for Part 2 of this blog, in which Vibh Forsythe Cox elaborates on increasing access to effective treatment and empowering the community.
Vibh Forsythe Cox, PhD, serves as the Training and Development specialist for Behavioral Tech, LLC (BTECH), the training organization founded by treatment developer, Dr. Marsha Linehan. She serves on the team that creates content for BTECH’s training offerings, including the newly released Online Comprehensive Training in DBT. She provides consultation to newly forming DBT teams within the online learning platform. She works as a therapist at Cadence Child and Adolescent therapy, a DBT-Linehan Board certified DBT program in Kirkland, Washington. There, she provides DBT and other evidence-based treatments for teens and adults with emotion regulation difficulties. Dr. Forsythe Cox earned her PhD in Clinical Psychology at The Ohio State University, where her research focused on characteristics of Borderline Personality Disorder and interpersonal emotion regulation. During her time at The Ohio State University, Dr. Forsythe Cox participated in specialized training in DBT, and assisted the Director of the DBT program by providing supervision and consultation to new trainees. She was also the 2012 recipient of the Psychology Department’s Meritorious Teaching Award. Dr. Forsythe Cox has experience providing DBT in a variety of settings, including university-based research, inpatient and outpatient hospitals, forensics, and private practice facilities. She is a Clinical Instructor in the Department of Psychology at the University of Washington, where she provides individual and group supervision to doctoral psychology students in the Behavioral Research and Therapy Clinics (BRTC). Dr. Forsythe Cox has also been an invited speaker at high schools, community colleges, and the University of Washington. Dr. Forsythe Cox is licensed as a Psychologist in the state of Washington.
- Botanov, Y. & DuBose, A.P.(2016). Dialectical behavior therapy: Examination of its evolution and global need.Hellenic Journal of Cognitive Behavioral Research and Therapy. 2(1), 5-10.