This feature by Vibh Forsythe Cox, PhD is part 2 of 2 in a series on World Mental Health Day, focusing on the goal of suicide prevention. In part 1 (read it here), Vibh talked about a needed shift in our approach to treating clients and the idea of solving the problem of a life that doesn’t feel worth living. This part 2 goes further into the topics of increasing access to effective treatment and empowering the community.
World Mental Health Day, which took place on October 10 was created with the goal of raising awareness, encouraging education, and promoting advocacy against stigma (Learn more here). The focus for 2019 was 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.
Increasing access to effective treatment
As you may have read in this previous blog post from Tony DuBose, PsyD and Yevgeny Botanov, PhD, in order to have any hope of reaching the 136 million people who are at risk of dying by suicide, we need to build the ranks of professionals who are trained to provide effective treatment. In my work with Behavioral Tech Institute, I have been privileged to meet hundreds of treatment providers who are committed to learning as much as they can to improve the treatment of their patients and to helping others learn to do the same. As is often the case with our patients, commitment is not at the heart of the problem. To get more providers who are trained to provide effective treatment, we need to make sure that the settings in which these providers work are aware of what is needed and understand the importance of investing both in their providers and their programs with client outcomes as the ultimate goal.
I have met providers who are working extra hours on top of already long days to make sure that their clients can access treatment. There are people extending themselves to make presentations to administrators, call insurance companies, and translate therapy materials into other languages just to get their clients the prescribed dose of the treatment that does exist. Often, stalwart treatment providers are in settings where they have limited resources (e.g., money, time, money to pay for time) to provide evidence-based treatment up to the standard that would be most effective for their populations. As Dr. Linehan and countless others have done to get support for DBT programs, sometimes intentionally focusing on clients with complex problems or unpredictable behaviors and helping them realize measurable change is the best way to demonstrate the worthiness of the investment in training for providers and revising existing treatment programs.
Treatment providers also need hope. We need hope that there are treatments that can work for our most complex clients, hope that the training to effectively provide these treatments will be accessible, hope that administrations can be convinced to support the needed structure for these treatments, and hope that it will all be worth it in the end. Not only can we increase access to treatment by supporting providers to receive training, but also by helping other providers figure out how to convince their administration to financially and logistically support the treatment. Practitioners of any treatment benefit from consulting with expert practitioners, encouraging peers, and hearing success stories from providers and from clients who received the treatment they needed to prevent them from dying by suicide.
Empowering the community
I believe that the shift toward seeing a crisis of lives not being experienced as worth living is needed not just in the community of mental health treatment professionals, but in our whole population. I have seen many online discussions focused on recognizing signs that a loved one may be considering suicide. I appreciate that the community outside of mental health treatment providers is working to be alert and be informed. My hope is that with a shift in focus toward reducing the problem of lives being experienced as not worth living we will be able to help expand their attention to recognize not just signs of impending suicide, but signs of suffering or dissatisfaction with life. I believe our behavior is different if we are in the practice of being alert to the suffering of others versus being alert only to the specific threat of suicide. I believe that expanding our thinking may save more lives. Providing psychoeducation to the broader population about the scope of mental health treatment, the different types available, and the barriers to access can be an important step in increasing not only the likelihood that people will seek treatment, but the likelihood that they will vote for the needed allocation of resources for mental health treatment.
Awareness and education are important steps toward reducing stigma around treatment . Stigma is one frequently cited barrier to seeking mental health treatment. People are afraid to talk about the experiences that might be causing them the most suffering. When people are afraid to talk about their experiences it limits how much opportunity they get to learn what kind of help might be available. The more loved ones and communities know about treatment options or have had and/or heard of positive encounters with treatment professionals, the better equipped they will be to discuss treatment with family members and friends who may, in turn, benefit from treatment. Many people don’t think to recommend that loved ones seek professional support unless what they are hearing sounds “extreme.” Hopefully, we can empower people to approach signs of suffering or even just dissatisfaction with the recommendation to speak to a professional, the same way they would for seeing a physical health specialist.
An unfortunate complication is that stigma also exists within the community of trained mental health providers. Even the most compassionate providers have prejudices and fear that can get in the way of providing the best treatment possible. The most potent tool against prejudice is exposure to new learning experiences that challenge previously held beliefs. In our quest to reduce stigma I urge that we not only take advantage of – but endeavor to create – opportunities for new learning for mental health providers and the communities they serve.
There is no one behavior or set of behaviors that treatment professionals and loving communities can do that will tip the scales. It will not serve the cause of suicide prevention to oversimplify the problem. We must endeavor to change the mindsets of our clients and their communities, and the policy makers who can increase access to mental health treatment that facilitates early diagnosis and treatment. It is for this reason that increasing mental health awareness is such important work. When we are aware of the need, aware of barriers to treatment, and aware of prospective changes that might increase hope for the 136 million people at risk of dying by suicide we can organize our behaviors toward making the needed changes.
Vibh Forsythe Cox, PhD, serves as the Training and Development specialist for Behavioral Tech Institute (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.
Disclaimer: The Behavioral Tech Institute blog is designed to facilitate the sharing of ideas, experiences, and insights related to Dialectical Behavior Therapy (DBT). The content and views expressed in the articles, comments, and linked resources are those of the individual authors and do not necessarily reflect the views, policies, or positions of Behavioral Tech Institute or staff. Content is provided for information and discussion purposes only and is not intended as professional advice. Contributors to the Behavioral Tech Institute blog are independent, and their participation does not represent an endorsement by Behavioral Tech Institute.