113 is a Dutch organisation that helps prevent suicide, an important cause for Movember. We spoke to director and psychiatrist Jan Mokkenstorm about dealing with suicidal thoughts, both for those who have them, and their family and friends.
What made you think of starting 113? “I used to work at the intensive, acute psychiatry ward at GGZinGeest. You meet people there that feel completely disoriented, often with suicidal tendencies. Sometimes we would lose people, despite all our attempts to help them. It was really rough for everyone, including the people who were trying to help. I would ask myself: Couldn’t this have been prevented? That was a difficult question to deal with, because the prevailing mindset was that ‘accidents happen’. The idea was that psychiatrists could help, but couldn’t actually make a difference. Now I think very differently about that situation. After doing several training courses in the US I learned what’s really going on in people’s minds when they think of committing suicide, and how you can get in touch with them”.
Can you explain what’s going on their minds? “Let me make a frivolous comparison, that will certainly resonate with men. People cheat on their partners, because they find something that they’re missing with their partner. That experience may lead to the person wanting to talk about that with their partner. But if they talk about it, they run the risk of losing their partner. People who are thinking of suicide are flirting with death, as an alternative to living. That flirting becomes a bigger problem, and the only way to break the cycle is by making it ok to talk about it. Returning to our example: When someone is cheating, people around that person tell them to simply stop doing it. The person who is cheating will feel ashamed, and be afraid that people will be angry with them. The same is true for people who are thinking of committing suicide.”
Accepting his patients’ suicide was not an option for Jan. He felt the answer could be found in working with family members and close friends to set up a support network and make suicide a safe topic of conversation. “I got acquainted with the concept of zero suicide. This may sound like a utopian dream, but let me share a couple of examples why it’s not so far-fetched. Imagine you could take a flight to the US for only 25 euros, but chances are 1 in 200 that the plane will crash. No one would take that flight. That’s why airlines take all the necessary precautions to reduce the risks. The same goes for the construction industry, where regulations ensure that we build safely. Everything that’s below an optimal solution will be optimised”.
A bigger issue than traffic accidents
”In the Netherlands we are ahead in the field of e-health”, says Jan. “Nine years ago we took advantage of that and started something for suicide prevention. Back then BNN hosted the Big Donor Show featuring a terminally ill woman who would give away her kidney to one of the three kidney patients in the studio. The show was a stunt to draw attention to a very serious problem, and the organ donation never took place. After this stunt we also received a lot of attention and were awarded with a prize by the Ministry of Health – but due to the economic crisis, the same ministry had to cut costs elsewhere”. “In the Netherlands people suicide causes 3.5 times more deaths than traffic accidents. That’s more than the number of people who died in the Big Flood in 1953. That means we have a Big Flood in the Netherlands every single year, and we need to stop it!”
Talking at work
”In our society we tend to talk about what’s going well, not about what doesn’t. It’s the same at work – when you hear about deaths from suicide, colleagues are always surprised. Together with Deloitte we started the Corporate Depression and Suicide Prevention Lab, which helps make depression and suicide an acceptable topic of conversation at work. Men particularly tend to have hard time talking about it. Men commit suicide three times more than women and are 3x less likely to seek help. That’s especially the case for middle-aged men (40+). We even started training barbers, so they can talk to their customers – because many men find it easier to talk in a barber shop. We’re doing the same for taxi drivers. We see a lot of suicide attempts in the LGBT community, where the rate of suicide attempts is four times higher than the national average. We had a boat at Pride (previously Gay Pride) this year, and behind us was Mr. B, a shop that sells fetish sex items. Afterwards they came to us and asked if we could train them in starting a conversation with their customers about suicidal tendencies. Obviously we were happy to do that!”
It sounds like you’re active on many fronts. How would you describe your values exactly? “Until February we were called 113Online, now we’re called 113 Suicide Prevention. We’re coordinating with the National Agenda Suicide Prevention, and are looking for opportunities to collaborate, conduct research and try to influence the media agenda.” How are you helping family and friends of those who suffer from suicidal tendencies? “On our website you can contact us and book a meeting with a trained professional. I wrote a book about it myself in Dutch. The most important thing is to continue playing the role you already have - don’t try to be the psychologist, but be the parent, friend or girlfriend you already are, who also shows understanding. The most important thing is to continue asking whether that person really is thinking about suicide. Don’t say that he or she shouldn’t do it, because then you’ll run into the risk that the person won’t communicate openly and honestly to you anymore. Show that you understand that the person is suffering from his or her thoughts and seek help together.”
Movember, men and suicide prevention
Suicide prevention is still a relatively new cause for Movember. What do you think of this addition? “I obviously think it’s great and important. When you speak about men’s health, mental health can’t be forgotten. And by growing your moustache you’re showing the world that you care about the cause. That’s really spot on!”
What makes fighting mental problems more difficult than physical problems? “Let me start by removing that misunderstanding: treatments for depression are actually more effective than treatment for high blood pressure. The problem is that this treatment often doesn’t start. Many people also don’t know where to go with their problems. The biggest problem is the stigma, the shame. Mental health problems say something about who you are, and what you are. It triggers the idea that you could have done something about it. People think that it’s their own fault and they are losers. Men find it especially hard to feel like failures. Therapy is mostly based on feelings and you could wonder if men feel comfortable with that. The US Army had the slogan ‘Therapy Helps’. Only when that was changed to ‘Therapy Works’, did men start looking for help. Men want a practical solution, something that generates results. That’s why I think it’s very important for men to run. Often running solves more than three consultations can do.”
What else could Movember do to stimulate the conversation? “I would be very specific in my communication. Testicular and prostate cancer are more specific than cancer. So speak about suicide with men.” Do you think it’s harder to speak about these topics with men than with women? “Men can speak about feelings, just not about feelings they don’t have. Of course men feel sadness, happiness and they can have hard feelings. What’s important is that you speak the language of the men in front of you. Be actionable, loud and clear. So, as Movember, be clear and say what this is really all about. People are dying because of suicide, that’s the point!”
Recognising a problem
We all suffer from a bad day every now and then, and sometimes that feeling can last longer. How can we recognise the difference between a temporary problem and a much bigger issue? “The easiest way is when someone openly gives hints. When someone says ‘I don’t really want this life anymore’ or ‘I don’t know if I will be around then’. People will drop something in conversation for someone else to pick up on. Sometimes people demonstrate behaviours that are unusual or uncharacteristic. For instance, they may be very sad, look dead tired, or sick like they’re dying. The opposite is also possible. People who have been very sad for a long time, may be extremely positive all of a sudden. They can start a nice conversation with you and thank you openly. Those can be farewell tours to give all they’ve got for one last time. And lastly, there are people who can be reckless, by drunk-driving a motorcycle for instance, or starting a fight. But those are just examples, and you should always remember that there’s no such thing as a checklist, not even for experts. Keep these examples in mind when you’re in doubt, and just ask openly and honestly: are you thinking about suicide? People are afraid that they may come across as interfering in someone else’s business or crossing boundaries that shouldn’t be crossed. But believe me, I have never heard one of my patients say that they had a problem with that behaviour.”
Talking to 113
Why would people talk to 113 instead of, for instance, with family or friends? “It’s good to have a place to fall back on; someone who doesn’t feel insulted or won’t create drama. We will never ask things like ‘but do you not love your children?’ We can listen and also provide professional confidentiality. But family and friends are needed to provide context, for instance by saying ‘he may seem fine, but normally around this time he would be sleeping’. I spoke about this with friends, who I thought might suffer from thoughts of suicide. They would say ‘you are a psychiatrist, so I prefer not to talk to you’. They all found someone to talk to in the end, and that worked out fine. The road can be tough, so my advice is to seek professional help, for your own safety.” What would you like to say to the Movember participants or the Movember Run Amsterdam participants? “First of all, thanks for doing this! Moving is a great remedy, but now take the next step to ask that important question. You will see that it works! Want to learn more? Check out 113.nl.