Last week, I attended a forum held by a coalition of neighbors who live near St. Paul’s Smith Avenue High Bridge. The group gathered to discuss ways that community members can build connectedness between individuals in order to help prevent suicides on the landmark structure.
One of the speakers invited to the event, which was attended by some 60 people, was Melissa Heinen, suicide prevention coordinator for the Minnesota Department of Health.
Heinen, a Minnesota native with a background in nursing, public health and accident reduction, spoke to the group in an accessible, knowledgeable manner. She outlined basic strategies for suicide reduction, safe responses to suicide deaths and talked about how the community should reclaim the bridge as a beautiful landmark, a place for walking, sightseeing and photo taking.
A few days ago, I talked to Heinen about her strong commitment to reducing suicide deaths. Heinen also outlined recommended strategies for responding to such incidents in schools.
MinnPost: How did you get interested in this kind of work?
Melissa Heinen: My brother-in-law died by suicide in the summer of 2001. Prior to that I hadn’t done much work in the area of suicide. I’m a nurse. But after my brother-in-law’s death, I became interested in suicide prevention.
For a time, after my brother-in-law’s death, I lived in New Hampshire, where I worked on reducing overdose poisoning. I also was on a survivor speakers’ bureau, sharing my story to help others who are responding to suicide.
MP: What are your job responsibilities at the Department of Health?
MH: I have three roles. One is to assist other agencies and communities in implementing the state Suicide Prevention Plan [PDF]. That’s a big piece of what I do. I’ve been meeting with the Department of Human Services and the Minnesota Department of Education to make sure that they think about suicide prevention when they are thinking about overall community health. The second piece is overseeing and implementing community grants and making sure that they are going where they need to go for suicide prevention. The third piece is providing community technical assistance for suicide prevention.
MP: How do you assist communities in implementing the state Suicide Prevention Plan?
MH: One of the ways I do that is by going to events like the West Side community gathering last week. When a community wants to get together to talk about the impact of suicide, sometimes they come to us to find out how we can help. A big part of what I’m doing at meetings like is trying to create local community capacity, to educate individual community members and inspire them to take further action so that eventually we will have a team of community “experts” who can educate others about preventing suicide.
MP: You said you give out grant funds to community organizations. Can you give me an example of one of your grantees?
MH: We have provided a grant to Suicide Awareness Voices of Education (SAVE) so that they can run a training program for journalism schools and members of the local media. The training will help them better understand how to avoid promoting contagion with post-suicide stories.
MP: When a school experiences a suicide, how can your office assist them?
MH: A school in that situation might want to schedule a day focused on suicide prevention. I could help the school respond in the case of a student suicide. I’d have to be invited by the school, though. I can’t just show up: We don’t have the capacity to do that. And it really only works when you’re invited.
Some schools have invited us to help out in these cases, and I think we’ve been able to help. But our presence is not the end-all-be-all at these events. The most successful interventions take a community approach. We might be there, but our job is to keep a low profile, to introduce community members to the supports that are available for them and then let them take the lead.
It’s important that organizations take a coordinated approach in these cases, that they have consistent messaging about what happened and that they maintain control over how that message is communicated.
MP: How can more people get trained in suicide prevention strategies?
MH: This last spring, in partnership with DHS, MDE and NAMI Minnesota, we hosted two trainings on postvention, or ways to respond to suicide without creating contagion in the community. We trained 30 people in one day. In that group there were about 16 people who were train-the-trainers so they could go forward after the workshop and train other people.
There have also been a series of postvention trainings going on throughout the state. We started out working with schools. This is an area we know. Youth are more impulsive and responsive to an immediate crisis. Because of where they are developmentally they can over identify with someone who died by suicide. We’ve also done trainings specifically for tribal communities so they could use this information within the tribes. We want trainers who know how to be present and supportive after a suicide in a culturally responsible way.
MP: Why is postvention important when a young person dies by suicide?
MH: Based on surveys of youth, we know that if someone experiences the suicide of a loved one, they are at increased risk of suicide themselves. And it’s not just close friends or family members: We used to think that if a young person’s close friend or relative died by suicide, it increased their thoughts of suicide. Research has showed us that a young person doesn’t even have to really know the kid who died to be at increased risk of suicide. If the kid who died went to the same school, that could be enough to increase a young person’s thoughts of suicide. Contagion can be that strong.
MP: Suicide prevention experts have told me that it is better to downplay a suicide, to limit dramatic public memorial services or symbolic tree plantings. Why is that?
MH: This is especially true in schools. We know youth act more impulsively. They are more likely to experience a mental health crisis on the day of a suicide attempt. And also young people are developmentally more likely to over identify with someone who has died by suicide. Say a young person is a soccer player and the kid who died was also a soccer player. If that kid is struggling with mental illness, she might think, “We’re similar. This is something I should think about.”
If there’s a big memorial at the school and the kid who died gets celebrated in front of their peers, a person who’s feeling like no one cares or notices them might feel like suicide is a way to really get noticed.
MP: So how do you handle that? Is it emotionally healthy to ignore a death or brush it under the rug?
MH: One of my roles is helping schools understand that they can still acknowledge the suicide death of a student but they can do it in a way that doesn’t increase contagion. I don’t recommend memorials or posters, but a school can put out a roll of white butcher paper and have kids write memories of the peer who died on that. Then school officials can roll up the paper and bring it to the family at the funeral. That’s a way to acknowledge the loss, but also a way to put some closure on it. From there you can move on, restart the kids and help move them forward.
We want the school to support students in their grief. We want to acknowledge the life that was lost. But we don’t want to make the way in which they died the focus of the event. We don’t want to make one death more shameful than the other.
It doesn’t matter how a student died: Their name doesn’t have to be on a bench. We don’t want to make the family feel like the school doesn’t care, but if a student dies by cancer or car crash, that usually doesn’t create contagion. We want to acknowledge the death without making it a permanent thing. You don’t want memorials that make suicide seem like a valid choice. When you’re feeling like your life sucks, if you walk by that memorial every day and you remember that that kid died by suicide, it normalizes it as an option. We don’t want to do that.
Posteveniton guidelines even recommend talking to the clergy before the funeral and making sure that no one says something like, “Now he is at peace and in a better place.” If I’m struggling with thoughts of suicide and I hear how my loved one is now peaceful and in a better place, that isn’t helpful to me as an individual.
We understand that this is a tough thing for people to balance and work through.
MP: Lately, I’ve seen more obituaries that are open and honest about a person’s struggle with mental illness and ultimate suicide. How do you feel about that?
MH: It makes sense to talk about the struggle with mental illness and say it is a risk factor for suicide. Doing that is different than having a reminder that this person killed him or herself. Wearing green ribbons to acknowledge mental illness is different from memorializing or glorifying how a person took their life. It’s a nuance and no one has mastered it yet. We have to balance destigmatizing mental illness with not making suicide seem like a valid option. It’s a complex thing.
It’s not an easy thing, but we have to be so careful about all of our communications around suicide. Everything makes a difference. Research has shown that even neutral reporting on suicide may increase the risk of suicide in a community.
MP: Are there Minnesota schools or communities that you think have done a particularly good job at responding to suicide?
MH: The Jed Foundation has a suicide-prevention model for college campuses. St. Cloud State has received the Jed Campus seal. I’d like to see other universities take hold of this approach and follow St. Cloud’s lead.