Expert Interview: Sally Spencer-Thomas, Psy.D.
In this Expert Interview, AdvancingWellness CEO Mari Ryan is joined by suicide prevention advocate and speaker Sally Spencer-Thomas, Psy.D.
Mari Ryan: Welcome to the Workplace Wellbeing Essentials Series. I'm Mari Ryan. I'm the CEO and founder of Advancing Wellness. It is my pleasure to welcome you today to this expert interview where we explore topics that impact employee wellbeing. My guest today is Sally Spencer-Thomas.
Sally is a clinical psychologist, inspirational international keynote speaker, podcaster, and an impact entrepreneur. Dr. Spencer-Thomas was moved to work in suicide prevention after her younger brother, a Denver entrepreneur, died of suicide after a difficult battle with bi-polar condition.
Known nationally and internationally as an innovator in social change, Sally has helped start up multiple large-scale gap-filling efforts in mental health, including an award-winning campaign titled “Man Therapy,” and the lead author on the national guidelines for the workplace suicide prevention.
Sally has held numerous leadership positions in suicide prevention organizations and won multiple awards for her advocacy work. She has a doctorate in clinical psychology from the University of Denver, a masters in non-profit management from Regis University, and a bachelor’s in psychology and studio art, with a minor in economics from Bowdoin College. She’s written four books on mental health in violence prevention and she lives with her partner and three sons in Conifer, Colorado.
Sally, thanks so much for being here today.
Sally Spencer-Thomas: Mari, it’s an honor. I’m so excited to be here.
Mari Ryan: Thank you, thank you. With all of that’s been going on with the pandemic, we are hearing so much more in the workplace about mental wellbeing and mental health issues. We both know that mental wellbeing is a concern all the time, not just as a result of the pandemic. With the pandemic many more people are feeling stressed, anxiety, all the changes that are taking place. The Kaiser Family Foundation reports that as many as 53% of U.S. adults have reported mental health negative impact due to worry and stress, but we also know that all pandemic stuff aside that in any given day, or week, or month, or year that many people are struggling with mental health issues and that they may also be struggling to the extreme, in some cases, with feeling that they have no alternative but to end their life and have serious thoughts of suicide.
I find in my work with clients that so often that suicide is really not thought of as a workplace issue. So I’m anxious to explore this with you and think about this in the context of the workplace. Before we dig into that tell us a little bit more about how you came to make this the focus of your advocacy work and your life work.
Sally Spencer-Thomas: First of all, I am so incredibly grateful to your willingness to bring these really hard topics to the forefront because if we don’t speak them, they remain invisible. So I’m really grateful for that.
As you mentioned, I have a degree in clinical psychology I got a long time ago and I was one of those psychologists that after I got out of graduate school and started doing the work of counseling, I was like, uh-oh, I don’t know that I’m a counselor. I literally loved learning about it, but I’m not sure I have the right personality to be in a room all day. That helped me work through a couple of career options, health and wellness, and then leadership development, which I loved. It was in 2004 that my brother died by suicide that I had a calling. I woke up to the fact that there was some really important gaps that needed to be filled and that we needed some innovation to fill those gaps so that people weren’t falling through the cracks.
One of the insights that came out of that incredibly horrible life experience that I gained was that there was a large group of people, men in the middle years primarily, that were representing the majority of suicide deaths. Most of them had never reached out for mental health services, ever. They had one attempt and it was fatal. That seemed like a really important gap to fill.
It wasn’t long after that we learned about that we said, well, the workplace. They might not be reaching out to our healthcare system, but most of them are working or just working, or looking for work, like it’s the workplace that is the system that is going to be intersecting with them. That’s got us eventually to develop these national guidelines for suicide prevention, which is a collaborative national program supported by many, many large-scale organizations.
Mari Ryan: First, I’m so sorry that you had to have this life experience in order to help you find your calling, but many people will benefit as a result of your commitment to this topic. I find it so interesting that the workplace has ended up being the container in the system where you are able to have some impact. I’m curious, you mentioned in particular men, and working men. Are they a particular risk group? Are there other particular risk groups that we should be aware of?
Sally Spencer-Thomas: I just want to make it clear that when we look at the death data, about 80% of people who die by suicide are male, but when we look at the attempt data the overwhelming majority are women. It’s not that women have less despair, it’s just that they are more likely to live because they use less lethal means. Because we have better data on death data – not everybody reports their attempt or it doesn’t show up in places where we are counting, we can now rank industry by suicide rate. That was a critical turning point. The CDC started coming out with reports in 2016. They’ve now had three reports that have come out and that was a galvanizing experience because now people could look at credible data and say, oh my gosh, we need to do something about this. Before it wasn’t even on the radar.
There are certain industries that are more at risk and they are all, or most, male-dominated industries, like construction, extraction, which is oil, gas, and mining, transportation, like rail and trucking and air, protective service, first responders, all of those types of industries are leading in now because they have woken up to this experience.
There’s a lot of other industries that have a better gender balance that are also paying a lot of attention right now. Obviously, the healthcare system. That was true even before COVID hit, it’s even more true now. The service industry, restaurants, theaters, all of these industries have been really hit hard by the pandemic and they were already vulnerable before this started.
Mari Ryan: It’s so interesting that … it’s so fabulous, of course, that the data is able to substantiate that and be able to help us focus the concern in those industries because that way at least they can start to be addressed as perhaps an industry problem or within specific employers, or organizations within industries. So that’s exciting to hear.
I’m curious, are there any risk factors or signs? So, this is not just men, it’s women as well. Are there any signs that we should be looking for? What are the things that we should as individuals and as managers and as leaders in organizations be watching for?
Sally Spencer-Thomas: I’ll use the pandemic as part of the example in my answer because it is so top of mind for people. The pandemic has raised mental health concerns in the workplace to a much higher level in the consciousness of employers, and for good reason. The pandemic is really a perfect storm of risk factors, so I’ll start there. Risk factors that would increase someone’s chances of having suicidal thoughts and behavior are things like isolation, things like job loss or financial destruction, things like relationship disruption, and when you put all those together on top of this huge fear of uncertainty, fear of our health and wellbeing, that is a huge, perfect storm of risk. Later on all of our natural disasters and social unrest, it’s no wonder that we are now starting to see the warning signs show up.
This happened pretty close out of the gate. You mentioned people reporting to Kaiser about increased concerns about anxiety and depression, but we are also seeing other things we can measure, like increased alcohol sales. One of the warning signs is that people’s use of substances goes up. They don’t feel well. They feel on edge, they feel despair, they feel overwhelmed, and guess what? Our alcohol and drugs will numb that out for a period of time, so people start to increase that self-medication.
We are also seeing increased domestic violence calls. Violence or aggression, agitation, even on the lower levels of people just being irritated all the time. Flying off the handle for small provocations. Again, we often say, hurt people hurt people. They don’t feel well and so they see the world through an antagonistic frame sometimes. So, we’ll see that.
We’ve also seen increased purchases of firearms, especially around the periods of unrest that we’ve had over the last year. Again, I want to be clear being a firearm owner does not mean that you are more suicidal; however, if you are suicidal and you own a firearm, you are far more likely to die. That accessibility to lethal means, getting it, learning about it, or even doing dry runs and practice, or researching things on the internet, all huge warning signs.
And then, people just shift their language as they become more and more despairing. Sometimes it’s a subtle experience with someone where the back of the neck hair goes up. It just doesn’t seem right. We call those pieces of conversation “invitations.” They’re actually looking to see who is picking up and sometimes it’s not even conscious. Picking up how much pain that they are in. It’s things like, I just don’t know what the point is anymore. Or why does this matter? Or questions about the afterlife or death or those kinds of things that your brain says something’s not right here. It does what I call a “brain wobble,” like they’re trying to tell me something but I’m not quite sure what that is. When we have those kinds of strange, provocative conversations our inclination sometimes is to be like, nah, I misinterpreted, I’m blowing it out of proportion or Joe is just being Joe. What we really encourage people to do is lean in and ask clarifying questions and meet the person with some compassion.
So, I could go on all day about warning signs but those are some of the real highlighted ones that people can look at.
Mari Ryan: Those are really good. Thank you, that’s important, and it’s important for us to be listening and paying attention in those situations for these kinds of things.
I notice in working with my clients that suicide is kind of a taboo topic. It’s not something that anybody talks about. There is stigma associated with it, especially in the workplace. How do we start to bring this into the conversation so that people are willing to talk about it and more comfortable with it?
Sally Spencer-Thomas: Well, you start by doing stuff like this, where you just talk about it in a matter-of-fact way like we would anything else. If you think about it, 40 years or so ago this is the same place we found ourselves in with cancer, like ooh, cancer. And now we’re like, yeah, cancer. People have it, people live through it, get treatment for it, we celebrate our people who survive it, we mourn the people who we’ve lost from it. It is part of our lives. Same thing here. Having these matter-of-fact conversations where we are talking about it directly matters in mass communication, it also matters in one-on-one, families, or systems kind of communications.
We find, again, if we take cancer as the case example that it was the science and the stories that got us through those discriminatory, prejudiced, or misinformed ideas about cancer. Same thing here. The better science that we have, the more we understand how this impacts all kinds of people, all the time, in various degrees, and the fact that people who live through it, who live through what we call suicide intensity, thoughts and feelings about suicide, who have lived through an attempt, are just like our cancer survivors. They are heroes in their journey of overcoming something incredibly painful and difficult and we can learn so much from their survival stories. And when they share their stories – and not everybody can – but when we hear those stories of a hero’s journey through overwhelming despair, it helps so many people. It helps people say, okay, you got through it, I can get through it. You took a roadmap that makes sense to me, now I see steps I can take. So that’s really powerful.
When I think about the journey that we’ve had on getting workplaces on board with this when we started in 2007, it was like banging your head against the wall. Employers would look at me like, suicide? No. That’s a medical thing. People need to take that up with their doctors. I said, but they are not, and they are here, and they are working. Perhaps, just like you do with some other health issues you should tackle this one as well and save some lives.
It took the data from the CDC and it took some very forward-leaning employers who said let me be the first. I don’t want this on my watch. I don’t want my people despairing in isolation. Let me be the first to try this and get it right. Their stories of embracing this and the outcomes that they had from this work started to tip the scale. Now we are in a place where people are coming forward all the time saying, what can I do? How can I help our workers? How can I get in front of this? Or support people that have been impacted by it.
Mari Ryan: So important, and just wonderful to hear that people are willing to step up and they are willing to start to bring this into the conversation. I’ve noticed in our conversations that you’ve been instrumental in developing national guidelines for workplaces on suicide prevention. Tell us about those guidelines. This sounds really exciting and great work that you are doing.
Sally Spencer-Thomas: Yeah, so I serve on a couple of committees in the United States and internationally where the idea of having some handholds for employers is really important. We started to look, there were other countries that had standards or physician statements on this, Australia, Canada. It was 2015 or so and we said, we really need a set of those in the United States. So we started researching, and having all kinds of focus groups with EAP people, employee assistance professionals, HR, safety professionals, people with lived experience who had their own suicide crisis while they were working, peer support groups and so forth, and just getting their input on what should be in these guidelines and what would be the best format for them, so on and so forth.
In October on World Mental Health Day, October 10, 2019, we – and by “we” I mean the American Association of Suicidology, The American Foundation for Suicide Prevention, and the United Suicide Survivors International, three national suicide prevention non-profits – we collaboratively launched these guidelines to give employers a set of guiding principles, so values, if you will, that help guide decision making, and nine practices. We wanted to make it very concrete. Here’s nine exact things you can do that will increase the likelihood that we can be proactive, that we can have early intervention for people who are in emerging crisis, and that we can meet people on their darkest day with our best game with dignity, respect, and partnership.
So, here we are a little over a year later. We have over 600 pledge partners. We really encourage employers and professional associations like unions and other groups to take the pledge to make workplace suicide prevention a health and safety priority. Then once you’ve registered as a formal pledge partner, and again, this is all free and publicly accessible, it walks you through a series of these steps where you earn badges as you become more suicide informed.
Then you have an external facing cue to let people know we take this seriously and this matters. It’s been super-exciting, and again, not unexpectedly, a lot of our construction partners have leaned in just because they are well aware of the risks, but also because they are very pragmatic people, like, we’ve got a problem. How do we solve a problem? And then they dive in.
So we invite people in, even if you are not in a position of leadership where you can make all these decisions to come in and learn a little bit more about it at workplacesuicideprevention.com.
Mari Ryan: We’ll include that in the show notes. Thank you first, for the great contribution you have made to that work and for the advocacy efforts to be able to bring that to workplaces and encourage employers to step up and take an active role in this. It’s just so exciting. I’m glad to hear there are some very concrete steps because I’m all about the concrete action, how do we get to action. So that would be my next question, what can employers do to support employee wellbeing on this topic to create awareness for suicide prevention? What are the first steps? What should they be doing?
Sally Spencer-Thomas: We’ve organized the nine practices into upstream - proactive prevention, mid-stream - early identification, and downstream - crisis response. On the upstream piece I’ll also comment awareness is necessary, but not sufficient for change. We knew that smoking was bad for us for years and years before people actually started changing their behavior. Oh yes, you have to get awareness, get it on the radar, and then taking action steps.
On the proactive prevention upstream part of it, we’re really looking for leadership, both formal and informal positions of leadership to drive a culture that is all about caring. I’ve got your back. We look out for one another. This is what we do because it matters to our community, it matters to our mission. So, all kinds of pieces under there about how you drive a caring culture.
A second piece is about effective communication. You and I talked before this interview about there is lots of language in the work of suicide and mental health that is laden with prejudicial experiences and ideas and misinformation and myths. We’ve only just known that language, so we just say it all the time. How to shift our language and communication strategy so that not only are we using empowering and dignified language, but we are also creating a roadmap for hope. This is another trap that people sometimes fall into is they just, I say, repeat the drum of the death data. They’re dying! They’re dying! Everybody’s dying! And yes, we have to create urgency with that, but you also need to give people a communication of hope. Most people who get depression treatment are helped. The overwhelming majority of people are going to live through their suicide crisis and even grow through it. So all kinds of other types of language that give people help and hope, and so on.
Another piece that is really important for us conceptually that I want to make sure that I emphasize here is that it’s not all about mental health. This is shocking for people. They are like, what do you mean it’s not all about mental health? What I mean is it’s not all about a “broken person.” Sometimes it’s also about a very toxic environment. It’s not good enough to send all people who are despairing to counselors because sometimes it’s the workplace that having bullying and hazing and harassment and discrimination and unrealistic expectations and trauma and not even letting their people sleep. All the counseling in the world is not going to fix that if they consistently show up in a toxic environment.
So, we have some strategies for workplaces to figure out what their psycho-social hazards are and how to eliminate them or mitigate them. So that’s all that top tier.
The middle tier is about early identification and then connecting people to what I call a “buffet” of resources because not everything works for everybody. Again, we want to start with self-empowerment. Just like any other health issue, you are going to be the expert on you, and if you can be mindful about when, let’s say when your breathing doesn’t seem right, or when you have headaches. If you are mindful of these things that are going on in your body, you can also be mindful of your emotional wellbeing. If you can catch it early, you are in the best position to do some course correction yourself.
We have a self-empowerment piece where we help people with screening, creating their own crisis inoculation tools so that when they do hit hard times, they know exactly what to do. We also know that sometimes we are not the best judge of ourselves and sometimes it’s our peers, our friends and family members who are like, hey, you’re drinking more than you used to, or hey, you look really exhausted, are you okay? So how do we create a peer support tier, if you will, within a workplace, a cohort of individuals who are naturally inclined to be good listeners and empathic who are then the go-to people when people are not doing well, that they can have private supportive conversations and that those peer supporters can also be trusted liaisons, so they need more professional support.
Also, in the downstream space we also have things like, is your EAP any good? Some of them are amazing, some of them went to the lowest bidder and they actually provide zero value. Knowing your mental health resources, not just a link to a website, but intimately, knowing the providers, having them come on site, doing lunch and learns, and developing relationships. Sometimes, especially with this real group that is reluctant to go this extra step, sometimes you’ve got one chance. You have one chance to make a good, solid connection for that mental health journey, so you’d better know what you’re doing. You’d better know what your resources are and have that relationship with a provider that you really trust.
Then, should there be a death or an attempt that rocks a workplace, you better have a plan on how you are going to provide grief and trauma support and then reintegrate the people who are most impacted.
Mari Ryan: Thank you for walking us through that model. It’s great to hear that detail and to have a sense of some of the different approaches that organizations can take. Again, just fabulous work on making this happen and getting these guidelines published so they are available to employers.
Sally, if our audience wants to learn more about you and the work that you are doing, where can they find you?
Sally Spencer-Thomas: It’s easy, it’s just my name, sallyspencerthomas.com.
Mari Ryan: Fabulous. As always, it’s wonderful to spend time with you. This is such an important topic, and I am so glad to be helping to spread the word about this and be willing to talk about it, and so grateful for all the work that you are doing.
Sally Spencer-Thomas: Bless you. Thank you, Mari, I appreciate this opportunity.
Mari Ryan: Thanks.
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