Helping the Helpers: Clinicians Need Support Too

Kent Corso: 00:00:05

Hi, my name is Kent Corso, and I'm your host for this episode of One Minute Can Save a Life. While I am a licensed clinical psychologist, none of these guests are my patients, nor does anything I say constitute medical advice.

The views conveyed during our conversations do not reflect the views, positions, or policies.

Kent Corso: 00:00:24

Of any private or public organization.

Kent Corso: 00:00:26

This is simply a series of conversations with people who have some connection to hardship, suicide, mental health, or loss. There's so much we can learn from one another.

Kent Corso: 00:00:36

So let's get started. Today, our guests are Tina and Madeline Malan. Why don't you go ahead and introduce yourselves?

Madelyn: 00:00:44

Hi, my name's Madeline, and I am a provisional clinical social worker in Rock Springs, Wyoming.

Tina: 00:00:51

Hi, I'm Tina Malan, and I am in school for social work and working on my bachelor's towards my master's.

Kent Corso: 00:01:02

Great. So I met Tina and Madeline in Rock Springs about two months ago when we had a community awareness event for suicide prevention.

Both of them have many things in common, but one unfortunate thing they have in common is that they both lost someone to suicide. So, Madeline or Tina, whoever wants to go first, do you want to tell us a little bit about your story?

Tina: 00:01:24

My partner of 36 years died by suicide. He was a mental health professional here in our community. We were all working towards having a practice together, and there was no indication.

We spent the day of his birthday on September 6 together and had a family barbecue the next day. He helped our daughter move things into her new home, and the following day, we celebrated her birthday at a brunch. And that night, he overdosed.

Today would have been our 34th wedding anniversary.

Kent Corso: 00:02:15

So, my goodness, I'm so sorry to hear that. You said there were no signs.

As we know, typically 80% of people who die by suicide, they do have some sign or give us some indication, and about 20% don't. So it sounds like your significant other, what was his name?

Tina: 00:02:33

James.

Kent Corso: 00:02:35

Sounds like James was in that 20%, huh? Yeah.

Tina: 00:02:38

And I think it's because he was a mental health professional and a psychologist.

I think he was very good at diverting any kind of attention to any kind of issues that he may be going through and turning it back around and putting the focus on you instead, you know?

Madelyn: 00:02:58

Well, and I would say that there were signs. Looking back, I think that they were very, very subtle signs over a duration of about a year. But anytime you asked, hey, is everything okay?

How can we help? You know, I'm worried about you. Like Tina said, it was always back to, oh, I'm fine, thanks for asking. But what about you?

Kent Corso: 00:03:27

So he would sort of deflect the conversation back to someone else, which it sounds like that's what psychologists are trained to do. I mean, so. So on one hand, he's sort of using his professional craft with.

With a lot of skill, but on the other hand, it kept people from really caring for him is what it sounds like.

Tina: 00:03:46

Yeah. And I think it's important for people to know that Madeline is his daughter. She's his youngest daughter, so.

And she went into the field because her dad was an inspiration for her.

Madelyn: 00:04:00

So I used to go to UW classes with him when he was doing his masters and sit and try to read books. And I often accompanied him to his private practice, his first one in Casper. And he was very inspirational. He was great with people.

He was extremely smart and charming. And I think for me, it was amazing to see that he cares so much about everyone else and that much more hurtful.

This loss has been that much more hurtful because he did care so much.

In the way that society deals with death by suicide and suicide loss survivors, I don't think takes into consideration how the grief is different, especially when you have a helping professional that was very active in the community.

Kent Corso: 00:04:55

So there are a handful of things you're saying there, Madeline.

One is that he sounds like such a great man and that he had so many wonderful things going for him, which is often the case when someone dies by suicide. It's not as if they necessarily have nothing to live for. It's often that there's a lot to live for, but there's also a lot of pain at the same time.

So I hear you pointing that out. What I also hear you saying is that the grief is different when someone dies by suicide.

And then a third thing, it's different when that person was a member of the mental health community. So could you talk a little bit about the grief first and how that's different when it's a suicide?

Madelyn: 00:05:32

I think that it varies tremendously because there is a huge stigma associated with the cause of death and it feels very isolating. For example, bereavement leave is looked at differently.

People are walking on eggshells to offer you support because they don't know what to say or they're uncomfortable and maybe they believe that it was a selfish act and so you aren't handled, I suppose you could call it with kid gloves after that kind of loss, because a lot of people think that, you know, they chose to do that. And I'm of the belief that that is not A choice. It feels like it's the only option, but unfortunately our society doesn't see it that way.

It is something that should be secretive and is less supported, or we fear talking about it and making it more prevalent.

Kent Corso: 00:06:34

So in other words, at a time where you and your mom feel this tremendous loss, under typical circumstances, people would have this outpouring of support and love, and instead they have sort of nervousness, walking on eggshells, and sort of awkwardness. So how does that feel?

Madelyn: 00:06:53

It feels like something's wrong with us and it's very uncomfortable.

Kent Corso: 00:06:59

So in other words, the stigma that keeps them from just being compassionate human beings ends up coming back to bite you as well, where it feels like you've done something wrong or you are not worthy of that kind of attention, or you're not easy for them to care for. These are my words. You tell me, Tell the audience.

Madelyn: 00:07:19

Absolutely. I feel like we are looked at just as poorly as someone that dies by suicide because we were associated with it.

And now that it is more talked about, I often get things like, while you're trained in this profession, how did you not know? Or he was trained in this profession, how did you not know? And it's.

It's almost like belittling or not being able to differentiate that a professional life and a personal life is very different.

Kent Corso: 00:07:52

That's right. That's.

Just because someone is a mental health professional doesn't mean they're not human, doesn't mean they are impervious to any kind of life difficulty or health problem. So I'm so sorry that you're feeling belittled or that the community sort of treats you as if there's something wrong with you.

It sounds, like very judgmental.

Madelyn: 00:08:13

Absolutely.

Tina: 00:08:14

Yeah. And that's something that I ran into with my co workers. They couldn't understand.

I took about three weeks of leave without pay because I just couldn't go back to work. And when I came back to work, both my co workers said, well, I don't feel sorry for people that commit suicide. I think that's selfish.

I think that he's a jerk, and I can't believe that he would do this to you. And I said, he wasn't trying to do this to me. He was suffering and he did this to himself.

And that's something that we need to understand that I can't hate him for. I feel sad that he had those internal struggles. You know, I can't imagine.

Kent Corso: 00:09:09

It takes incredible strength and maturity, Tina, to adopt a mindset like you just described, where you're pretty much saying, this is not about me. This was someone who was in a lot of pain and I have empathy for him. I feel bad for him.

Am so sorry that he felt so bad that he chose to end his own life. If you could speak to the community members around you, how would you ask them to treat you regarding this?

Because it sounds like it's a swing and a miss as far as their attempts to be either good colleagues or good neighbors or what have you. So what's a tip you can give them or what would you want them to hear?

Tina: 00:09:49

I think that one of the most important things is I find that people don't want to talk about him. They act like this is.

Like it's complete taboo to even mention his name or I understand that sometimes when people die, people only remember the really good things about them. We all have flaws, we all have struggles. And so I want to just talk about him the way he was. He had many wonderful qualities.

He had some that were irritating just like anybody else. But I just want them to say his name. You know, I want people to acknowledge that he, the life that he lived.

Kent Corso: 00:10:40

Isn't that what they would do if he had died from cancer or died from a heart attack? They would talk among themselves or with you about fond memories or things that they appreciated about him.

I think we have to help people understand that if someone makes the decision to end their life, that doesn't negate all of the wonderful other attributes the person had. And I think if we consider faith, if faith is a part of our lives, let's just take for example, Christianity.

We've got to challenge ourselves not to judge and to rather be compassionate and to be empathic because we haven't walked miles and miles in that person's shoes. And even things that are taboo in a faith based context. So if we're talking about sins and things like that, we don't do them. We try hard not to sin.

It's not that we don't talk about it. How can we ever teach our children to have a righteous path and to live the way our faith guides us to live if we don't talk about those sins?

So there's this disconnect that I'm noticing and I don't know if it's faith based or if it's just something else, but it's not helpful, is it?

Madelyn: 00:11:52

No, not at all.

And I often find that in our community, religion is used as a reason to not help people or not talk about things and rather push them under the Rug hoping that this is helpful, but what I've found is that makes it so much worse for the people who suffer and the people who experience loss in this way.

I think it's very isolating for the people that are struggling with the mental health side of things or with the lack of purpose along with the grief that comes with suicide.

Kent Corso: 00:12:35

And I think we can talk all day about what would Jesus do? But humans are not divine and we struggle. And it's a lot harder for us to do the right thing. It's harder for us to take the road less traveled.

It's harder for us to work within these complex situations like suicide, especially within a small community.

Now, you have both talked to me a little bit about how mental health providers seem to be treated like second class citizens when it comes to their own struggles. Can you talk a little bit about that?

Madelyn: 00:13:09

So as a mental health provider at a community mental health center, I noticed that I have people that I work directly with that care about me. Right. I have a supervisor who will engage with me.

But a pattern I notice is that once someone enters private practice or decides to not work in a large agency type setting, they lose a lot of that. And like I said earlier, nurses during COVID they were frontline workers. They mattered.

Their mental health was taken into consideration, those struggles that they were having.

But meanwhile, mental health providers in our smaller communities are fighting against a public health crisis with suicide and no one is worried about us. And I think that that's something that my dad, James experienced.

You know, he needed help, but it was so pushed aside that mental health providers are more than just providers that we are experiencing burnout. We have high rates of substance use.

You know, we're an at risk population and we don't have policies that require mental health providers to feel supported or get the help that they need or have access to that help. And so I think it makes, it makes the burnout a lot harder to deal with because we have nowhere to turn.

Kent Corso: 00:14:49

It sounds like you're saying two things, Madeline.

One is that for James, when he needed help, people sort of looked at him and said, well, look, you're a mental health provider, you should be able to handle it.

Madelyn: 00:15:01

Absolutely.

Kent Corso: 00:15:02

Is that, am I understanding?

Madelyn: 00:15:03

Yeah, absolutely. Or hey, you've helped a whole generation of mental health providers become mental health providers.

You've provided supervision, you've worked directly with these people. And so, nope, we can't help you. We know you too well. That's a conflict of interest.

Kent Corso: 00:15:22

Oh, so the old dual relationship issue that is in Most ethics codes. Is that what you're referring to, Meline?

Tina: 00:15:30

Yeah.

Kent Corso: 00:15:30

So for our listeners, for our listeners who are not familiar, when you're a healthcare provider or an allied health provider, so mental health or some other branch of the medical field, part of the ethics code says you're not supposed to have dual relationships. So I'm, if I'm a physician, I'm not supposed to treat my wife. That would be a dual relationship. She can't be my wife and be my patient.

And what I hear you saying, Madeline, is that because he was so well known in the community and had practiced for so long, people felt like, well, we know you as our supervisor or as our colleague, so we can't treat you. Is that what happened?

Madelyn: 00:16:03

Absolutely. And he actually reached out for help on several occasions and was turned away. And because he was in private practice as well, he lacked insurance.

He couldn't go to Utah, he couldn't go other places. It was inaccessible in many areas for many reasons.

Kent Corso: 00:16:23

That is so unfortunate, because ethics codes are not supposed to be black and white. They're supposed to be flexible.

And especially when we're talking about practicing in rural communities where everyone knows everyone, that's like saying, well, I guess the mayor can't go get mental health help. I guess the police chief or the fire chief can't get mental health help because everyone knows these people.

So that we have to be flexible in our thinking. Because to your second point, no one is caring for the caregivers.

We are going to burn out as well if all we're doing is trudging through all of these mental health problems, whether we're talking about suicide or youth mental health problems or just other adult mental health problems.

Tina: 00:17:06

Well, and something that James encountered, too, I think, is with his mental health practice, if it is known in our community that he is seeking mental health services, is that going to negatively impact his credibility in his community?

Kent Corso: 00:17:30

Right.

So in other words, will people stop referring patients to him or clients to him if clients of his find out that he also is seeking mental health, will they discontinue treatment? Is that what you mean, Tina?

Tina: 00:17:43

Exactly. And we're it's such a small community, and really Wyoming in general is a small community in itself.

And I think that when people find out about things in your community, and I mean, there's always a chance that somebody's going to see you going into that mental health provider's office. You know, that. And a lot of things, just to be honest, in a small community like this, a lot of confidentiality isn't administered.

Kent Corso: 00:18:18

Let's be honest here. The mindset you're talking about is kind of part of that stigma. It's part of the assumptions we make.

It basically says that all doctors and nurses and therapists are perfect. They are completely invincible. Right. Obviously, that's a flawed idea. No one is perfect.

So how do we get the public to understand that the medical providers, the mental health providers, they struggle with stress and depression or anxiety just like anyone else?

Tina: 00:18:48

Well, I think we really need to talk about mental health a lot more. I mean, it's not something that is discussed. We push it under the rug. It's a dirty little secret kind of thing.

And I think that we need to understand that everybody, Nobody has a perfect life. Everybody has a time where they're going to go through grief or they're going to have anxiety or. And I think everybody just says, suck it up.

You'll get through it. And that's. We need to not do that.

Kent Corso: 00:19:22

So, Tina, I'm a nerdy behavioral guy, so I'm going to ask you to be even more specific. How do we have these conversations? Where do we have these conversations? Is this parents talking to their children? Is this programming in schools?

Is this a public service announcement from a local elected official, or all of the above?

Tina: 00:19:40

I think all of the above. I think it needs to start at home. We should be parenting our children, and we should be talking to them about feelings and all those things.

But then I think it also needs to be in the schools. We talk to kids about sex education, but we don't talk to them about the.

The repercussions emotionally about having those kind of relationships and things like that. So, I mean, I think it. We need to talk about mental health in schools, and we need to talk about having more school counselors. We.

Most of our schools have 400 to 500 students and one mental health professional. You can't help. They can't be effective with one mental health professional. I mean, these are kids that are going through changes.

They're going through. Life is hard now for kids. They don't have two parents at home. Most of them.

You know, we need to be supporting the idea that we need to talk about feelings. We need to talk about it's okay if you're not okay. And what are we going to do about that?

Madelyn: 00:20:50

And I'd like to add to that because I think that the conversations are super important in schools and at home. But I would like to take that a step further. And I think we should be promoting coping skills.

We can talk all day about mental health and those barriers and changes, but it's how we adapt and how we overcome those and the skills that we're provided to do that.

Kent Corso: 00:21:15

That's really well said, Madeline.

I mean, if we're going to talk about nutrition in school and try to teach kids how to be healthy physically, it just makes sense to teach them how to be healthy emotionally or from a mental health perspective. And going back to your point, Tina, parents talk to the kids about all sorts of things.

If we're going to talk to our kids about firearm safety so that they don't hurt themselves physically, wouldn't it also be helpful to talk to them about safety things like suicide? I mean, we talk to them about fire safety. Right.

So this is just a safety issue, and it just makes good sense for the whole community to be having more conversations about this. I think one of the barriers is that many parents are uncomfortable having this conversation.

Many educators are uncomfortable having this conversation.

But it's not like we're disregarding that cultural value of being resilient or being a cowboy or being tough or whatever that sort of rugged identity is. Even people who are resilient, the reason they're resilient is because they know how to cope. Now, people cope differently.

And so why not expose our kids to various ways of coping so that they can figure out which one works best for them? Right?

Tina: 00:22:24

Right. And that's what one of the things that James used to always say to our daughters is. We want to make sure that you have all the tools in your toolbox.

You need to be able to pull out those tools when you need them. You may. They may sit dormant for a while. You may not need them.

Kent Corso: 00:22:41

That's exactly right. Well, we're almost out of time. I just want to ask one more question.

There might be some people listening to this podcast today who have previously thought of ending their life. Or maybe they're currently thinking about how tough life is, and maybe they're thinking about suicide.

Oftentimes, those who attempt suicide or die by suicide will say, I'm a burden to others. My family, my loved ones, they'll be so much better off without me. Are you guys better off without James?

Madelyn: 00:23:12

No. No. Every day is consumed by thinking about how much I wish he was here.

And if anybody feels like a burden, I want them to know that someone will listen and someone cares. And I wish that my dad would have. Would have leaned on me a little more.

Tina: 00:23:34

I am consumed by grief every single day, and I can't imagine living the next 20 years of my life without the person that brought so much joy to my life. So, no, no, life is not better. Life is hard every day.

Kent Corso: 00:23:59

Thank you for sharing that very raw emotion and sentiment.

We've got to get our fellow community members, citizens, friends, family, colleagues to understand that those who are left behind are left with tons of scars and complicated emotions and complicated social situations as a result of the suicide. And that's not a guilt trip. What it's saying is, this is not just about you.

And if you're having a lot of pain and you choose to end your life now, you're multiplying that pain because you're leaving all of the loved ones behind with a lot of complicated grief and other issues. So I love your message, Madeline, and that is that help is available. This is our podcast for the month of November.

And so one last thought is that it's a time to be grateful and thankful for what we have. And so I just appreciate you both for being willing to tell your story, to be brave enough to come on our podcast.

Is there any last comment you'd like to say to the audience?

Tina: 00:25:00

Seek mental health services. Utilize the people that are out there. And if you're a mental health professional, don't worry about what everybody thinks. Take care of yourself.

Because you can't take care of your patients, your clients, if you're not taking care of yourself.

Kent Corso: 00:25:21

Thanks so much, ladies. I appreciate you.

Tina: 00:25:23

Thank you.

Kent Corso: 00:25:25

Thank you for listening to this episode.

Kent Corso: 00:25:27

Of One Minute Can Save a Life.

Kent Corso: 00:25:29

Take care of yourself. Take care of your neighbor. Be bold. Ask the hard questions. Because if you don't, who else.