November 18, 2015
By Simon Delisle and Audrey Fraizer
Matter of life or death
Suicidal caller most often has plan in motion
As a professional EMD, Simon Delisle believes he made the right choice for a career. After all, he is a person who likes to help others, and in the communication center he can do just that without ever asking about payment.
“It’s ideal,” he said. “We are the first line of help.”
So, what happens when a dispatcher can’t help because the person calling has no intention to follow the advice given? Rather than a call to seek assistance, the caller has imminent plans of ending his or her own life and admits the intention independently or it’s discovered through the calltaker’s questions.
“It’s more often the MPDS helping us to figure out what’s going on, and, at this point, we can try to establish a personal connection,” he said. “It can help, but don’t expect miracles.”
Statistically (see sidebar on page 29), chances are high that a 911 calltaker will answer a call placed by a suicidal individual. Delisle goes one step further in his assessment, particularly for people in the 911 business for the long haul.
“It’s not a matter of if you’re going to get a call from someone suicidal,” Delisle said. “It’s more a matter of when.”
Delisle has answered calls from individuals threatening suicide—more of a call for help—and from individuals who have made the decision and are calling 911 immediately preceding taking their lives to save their loved ones the pain of finding the remains. The former made up the greater percentage of calls during volunteer work with a suicide prevention line; the latter is more likely for 911.
“The 911 caller is often at the edge of the act,” he said. “For someone that close, stalling until help arrives is your best bet. Stay on the line.”
How do you stall an individual on the critical threshold?
“Get the person to talk to draw attention somewhere else while help is on its way,” he said.
He also suggested paying close attention to the caller’s tone of voice and the language used—“I’m thinking of ending it all” versus “I’m going to kill myself.”
Staying on the line can be crucial.
“Sometimes even talking can give the person relief,” Delisle said.
Jim Marshall, Chair, 911 Wellness Foundation, emphasizes engagement, and it can begin with something as simple as asking the caller’s name and addressing the caller by name throughout the call.
“Appeal to that person’s will to live,” he said.
Delisle’s career in emergency dispatch was interrupted briefly with a job at a suicide hotline after completing a degree in psychology and psychoeducation.
“It’s kind of a hybrid between counselor and social work,” he said.
During his tenure at the hotline, he noticed the similarity between the two professions. They both correspond to assisting people in crisis and, consequently, they both appealed to the altruism he looks for in a job. He returned to dispatch, a profession requiring his compassion and ability to coordinate the complexity of response.
“I came back to the headsets,” he said.
The time away, combined with his degree and experience, taught him a valuable lesson. People in the dispatch position can better negotiate with the distraught/suicidal caller when understanding the suicidal planning steps.
“Awareness creates empathy,” he said. “You can better put yourself in the caller’s situation.”
Step 1: Distress. An obstacle that requires a solution confronts the individual; this could include finances, personal relationships, or job loss.
Step 2: Flashes. No solution seems to work and the individual feels let down, frustrated, or depressed and wants a way out.
“The person’s not really thinking about dying,” Delisle said. “It’s more about pressing the restart button and making the obstacle go away.”
Step 3: Ideation. Suicide becomes a possible solution, and the individual considers scenarios of how it could be done.
“At this point, the person might recognize his thinking has gone too far and call a suicide hotline,” Delisle said. “The thinking is telling the person he needs help.”
Step 4: Rumination. Suicide becomes the focus, the definitive way to make the problems go away.
“The person begins to make plans,” Delisle said.
Step 5: Crystallization. The decision is made; suicide is the only viable option.
“Planning can include how and who will find him,” Delisle said. “He might call 911 to alert others [than his family or friends] where he can be found.”
Step 6: Acting out. The person carries through with plans.
Of course, nothing is 100 percent predictable, Delisle said.
“Any person can go from one step to another, skip steps, or go back steps,” he said. “That’s why it’s important to explain the steps people thinking about suicide go through.”
Don’t take blame
Recognizing the steps, however, is certainly no guarantee that the result will work to the advantage of a caring individual. Admittedly, every 911 call presents the possibility of serious injury or death, and suicide is certainly not an exception. It’s similar to any situation, Delisle said: “We can’t blame ourselves.”
The trauma of a caller threatening to and actually ending his or her life takes an emotional toll on the dispatcher on the line. Delisle took an immediate break from the phones the time his caller committed suicide while he was still on the line.
“I talked to two colleagues that I knew wouldn’t judge the way I was feeling,” he said. “I thought the next would be too difficult after what happened, but I went back to the floor anyway.”
Ultimately, the dispatcher has to decide what to do next. At some point, he said, the dispatcher has to seek relief and that can be achieved through talking to someone, exploring spiritual beliefs, and understanding the limits of intervention.
“Accept we are not superhuman,” Delisle said. “We are human. We did all we could do.”
“We never want to default to the position that there’s nothing that can be done,” he said. “But we are not God.”
Mental health influences suicide rate
Majority committing suicide have mental illness
Between 80 and 90 percent of people who commit suicide have mental illness, and the primary mental health disorders associated with higher risk of suicide are depressive disorder, bipolar disorder, schizophrenia, and anxiety disorders (post-traumatic stress disorder (PTSD), panic attacks, and phobias).1
According to the World Health Organization (WHO), globally, more than 350 million people of all ages suffer from depression.2 Not counting the effect of secondary disease states associated with depression (e.g., diabetes and cardiovascular disease), by the year 2020, unipolar depression is projected to be the second-leading cause of disability worldwide and the leading cause of disability in high-income nations.3
People living with a bipolar mood disorder are at risk during the depressive and manic phases. During a severe depressive episode, it is unlikely that the individual can continue with social, work, or domestic activities, except to a limited extent; manic episodes involve elevated or irritable mood, over-activity, inflated self-esteem, and a decreased need for sleep.4
Between 30 and 70 percent of suicide victims suffer from major depression or bipolar disorder.5
The numbers, however, do not fully reflect the prevalence of mental health disorders. For example, two-thirds of people in the world with depression do not realize that they have a treatable illness and do not seek treatment. Only 50 percent of people diagnosed with major depression receive any kind of treatment, and only 20 percent receive treatment consistent with current practice guidelines of the American Psychiatric Association (APA).6
Up to 40 percent of the mortality rate can be attributed to suicide; the estimated lifetime suicide risk is 4.9 percent for people with schizophrenia.7
These types of disorders are caused by a combination of factors, including changes in the brain and environmental stress. While credible, international statistics are difficult to come by. An estimated 40 million adults in the U.S., or 18 percent, have an anxiety disorder. Most people develop symptoms of anxiety disorders before age 21. Women are 60 percent more likely to be diagnosed with an anxiety disorder than men.8
So, when a caller admits to a mental health issue, please remember that this person is more at risk, needs more empathy, and would benefit greatly from staying on the line with you.
1“Frequently Asked Questions.” American Foundation for Suicide Prevention. https://www.afsp.org/understanding-suicide/frequently-asked-questions (accessed Aug. 12, 2015).
2“Depression.” World Health Organization. 2012; October. http://www.who.int/mediacentre/factsheets/fs369/en/ (accessed Aug. 12, 2015).
3Andrew LB. “Depression and Suicide.” Medscape. (2014; August 5). http://emedicine.medscape.com/article/805459-overview (accessed Aug. 10, 2015).
4See note 2.
5“Suicide.” Mental Health America. http://www.mentalhealthamerica.net/suicide (accessed Aug. 10, 2015).
6American Psychiatric Association. “Practice Guideline for the Treatment of Patients with Major Depressive Disorder (3rd edition).”
7Hor K, Taylor M. “Suicide and schizophrenia: a systematic review of rates and risk factors.” Journal of Psychopharmacology. 2010; Nov. 24. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951591/ (accessed Aug. 12, 2015).
8“Anxiety Disorders.” National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/Anxiety-Disorde... (accessed Aug. 12, 2015).
To thyself be true
Suicide calls convince dispatcher to put dream job on hold
The black armband Ryan Dedmon wears around his upper right arm is a reminder of the profession and people he holds dearly but chose to leave—at least temporarily—for his own well-being.
Dedmon is a former dispatcher for the Anaheim Police Department (APD), Calif. In mid-November 2013, he emptied the contents of his locker and walked away after 11 years in a law enforcement career he adored.
Dedmon did not want to transfer to another position within the department and he did not want to go out on disability.
“I did not think I would be able to walk around the department with my head held high with people knowing I was transferred to another position because I was incapable of fulfilling my duties in dispatch anymore,” Dedmon posted in a segment of his four-part series detailing his career and decision on the blog Operation 10-8.
He was also determined to confront the demons—acute stress disorder and post-traumatic stress disorder (PTSD) directly related to his job—forcing his hand.
And in the past two years, he has done just that. He keeps busy but in a healthier sort of way than the workaholic habits he used to deflect his emotional imbalance while in dispatch.
Dedmon’s blog (operationt8.com) honors first responders and addresses PTSD through his personal narrative. He’s an adjunct instructor for the Criminal Justice Training Center at Golden West College in Huntington Beach, Calif. He is a volunteer for the Orange County Sheriff’s Advisory Council’s Project 999, which provides financial assistance to families of officers killed in the line of duty, and the 911 Wellness Foundation, established in 2011 by Clinical Psychologist Jim Marshall.
“Jim was a game changer for 911,” Dedmon said. “Dispatch was overlooked. We were neglected. Whether or not it was intentional, I don’t know. It’s just the way things played out.”
Although several PTSD relief organizations existed within EMS, the first link in response was not given the benefit of acknowledging stress; Marshall recognized that something needed to be done. The foundation that grew out of his concerns is devoted to the psychological and physical health of dispatchers. The nonprofit organization, governed by a board of mental health experts and career emergency communication representatives, conducts research, sponsors national forums and workshops, and—vital to Dedmon’s journey to wellness—it provides a platform for discussion and support.
As Marshall explained, the 911 Wellness Foundation is not a service organization; it was created to fill a niche that few recognized needed filling prior to his work.
“We are devoted to the wellness of telecommunicators, 24/7,” he said. “By pushing the topic, the foundation has helped bring it to the forefront.”
Dedmon is a subject matter expert for the foundation’s board, and he is a compassionate voice and face in the dispatch community.
People follow his advice: “Take care of thyself” because, “If you don’t, you’re going to reach the point where you can’t help anyone else.”
In other words, “Find your happy place,” those things you liked to do before the job ate away your life, he said. Dedmon likes to search out friendships that do not require hyper vigilance, or the assumption that he is there to save their world. He distance runs. He shares his story and has been shocked by the response.
“It’s overwhelmingly positive,” he said. “The audience relates. They thank me for being the voice, and by reading my blog or listening to me speak they can better cope knowing they’re not alone.”
Destined for the job
Dedmon was destined for public service, favoring the TV shows “Law & Order” and “Matlock” in his youth and anticipating the day he would exchange his civilian clothes for a police uniform. During his last semester in a criminal justice degree program at Biola University (California), he accepted an internship in the gang division of the APD. He met his career mentor, Officer Kathy Johnson, Background Investigator in the Personnel Division.
The police job he eventually landed at a neighboring department did not satisfy his true ambition. He wanted to be involved from the start and be part of a team that got an adrenaline kick from helping to apprehend the bad guys, getting response to the scene, and trying to keep the scene safe for police officers and bystanders. He quit the force and returned to the APD, this time in the communication center.
“I loved dispatch,” he said.
A fringe benefit he hadn’t anticipated was working alongside Johnson; the officer had transferred to dispatch when cancer and the debilitating treatment she received forced her into a less physically demanding duty. They worked well together.
“She treated me like a colleague at her peer level instead of as a mentor,” Dedmon said.
Life was good until four months into the job when he received “one of the worst phone calls imaginable.” Johnson was dead. She had committed suicide at home, leaving a note on the door giving special notification instructions for the police arriving on scene. She could no longer tolerate the illness and its effects.
“I found myself swimming in a wide range of emotions, doing my best just to stay afloat, like a dog paddling in the open ocean,” Dedmon wrote on his blog. “Her death deeply troubled me.”
He turned to what he calls “occupational therapy.”
“I did what I do best: work, work, work,” Dedmon said.
Dedmon worked so hard that in 2012 he was selected Telecommunicator of the Year for Southern California.
Overtime, volunteer commitments, and holidays skipped to cover open shifts kept his emotions at bay. He took the shootings, stabbings, rapes, robberies, assaults, and other violence in stride. But nothing prepared him for the call he answered on a Saturday afternoon in spring 2013.
“I need the Anaheim Police Department,” the caller said.
“This is the Anaheim Police Department. Where are you?”
“I’m at a business at 1234 N. Kraemer Pl. in Anaheim.”
“What is your emergency?”
“I am really sorry I had to call you and involve you in this. I have a handgun, and I am going to shoot myself. I will be dead by the time police get here. You will find me outside in the rear parking lot. There is a note I have written in my back pocket. The note has contact information for my family. I am so sorry. Goodbye.”
The caller was dead from a self-inflicted gunshot wound by the time police were able to reach the scene. Although Dedmon had handled other suicidal callers during the three years since Johnson, this call was different.
“Bob was my first gunshot victim,” he said.
He took off a few days from work, and once back got into the same routine; he plunged into the job. Then came a call nearly eight months later, on Halloween. A father called to report that his daughter had shot herself. She was 51 years old, and Dedmon stayed on the line for nearly a minute listening to her gasping for air over the phone the father had placed near her while he let the police in through the door.
This would be the last 911 call that Dedmon would answer and his last day working as an APD dispatcher.
He held on for three weeks, meeting with two officers from the peer support program APD had recently established. The two calls played over and over in his head, taunting his feelings of self-worth in his inability to save the victims. He wept. Guilt plagued him. He felt responsible for the death of Johnson.
“I constantly thought about Johnson and things she did and said that might have warned me of her desire to end it all,” he said.
He made a tough decision. He was depleted. He was exhausted. He resigned, but, at the same time, he never gave up on returning to police 911 communications once he had dispatched his demons.
“Public service is in my heart and mind,” he said. “And I was a damn good dispatcher. But what I will handle better this next time is taking care of myself.”
Lending a layer of support
EMS chaplains build listening relationships
The Rev. Russ Myers doesn’t wait for things to happen, and because of where he chooses to practice his vocation, he doesn’t look forward to things that he knows are inevitable. But he’s always ready to assist when he can.
“This is a job where distress happens to everyone eventually,” said Myers, the first dedicated chaplain for Allina Health EMS in St. Paul, Minn. “Our people endure a lot of stress, and Allina asked ‘What can we do to help?’”
For starters, the President of Allina Health EMS, Brian LaCroix, coaxed Myers into an on-call position in combination with a full-time chaplaincy position he then held at United Hospital, which is affiliated with the Allina Health System. In less than a year, the .2 FTE (full-time equivalent) had progressed to half time.
“I wrote the job description,” Myers said. “We agreed this would be proactive, not reactive. I’m not waiting in the office for the phone to ring.”
The primary responsibility is straightforward: build relationships.
This is the core of “chaplaincy care” and the philosophy underpins, even enables, all the other dimensions of chaplaincy care to occur, according to doctrine of the internationally recognized Association of Professional Chaplains’ Commission (APC) on Quality in Pastoral Services.
Through establishing relationships, chaplains are better able to move people along a spectrum from feeling emotionally exhausted—through stages of grief, fear, anger, and disillusionment—to an emotionally stable, less stressful place where life can eventually return to normal.
Creating that relationship does not involve proselytizing. Chaplains do not try to persuade anyone to join a religion, cause, or group. They don’t preach religion or demand belief in a higher power.
“I’m not here to convince anyone of our personal religious beliefs,” said the Rev. Albert “Al” Kleinsasser, EMS Chaplain, HealthEast, St. Paul, Minn. “This is not about religion. I am here to offer support.”
The intended recipients define a major difference between hospital (hospice, long-term, and acute care) and EMS chaplaincy. Myers and Kleinsasser concentrate support on staff and to a less extent on the patient, although the role is not mutually exclusive. Primarily, however, they develop relationships with EMS response teams.
“I go on ambulance runs,” said Kleinsasser, who stayed on part time as the HealthEast EMS chaplain when he retired in December 2014 as hospital chaplain. “I sit in back of the ambulance and [when at the scene] go off to the side while EMTs and paramedics are medically assisting the patient. I help the family if need be, but I’m primarily there to support EMS.”
Support is discreet, non-demanding, and non-judgmental.
“This is another avenue of listening by someone in a different EMS role,” Kleinsasser said. “It’s low key. It’s about being there with them, present. They will never remember verbatim what I’ve said. They will remember Chaplain Al was at their side during their time of need.”
Kleinsasser and Myers are available to meet with crew members immediately after an incident, at a debriefing, a follow-up later on, or in response to requests by supervisors in relation to situations that might require their attention. They arrange to meet in a coffee shop as easily as the employee lounge. Neither waits for formal introduction or an incident to spur contact. They do not wait for the phone to ring, a text or email to arrive, or for a knock on the office door. They go to the places where people work. They ride with the ambulance crews. They don’t push.
“I reach out, recognizing the person might be going through a hard time,” Myers said. “But it’s up to the person to reciprocate.”
Myers emphasized their proactive attitude despite a low-key approach. By developing relationships and building trust, chaplains can respond effectively to an individual in crisis.
“We’re here to provide support emotionally and spiritually, and I don’t want to be a stranger when I show up at the time my support is needed,” he said.
He noted the intensity of dispatch from his first visit.
“I like to see myself as a layer of support for them,” he said. “I am a resource for them not only on the job but also for what’s going on in their personal lives.”
Allina Communication Director Chuck Kaufman said Myers is one of the staff; he never imposes his religion or forces counsel.
“He’s welcomed everywhere,” Kaufman said. “He’s become part of the culture. He participates, reaches out, and I don’t think he has a hard time finding something to talk about.”
Chaplains are also lightning rods for distress, and they learn not to take the emotionally driven outbursts personally. They encourage people to attend to their spirituality, which is not the same as converting to a religion.
“I never tell them where to get it,” Myers said. “I will talk about religion if they want to. I won’t bring it up.”
Kleinsasser said personal beliefs contribute to the work.
“You have to be grounded in what you believe,” he said. “It helps in relating to others, but there’s also a balance. We put our feelings aside. This is about the journey the other person is going through.”
Chaplains are ministers from a variety of faiths who offer a broad range of services that contribute to overall spiritual and emotional well-being. Chaplains are traditionally attached to nondenominational organizations, such as state or federal correctional facilities, universities, military bases, and hospitals and other long-term or acute patient care settings.
They are also highly accomplished professionals. The idea of finding retired clergy to provide chaplaincy services has been largely replaced by strict standards for education, training, and certification.
Myers and Kleinsasser are APC-certified chaplains, having completed an additional 1,600 hours of Clinical Pastoral Education (a residency within a hospital setting) beyond their bachelor’s and master’s degrees. They must complete a peer review every five years and show proof of an annual 50 hours of continuing education.
Practicing his religious vocation outside a church proper was something Myers wanted to do even before accepting the position he helped create. He is a minister for the Evangelical Lutheran Church in America and, after ordination, served as pastor of two rural congregations for 4 1/2 years. He took some time off to pursue an advanced degree, and the program he selected included visiting hospital patients.
“Then the chaplaincy bug bit,” he said.
He completed a one-year chaplaincy residency at a Level 1 trauma hospital in Minneapolis prior to becoming a chaplain with Allina in August 1993; he has been with the company for 22 years.
Kleinsasser is an American Baptist. A college job driving a hearse for a funeral home that doubled as an ambulance in an emergency was a factor in a later decision to join the ministry. In 2006, he transitioned from being a pastor at the First Baptist Church in Winona, Minn., and pursued a chaplaincy program. HealthEast asked him to develop the EMS chaplaincy position nearly four years ago. He contacted Myers and they collaborated.
Both are the first EMS chaplains at their respective agencies. They started at the ground floor and expect the position to continue well beyond their retirements. Inside the system, they are fixtures. Their visibility provides a platform. The two professions—EMS and chaplaincy—also intertwine through an underlying truth that connects them.
“The work never gets any easier,” Myers said. “It just gets more familiar.”
If you’d like more information about starting an EMS chaplaincy program at your agency, you may contact the Rev. Russell Myers at Russell.Myers@allina.com or the Rev. Albert Kleinsasser at firstname.lastname@example.org.