Intro to Crisis Awareness with Michele Pascoe | Others Over Self Leadership Conference

So our next presenter is Miss Michelle Pascoe. She's a U.S. Navy veteran who served from '91 to '94. She was an aviation electrician. She's a proud Western Michigan University graduate of social work. She got applause and I only did the first line of her bio. She currently serves as the veteran navigator for Battle Creek area through an organization known as Summit Pointe, and she is part of the Walking with Warriors program through the Michigan Department of Health and Human Services. Ladies and gentlemen, Ms. Michelle Pascoe.

I'm Michelle Pascoe. Today I'm going to be talking about crisis awareness, so, and I'm going to be making funny things because I don't think this works, so I'll be doing it to Kelly. So just so you guys know, so So as she said, I work for Summit Pointe, which is a community mental health. Been at Summit Pointe for going on 24 years. So I've been there a while in a lot of different roles there, but just, that's me. I'm married to a Marine too. So next. So this is what we're gonna be talking about today. Mental health and crisis challenges. And then we'll go into It's okay.

I'll—

we'll be going into the risk factors. So we'll go ahead and get into that, and then we'll talk about military resources at the end just so you guys have. And then if we get to the end and we don't have time for questions, I'll be here during lunch so you guys can come see me. So mental health statistics in the United States. So we're going to go ahead and go through some of these. Now, don't get too caught up on the statistics. What we're just trying to show you with the statistics. They're not perfect, as we all know, but just to get an idea. So 1 in 5 US adults experience mental illness each year. Veterans though are 2 times more likely to have mental illness. 15% of combat veterans have PTSD compared to 4% of the population. 1 in 20 US adults experience serious mental health issues and 50%— is that— that's like together, isn't it? Okay, it looks really weird up here, sorry. 50% in lifetime mental illness begins at age 14 and 75% by the age of 24. So what I want to kind of say is a lot of times you think about when someone goes into the military, they're young. So sometimes they already have maybe struggling with some mental health issues and then you throw them into the military and then you throw them and then you wonder why sometimes people then will will have some, you know, suffer from mental health later. And especially age 24, you think about the military, a lot of times people are in their 20s. So, and then, yeah, this is different than mine. Sorry, you guys, this is different. So I think I need to put this down. And then suicide is the second leading cause of death among people between age 10 and 34. So a little bit here, military culture, post-military services. So as we can see, many times people will develop new mental health conditions while they're in. A lot of times it can be due to anxiety, depression, sleep problems, insomnia, moral injury. Shelley, we touched on that earlier. Long-term consequences of injuries. So someone got hurt in the military and they're continuing to have issues from that injury from when they were in. Financial stressors, family person relationship, we've seen that all. For any of us who've been in the military, that's probably one of a lot of things that's going on with deployments and so forth. Returning to civilian employment, we hear a lot of that, that a lot of times it's hard for somebody to get back into the civilian world after being in, especially people who have served, you know, and retired, and that was kind of their purpose during that time. Loss of purpose, and then survivor's guilt for some people who have had combat experience and had that and have seen things while deployed that made them really angry at the world. You know, a lot of times people had to do things maybe that they didn't want to do morally, and they struggle with that. And veterans are used to living a structured life. Someone said earlier about being on time, I think it was Doug, and I'm not one of those people. I'm always late. So I'm the one who breaks that rule. And I say that— I do a military cultural training, and I always say that because I am usually late. So— but most people in the military are on time. Or as my husband says, if you're on time, you're late. So I just wanted to get a little bit into here. Don't want to focus too much because that's kind of been our world. But just to kind of let you know, during the time during the pandemic, Spikes in anxiety, depression. I don't think a lot of people I know when that was going on, a lot of isolation, right? Not knowing. So as you can see here, they kind of just give a little bit of a timeline. Look how the numbers, how it just all went up. So when it first started, but as it still went on, it still kept going up. So obviously when COVID was in, it surely did not help anybody. Who was suffering unfortunately from mental illness as well as substance abuse. So on here, and don't say, I know I said this to somebody and they did the one that was bright and big to them, but just share anything in here when you said when you're working with veterans that you think that pops out at you. Strong? Trauma. Oh, trauma, okay. Anyone else? Anxiety. Okay. Anybody else see anything that kind of jumps out? Depression. Stress. Yep. So as you can see, this with using that and why, you know, and it kind of goes into when we're looking at that as we're talking about being in, in the problems that some people face with having mental illness. We're gonna go into the substance abuse, traumatic brain injury, post-traumatic stress disorder, and suicide. So just a little bit. So 1 in 4 struggle with illicit drug use. 4 in 5 struggle with alcohol abuse. 1 in 13 struggle with co-occurring, which is alcohol and drugs. One of the things we find is a lot of times is you don't know which one came first. Did somebody have a mental health issue then that led to the substance abuse, or did they have a substance abuse issue that then led to a mental health crisis, psychosis, and so forth? Mental health disorders render veterans and active duty military vulnerable. And I think that's one thing when you're young, when you go in, think about it. I mean, it's alcohol, it's getting together. You're not with family for the most part. You're already at a deficit in a sense if you have any of those addictive behaviors. You're more, you know, it's a little bit more likely that you could suffer from substance abuse use. And then nearly 40% of Iraq and Afghanistan veterans have shown signs of alcohol abuse. So the PTSD is slightly more for veterans than the civilians, as you can see the number. Why do you guys think that is? Does anyone have any thoughts? Exposure. Did someone say something over there? You said exposure. Okay. Yeah. And then, yeah. Military and civilian is totally different. And we have, I mean, in the military, you don't have the say-so of certain things. You gotta do what is told or that's your butt. So in the civilian land, it's not like that. You know, you can, you know, have a choice to do whatever. But exactly. And I think Doug showed that on one of the slides, the difference between civilians and veterans. He had a slide on there that showed kind of the difference there. PTSD is also common, more common among females, 13% out of 100% versus male, 6 out of 100. And there's no stats or anything, but we are learning more and they're doing more looking into about the transgender veterans and those who do not identify as male or female, non-binary. So I'm sure as time goes on, we'll have a little bit more information about that. So one reason PTSD can be more common with women is due to military sexual trauma. Obviously, military sexual trauma is not a diagnosis, it's PTSD. The military sexual trauma then caused the PTSD. So although MST can happen to anyone in the military, it is more common to happen with women. 1 out of 3 women and 1 out of 50 of the male veterans report experiencing. Now that's screening by the VA. So just think of the numbers that are out there for people who aren't eligible for the VA or don't go to the VA. So just, just to be aware, that's definitely something. And I know that the VA and other places with the MVA and all that, they're really working towards more services and assisting people. And then this is just a little thing. 24 million people are suffering from PTSD right now. 50% of all outpatient mental health patients have PTSD. And approximately 8 out of 100 veterans have PTSD. It's pretty high, and that can do related to, you know, some type of obviously trauma, combat, MST that we kind of talked about. So these are questions into— okay, so we're gonna talk, we're gonna go into suicide. And so these are just 5 questions. If you think it's true, just go like this. If you think it's false, go like this, and if you don't know, Go sideways. Okay, so individuals who self-injure are suicidal. What do you guys think? Okay, that's no. What we see with people who have self-injured, people who have self-injured, it's more they're trying to get rid of the pain. It's not necessarily that they want to complete suicide and to do that. So that's Now I'm not saying some people who do have that might have those suicidal tendencies, but it's not all people who self-injure. Once a person becomes suicidal, they will always struggle with thoughts of suicide. And that's not true. And just, and that's just with, you know, somebody could have suicide ideations their whole life. They could, right? And never act on 'em. They could, I work with a wonderful man, Scott, who had some and actually tried to commit suicide. He's in his 40s now. He doesn't have that. He's worked through that. So hopefully with treatment and help that somebody won't always have those thoughts of hurting themselves. Yeah. So you don't look at that, working out the home with all these young folks, adding all these and adding. Nope. Firearms are the most common suicide method used, accounting for over half of our suicides in America. Okay, that's true. So, and then talking to someone about suicide will make them more likely to become suicidal. Suicide will make them more likely to become suicidal. Yeah, and I think no, you know, that's why we ask the questions, right? Where you need to be direct, and we'll go into a little bit with that. Talking about it does not make somebody all of a sudden want to hurt themselves. So just a little bit, distress warnings, what to look for. Extreme mood swings, anxiety, depression, hopelessness, feeling like a burden, you know. I'm a disappointment, those type of things you might hear. Misusing drugs and alcohol, talking about dying or suicide. A lot of times we'll see that where people will start talking more about it. So that's just need to be aware. Posting concerns on social media. So I think now the age that we're in now, we've seen that a lot where people will see something posted and then they will let somebody know. So they can get the help that they need. The more kind of warning signs, the higher risk that somebody is. So this is just a little kind of like we've been talking about, the veterans and risk factors for suicide. You can see coming into military, young and broken, right? So like I said, sometimes people have come in and they're, they've already had some trauma and some other issues coming in. Then they come, you know, into the military, have some things happen, that they might have that suicidal thoughts and so forth. Victims of abuse, legal problems, relationship issues. As you can see, there's a theme with a lot of the stuff we're talking about here. Fear that coming forward will have a negative impact. So, you know, a lot of times, and I know they're trying to do better now currently, but say if you're military police and you come across and you say that you're having that, you might not be able to be in that career anymore. They might take your gun, you know, It's great that maybe they'll get some help, but that's who they are. So a lot of times many people don't want to come forward with this when they're feeling that and struggling. Someone close died to them. We'll see that sometimes. They'll have somebody close, and then they will go ahead and struggle and possibly try to commit suicide as well. Oh, significant life events too. So starting a new job, getting divorced, having a child, right? We hear a lot more about postpartum depression. Depression, right? Those type of things can also lead— that makes you more of a risk. So just a little bit, nearly 1 in 4 active duty members show signs of mental health conditions. Suicide rate is 57% greater than non-veterans. And then 80% of veterans' caregivers are showing signs of increased stress and anxiety. I mean, I think that's a lot. Think about when you're taking care of somebody We always seem to kind of forget about those people that are taking care. So caregivers are very important. I know the VA, they do have a caregiver support program, so they are trying to kind of help people, but they definitely have an increase due to that. Just a little bit, all wounds don't show, right? So we always think, I always hear, you know, people say, you know, physical disabilities, you can kind of look at somebody and tell. Right? I mean, that's not— a lot of people have issues, whether it's a traumatic brain injury, right? Whether they're dealing with the PTSD. So just some numbers here, and this is going back to 2012, so I know it's been a little bit, but more military deaths by suicide than in combat during 2012. 20% of national suicides are completed by veterans. And then traumatic brain injuries can increase those thoughts. So I mean, and anything with a TBI, relationships, so forth, substance abuse, and so forth, a lot of times can come with the TBI if someone has a TBI. So what can you do? So this is the thing, I mean, I want you guys to be able to leave. So if you do come across somebody that you know that maybe to just be aware and to get them where they need to be. So again, take all signs seriously. Allow the person to talk freely. I think it's that. Be that listener, right? Don't— let that person be able to feel comfortable and be able to explain. Give yourself plenty of time. I always say that. Don't have an appointment 15 minutes like, oh, I got to be here. You know, that person may then feel that you're not caring. So make sure you have time. Remember, suicide is not the problem, it's only a solution to their perceived problem, okay? So for something that maybe you don't feel is a problem, another person will. And that's also respect, we're all different. Ask the question directly, and this is what we say, "Are you thinking of killing yourself?" I do QPR, I'm a facilitator for that, and we make the class say that all the time. Because it's hard saying those words. Even me who's been doing this for 20+ years, it's still hard. I was a crisis worker. Bless you. Still hard. So asking that, are you thinking that, like asking a question when you're saying it, being direct with somebody. And the hope is, is that once you say that, that will then open up the doors to assist them. Offer hope. Talk in a private setting and either call, call with them or, you know, be able to, for them to go with them. I know in Callum County we have a 24-hour urgent care for mental health and substance abuse, so you can walk in 24 hours. I know some places across the state are going to that, but you know, if that's the case, bring them in, they'll meet with a clinician, and then hopefully from there we'll be able to get them the support, whether it's outpatient or inpatient support. So just a little bit, 5 action steps. Again, ask, right? Are you thinking? Keep them safe. I always say lethal means. When I used to do on-call, a lot of times it was, okay, can you put the knives away? Do you have the guns locked away? Making sure they don't have access to those lethal means. Another question sometimes with the follow-up is, are you thinking? And if they say yes, do they have a plan? That's again, very, very important. Some people might just have that ideation, maybe they're just thinking of it, but some people truly have a plan and that's even more than you wanna make sure you get them to where they need to be, 'cause they're already, Thinking beyond just that first thought. Listen carefully, acknowledge, right? Acknowledge how they're feeling, connect them, and then stay connected. So I know for our urgent care, if somebody comes in, I think we, we follow up 7 days, 14 days, and I think 30 days, somewhere around there. So someone's calling to check in them. Hey, did you go to your first appointment? Are you doing okay? Do you need something else? So I think just making sure that you just don't blow that person off. Follow up with them. So 2020, President Trump signed the National Suicide Hotline Designation Act into law. So 988. So I know that's a lot now. So 988 is texting, which I think is amazing because I think a lot of people do text now more than they did before. And now seeking help for mental health is just To me, just as easy as seeking help for physical health. That's what we always say with somebody, you know, it's okay. You know, we know when somebody heart attack, diabetes, you know, as far as that we talk, but mental health is also something that people, it's a mental health emergency that can lead to other things. These are just some resources on here that you can, that they kind of gathered. So these are the resources I was talking about. These are some, but these are resources for suicide trainings. Has anyone taken like suicide training? Okay, so a lot of these are free. I know QPR is free. We offer them a lot of times across the state, but I do have some information. My colleague does them online, so you can jump online, which is kind of nice. But the ASIST training, I went through that. It's a 2-day. Did anyone ever go through ASIST? In here? Okay, so it's a 2-day. It's 2 days. It's pretty intense. It's— you sit in a circle, so very vulnerable, but you learn how to ask those questions, recognizing them, providing a skilled intervention, and then a safety plan. So that's ASIST training. QPR stands for question, persuade, and refer. So again, we look at that as like a CPR. Right, that we do for medical stuff. You're gonna question, are you thinking about killing yourself? You're gonna persuade them to, are you willing to get help? Can I go with you to get help? And then referring them where they need to be. You don't have to be that professional. You don't have to know all those answers, but you need to get them to professionals so that they can help them. And then VA SAVE. So that's training will help you act with care and compassion if you encounter a veteran who's in crisis. The acronym SAVE stands for signs of suicide thinking should be recognized. Are you thinking of killing yourself? Validate the veteran's experience and encourage treatment. So you can see all 3 of those all kind of say the same thing, little different. So I guess what my take back to this is, is making sure you feel comfortable Comfortable enough asking that question, right? And making sure you're okay with them when they, if you do ask that question, that you're okay with what they're gonna answer back. I think that's what everyone's scared of. What if they say yes? What am I supposed to do? Getting them to where they need to be. These are apps. The VA too, if anyone goes to the VA, they have tons of different apps you can get through the VA. But here's some community resources with apps. I know a lot of people use apps. So that's a resource. And next. And next. Thank you. And questions? I think I did my time. Whew. Any questions?

Sure.

Can you go back one? Okay. Oh, I'm sorry. Did you get it? I'm sorry. Any concerns, comments, anything? But you guys, I'll be here for lunch, like I said. I didn't know if I was going to be able to talk. I do talk fast. I'm from New York, but still, can't take that away from me. But yeah, so also we say, you know, plant the seed of hope. Everybody who has hope, you know, I think when we have hope, we're willing to move on. So that's one thing I can leave you with. Plant the seed of hope. So thank you.

Michelle, I have a question. Sure. Do you see any differences? Because you have a long experience from people who have served in the military and also who have not. Do you see any differences related to mental wellness from a treatment standpoint?

I think some of them are different, and I think it depends. You know, you have veterans who have served in combat, so there's some of their stresses are a lot different than maybe somebody who didn't. And I can say, you know, I mean, I've been out for over 20-some years. Over. I've been a social worker longer now that I've served in the military, so I'm not as maybe structured as some other people who've either retired, who have been in. Um, so I would say maybe, just maybe, what they're coming in for, but not anything else different. You're still trying to help them, assist them, get what they need, um, whatever that trauma looks like for them, to get them where they need to be. So I see it two ways. Um, it depends where you are in your healing journey. Right? So some people, it could be really hard, especially if it's something that's new. It might be too, too real, too raw. But then I've seen other people like Scott, like I said, my wonderful coworker. He, he tells a story and to see where he, he came from, that's been very healing for him. His biggest thing was what he always says is, um, someone asked him when he, he said he was in the psychiatric hospital. And you must have been in a lot of pain to do what you did. And that's what made the difference in his life, just that one sentence. And he was seeing a lot of different people. It was just that person acknowledging and then validating how he was feeling. And then he went and got, you know, further help. And now that's what he does. He's our suicide prevention coordinator. So yes, no judging. I think that's the biggest thing, you know, um, you don't want to judge. As soon as the person feels judged, they're gonna shut down. So when they feel safe, right, I always say that when somebody can feel safe in their environment to be able to share, that's very important for individuals because when you don't feel safe, you're not going to share. Well, thank you. I appreciate you guys being here and I look forward to spending time with you for the rest of the conference here.

So you get another fireside chat with Shelley for a few minutes. Raise your hand if you know somebody and/or is even yourself that has been battling mental wellness issues over the last year? It's almost every hand in this room. We wanted to make sure to include Michelle's talk today because that is the crux of what we do. If the human being is not here, what the heck are we doing? It's easy to kind of blow it off and to use phrases like saving lives and suicide prevention. I'll tell you from a clinical provider standpoint, my witness, as well as those that we work with, is that there's too much talking about suicide prevention and not enough tactical boots on ground asking the tough question. Are you thinking about taking your own life? Has anybody asked somebody that question this week? My hand is raised. I have a very, very, very dear loved one that is at that point earlier this week. And when that point happens, as Michelle said, you have a very small window to make an impact and make a difference. Don't be afraid. We cannot be afraid as a society to ask that question so that we can move through and forward that point. There's a lady sitting in the front row, Erica Hoover. Wave. Hi, Erica. She sent us a wonderful slideshow that had information on there about— did anyone catch that bullet that firearms were the number one used? So we're going to continue to share Erica's resource because it also had in there good breakouts of statistics of the timings. Okay, so when I hear somebody tell me that they're having that thought, I know that I have a 15-minute window, right, sir? A 15-minute window where I can make a significant impact. If I can just get them through 15 minutes, it's gonna be okay. And then if I can get them through that 1-hour window, then the statistic of them following through to completion as like 90% less. I mean, it is significant. So think of it incrementally. When you hear those words, if you ask that question and the answer is like, you know what, yeah, I just want the pain to stop, boom, 15 minutes, your timer starts and you don't leave that person. And you can breathe easy after a few tough moments. And then when the hour mark comes, you know what, pat yourself on the back. Y'all are going to be okay. And it doesn't stop there. I mean, the, the care continues, right? Because now we're not counting weeks or hours or months or years that we have with our loved one. We're talking about minutes. Count the minutes. 15, 30, an hour. I woke up this morning and guess what? I got another day with my loved one. And that is such an incredible and precious gift. And I hope that we as a society and as a community that cares can continue to give that to each other. I genuinely hope that tomorrow you're back here with me.