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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5159
Experience:  Dr. Mark is a PhD in psychology in private practice
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Hi. My best friend tried to commit suicide yesterday with

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Hi. My best friend tried to commit suicide yesterday with pills. She does have a history of depression and she has mentioned in the past she has a "suicide kit" tucked away. She had a meltdown and called me and I ran over there. She was a mess. I made her promise not to do anything and I would come back. When I returned an hour later, she obviously took something and I had to call 911, she had vomited all over the place.
I don't know what to do. Yes she's an adult, yes she's not my responsibility, but she has no one, her family lives in Arizona and are crazy.
I know she has a psychiatrist but from what I hear of them, they seem so aloof and removed when making med adjustments.
Now she's at the hospital and she's back to her old self, she has 48 hours left of a 72 hour hold.
I actually called suicide hotline and ironically enough they were not helpful at all. In fact the person was really clueless, I'm sorry to say that because I am sure they help many people but this person wasted my time actually.
I guess my question is, what am I do do if this happens again. she has no health insurance, she needs follow up care, like a psychologist. At least she called me, but what if I'm not available all the time? I truly believe part of her wants to really leave the planet, but a large part of her doesn't. I know I would never find her suicide kit, she's too clever to leave it find-able.

Let me add, this really is a friend, not myself. And I don't want to turn into a co-dependent friend, I know she's an adult and is responsible for herself and I'm not responsible, but I also feel like she can slip through the cracks so easily and become another statistic.
Also, her father committed suicide when she was a young girl, so I know it runs in the family
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 3 years ago.

Hi! I believe I can be of help with this issue.

First, I want you to know that at the end of my answer I'm going to put in an anxiety reducing technique for YOU to use when you are feeling overwhelmed by your friend's situation. It, of course, is also for sharing with your friend for when she's feeling hopeless or feeling anxiety to help her just have a minute's relief. This is something the two of you can use and know you can refer to with each other so that when she's on the verge you can tell her to do the technique until you arrive. But now to start the answer:

I do not know your standing with the hospital personnel. Your friend needs to sign a release for the doctors to talk to you. RIGHT AWAY. Why? Because BEFORE she leaves the hospital, you need to get them to help in setting up the post-hold therapeutic process for her. Otherwise, they may just let her go and get on with the next emergency they have to deal with. But you need them to have a meeting with you. You need the psychiatric ward's social worker who's the case worker here involved. You need the doctor(s) at the meeting too. The case worker will need to set this up for you. Agenda? Post-release care and procedures.

They need to switch your friend over to the outpatient unit. That means the county mental health agency that deals with non-insured people. So, you want the social worker to be instructed to help in identifying who the caseworker will be in the outpatient unit. Who the psychiatrist will be. If there is a therapist available who that will be. I recommend you call the social worker who will be the outpatient caseworker first. You want your friend in Medicaid's system. She will then be eligible to retain a psychologist as well who accepts Medicaid. So that will be your team when she's out: case worker, psychiatrist, both from the mental health agency of the county and the psychologist you need to retain.

This is a lot of work, I know. But it has to be done. If you are friendly and let them all know you understand how busy and overworked they all are and how your friend is not the worst they're seeing, and how grateful you are to them, they'll go the extra mile for you. I know: I work once a month as part of a team with these folks to stay in touch with that part of life now that I'm in private practice.

If none of that works, plan B to get her on Medicaid. You need to Google "mental health {name of your county} county {name of your state}". This should give you in the top results the name of the public mental health agency you need to contact. It goes by county. You need to call them and ask for "intake". You need to tell them her situation of suicidality and no insurance and let them help you get Medicaid or whatever state insurance you need to get as someone who can't afford insurance. You need to tell them all the symptoms you've told me and ask them for an appointment with a staff psychiatrist for evaluation. That will give the intake person the idea and then she or he will tell you what you have to do. Do this step also as soon as possible.


Let's now address some self work you can do with her. I know this sounds strange given that she MUST get psychotherapy as well as ongoing psychiatric care. But, you can still help in important ways! Don’t underestimate the value and power of self-work. The most important part of this self work is the reorienting of her view of life. Her current view is dominated by the fear, sadness, and disappointment and confusion. That domination is an attitude. I want you to reorient your attitude and thus hers to one of HOPE. Hope is not a magic potion; hope is part of confidence. I want to make sure that your confidence system is in place. Because negative thoughts and self blame can sap the confidence out of a person. Therefore, I want you to start reading motivational books with her. You need to see if she can let herself be inspired by them through your getting inspired. These are the best out there! If you can, great. It is not a magic cure, though. It is a way for you to change your mindset from "I am really sad and unworthy and lonely" to "I want to move forward and become the confident person I can be"...and as strange as you might think this suggestion is, I'm not asking of you that you succeed. You're not trying to replace therapy. You're giving your friendship something more to work on than just negatives.

I think very highly of the first book on my list, which is a real classic: The Seven Habits of Highly Effective People by Stephen Covey. It is assertiveness thinking, but it is adult thinking all the way and is the book that has helped more people than probably any other.

The second book is by Anthony Robbins. He's one of those speakers who fills up huge auditoriums. For a reason. He's a terrific speaker and writer. The particular book (if you like it, try his others): Awaken the Giant Within.

You can find both of these books easily on the internet with little investment. These books may help you refocus your attention as you deal with insurance and getting a good diagnosis and psychotherapy.



Let me finish by recommending a good workbook that I've used in my practice. Get it from the library and see if she's willing to start it with you. Here it is:

The Depression Workbook: A Guide for Living with Depression and Manic Depression by Mary Ellen Copeland. Amazon: http://www.amazon.com/Depression-Workbook-Guide-Living-Second/dp/157224268X/ref=sr_1_1?ie=UTF8&s=books&qid=1284317815&sr=8-1-catcorr

Final word: I've given you lots of tasks because I honor and respect your sincere and beautiful friendship feelings and desire to help. BUT you know the next part: your friend's getting better or not, her staying alive or not, is NOT your responsibility. You can't own her healing and you can't own her disease. It's hers. YOU can only be her friend. I wish you the very best!

Now here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from panic attacks or anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum. And this is good also for just general anxiety without panic attacks or suicidal thoughts as well. You need to do this to help you regain your footing throughout the day to keep on track through your tasks.

I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in a panic attack is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again,

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5159
Experience: Dr. Mark is a PhD in psychology in private practice
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Dr. Mark
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Dr. Mark is a PhD in psychology in private practice