Sally Buchanan-Hagen

@sally-buchanan-hagen | contributor
Sally Buchanan-Hagen is a registered nurse and works in the emergency department. She also teaches undergraduate nursing students Mental Health Nursing and is a Consumer Academic. Sally was diagnosed with bipolar type I disorder when she was 22 and is now passionate about mental health promotion. She blogs for The International Bipolar Foundation and bphope. She has also written for The Change Blog, Youth Today, upstart, and the print magazine “Better Mental Health Magazine.” Sally volunteers for the Black Dog Institute in the roles of Youth Presenter and Community Presenter.

What People Don't Understand About Living With Mental Illness

When I tell people I have bipolar disorder, some people say they “understand my experience.” This is fine if they have also been affected by mental illness. However, I can’t help but feel slightly skeptical when people tell me they understand when they haven’t been touched by mental illness. Unless you have been personally affected by it, you don’t know mental illness. You don’t know mental illness. You don’t know mental illness when I travel to all the pharmacies in my region so I don’t have to face the embarrassment of going to the same one every weekend because I have at least six prescriptions to fill. Despite these efforts, all the pharmacists still know my name, my meds and my doses. The same can be said for my local pathology clinic where all the nurses know my name, my meds and my blood tests because being on medication that can potentially be toxic requires frequent pathology. You don’t know mental illness. You don’t know mental illness when I get to the end of winter utterly relieved that I have gotten through my seasonal depression alive. You don’t know mental illness when that same relief is coupled with dismay and despair at having to increase my medications because I’m at risk of summer mania. Yet, these medications make me feel so lethargic, apathetic and flat, question what the point is because it feels similar to depression. I wonder which is worse because they sure as hell don’t feel good either way. You don’t know mental illness. You don’t know mental illness when I haven’t felt normally tired since I was 18, before things really went down hill. You don’t know mental illness when the thing I miss most is waking up refreshed because my medications make me feel groggy. You don’t know mental illness when the evening is the worst part of the day because the grogginess begins to lift, and I get a glimpse of what life is like without a foggy head. Yet, cruelly it’s also the same time of day when I have to take the medications that cause the foggy head. You don’t know mental illness. You don’t know mental illness when my friends suggest a holiday away, even a night away, and I have an internal battle between wanting to go and be a normal 26-year-old and feeling utterly terrified of going. I know that even a slight disruption to my sleep routine can make me manic. You don’t know mental illness when I hear of my friends’ big weekend, and I feel bitterly jealous. If I were to do the same, then I’d probably end up in the hospital manic. You don’t know mental illness. You don’t know mental illness when a friend or family member says, “You seem quite high lately,” when I think I have been going well. Those simple words makes my blood run cold and feel like a punch in the guts. Worse still is when strangers tell me to “smile” when I’m depressed, and I’m just congratulating myself for getting out of the house and keeping myself alive. You don’t know mental illness when I constantly feel like I am being examined as if I’m in a petri dish, and this makes me constantly assess my own actions and words until I feel like an alien in my own skin. You don’t know mental illness. You don’t know mental illness when the side effects of medications that impact other areas of my health have already begun. You don’t know mental illness when I work hard every day to stay physically fit, but I already have high cholesterol and an underactive thyroid. So at 26, I need to manage health conditions a 26-year-old shouldn’t have to manage, even though to the unknowing person I appear to be in pretty good shape. You don’t know mental illness. You don’t know mental illness when I still have recurring nightmares about the hallucinations I had when I was psychotically depressed more than two years ago. Some nights, I dread going to sleep. You don’t know mental illness when I sleep on my mother’s bedroom floor when I’m suicidal so I feel safe because I know I won’t hurt myself through the night. You don’t know mental illness. You don’t know mental illness when people lower their expectations of you purely for having a medical condition. You don’t know mental illness when it takes the things you love like travel, work, friends and partners. You don’t know mental illness when it takes away the one thing you felt sure about, the one thing you could rely on, the one thing you could trust, yourself. You don’t know mental illness, and you’re lucky. If you or someone you know needs help, visit our suicide prevention resources page. If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741 . We want to hear your story. Become a Mighty contributor here. Image via Thinkstock.

What Bipolar Disorder Recovery Looks Like for Me

Recovery. It’s a word used a lot in the mental health world. Ask anyone — psychiatrists, psychologists, counselors, family and consumers — sustained recovery from an episode of mental illness is what we all strive for. However, what does “recovery” look like? No person’s recovery is going to be the same; therefore, no recovery goal is going to be the same. I have bipolar disorder, and unfortunately, I am in the group of people who don’t respond that well to medication. Medication can stop the great peaks of manic elation and decrease the time spent in the most despairing depths of depression, but for me, it is not a miracle cure, and I still get residual symptoms. In an ideal world, everyone would love for my recovery to mean the cessation of all manic and depressive symptoms — for me to be constantly euthymic (stable) — but we don’t live in an ideal world. For that to happen, I would have to be on a lot more medication with higher doses. I’ve been down that road before, and for me, the side effects don’t allow for much quality of life. Instead, my recovery goal isn’t to banish the symptoms completely, but to live with the ones medication can’t get rid of. In all honesty, if I did have the option to banish all of my symptoms, I’m not sure I would take it. I’ve lived for so long with ups and downs that I’m used to that way of life. For a long time, what I thought was my “normal” self was actually my hypomanic self. It’s confronting when the person you thought you were turns out to be an unwell version of you. New approaches to recovery in mental health are person-centered, which is about what the individual person wants for their recovery. Previously it was thought that if someone with mental illness was completely symptom-free, they were in recovery. Now it is recognized that this isn’t necessarily the case. As I said previously, if I were to live a life free of symptoms, I would have to be over-medicated, miss out on the social life of a 25-year old and have a decreased capacity to work and study. I bet I’m not alone in this scenario. What’s the point of being symptom-free if you have no quality of life? Is it any wonder some people aren’t always concordant with treatment? Instead, a happy medium has to be reached so we can live to our full potential. For this to happen, there has to be a dialogue between you and your treating professionals as well as the loved ones involved in your care. Let your health professionals know what you want for your recovery and explain this to your loved ones so they know what to accept as part of your recovery. Having everyone on the same page can increase compliance, support and ultimately happiness. I recently had that conversation with my family. What I want from my treatment is little peaks and troughs. Since the age of 14, I have lived with cycles of depression, so “mild” depression for me is manageable. When I am hypomanic, I function better than normal. Before I was diagnosed, I would instinctively fit my life around my mood cycles — accomplishing as much as I could when I had high energy levels to compensate and prepare for the times of low energy. This is who I am. I am a person who is all-or-nothing. I am someone who lives life fast-paced and with passion, but I am also someone who experiences great apathy or melancholy. I am not a person who sits constantly at baseline. I don’t want to get off my “roller coaster” completely, I just want to switch to a less extreme and more controllable one so I can still enjoy life and feel like myself. Obviously this scares my family. They’re scared of the elevation turning into full-blown mania where I lose insight and become psychotic. They’re scared of the severe depressions that last for months and that can potentially kill me. However, they also want the best for me and for me to be happy. After a lengthy discussion and re-evaluating the early warning signs that indicate things are getting out of hand, we agreed on what I want from my recovery. Having clear expectations of what you want from your recovery and letting everyone know these expectations means you can all work towards your goal together. I think the most important thing about recovery is recovering your quality of life. It’s your recovery, and as long as you are happy, functioning and safe, that’s all that matters. Editor’s note: This is based on one person’s experiences and should not be taken as medical advice. Consult a doctor or medical professional for any questions or concerns you have. Image via Thinkstock Images

Tips for Visiting Someone in a Psychiatric Hospital

I’m writing while I’m recovering from a manic episode. This means I’m no longer psychotic or severely manic. I’m still in hospital because we’re in the process of changing back to my old medication regime, my sleep cycle needs work and there’s the risk of “manic misadventure.” We’re “fine-tuning” everything so I have a successful and long recovery/remission out in the community. During my past hospitalizations, I’ve identified some “do’s” and “don’ts” when it comes to visiting (or not visiting) loved ones in hospital, and I’ve put them together in a rough guide. As everyone is different, I would like to point out this is how I like to be treated, and it’s always important to gauge the patient’s individual situation when visiting them. Don’ts: 1. Don’t show up unannounced. Like with physical illnesses it can be tiring having visitors. Particularly if you’re depressed and just need time to yourself. But… 2. Don’t make yourself scarce. Don’t be afraid to message or ring the patient if you can’t get to the hospital. Send cards or flowers to let them know you’re thinking of them. Psychiatric hospitals can be intimating and visiting someone in a psychiatric hospital can be confronting, but this is not an excuse not to visit (besides psychiatric hospital aren’t scary, they’re just normal hospitals with normal patients). During my first manic episode, two of my good friends hardly visited for two months, which really hurt. The hospital can be lonely and boring, so getting visitors is always the highlight of the day. (I would like to point out that those two friends have been fabulous during this manic episode.) 3. Don’t pity the patient. I don’t want pity. I want empathy and at times I want sympathy, but I don’t want anyone to pity me. Pity can feed the ruminating spiral of depressive negativity and puts a wet blanket on resilience. Yes, having bipolar can be difficult at times, but it is manageable and I normally live a rich and fulfilling life. So please, no pity parties. 4. Don’t act like the patient is a different person or what they have is contagious. This is very insulting. 5. Don’t blame the person for being in hospital. No one wants to be so unwell they have to be in hospital. It’s no one’s fault, but the guilt of this can still be crushing. Dos: 1. Do visit when you can, but always ask the patient if they’re up for it. Visitors are a source of support and they break up the monotony of the daily hospital routine. I love getting visitors. 2. Do send flowers and cards. Not only is it a nice gesture and brightens the room, but is normalizes the experience of being in a hospital as a psychiatric patient (in this day and age there should be no difference between how psychiatric and physical patients are treated, but that’s a whole other blog topic). 3. Do ask if they need anything while in the hospital like magazines, a favorite snack or if a simple job needs to be done around the house. Continue that care when they’re initially out of hospital like you would for someone with a broken leg. It’s hard getting back on your feet and into your regular routine once you’ve been discharged, so a little extra help is often needed. You don’t need to spend all of your time caring for the person, but little thoughtful gestures go a long way. 4. Do bring fun activities into the hospital. As I said, hospital can be pretty boring. I don’t know how many hours I whittled away playing monopoly or cards with friends, or just coloring on my own. These help to pass the time. Of course, some patients may not be up to playing games, it just depends on the patient’s current situation. 5. Do validate! Never underestimate the power of validation. If someone is depressed, instead of responding with pity or an upbeat (and often corny) saying, say: “That sounds really tough” or something similar. If someone is psychotic, then their psychosis is as real to them as whatever’s going on in your life. Don’t dismiss it. Listen to them and take what they have to say seriously. 6. Do treat the person the same as you would when they’re well. Your loved one is still in there and no matter how unwell they are, they will know if you’re treating them differently. When I’m psychotic, although I lose touch with reality, I still retain my intelligence and empathy and I can tell if people are treating me differently. When they do, it makes you feel misunderstood, isolated, paranoid and alone. 7. Do acknowledge we’re unwell, stay in touch and offer to help out. The biggest detriment to us when we’re unwell is silence — like our mental illness is taboo. Silence adds to stigma and prevents people seeking early treatment, or stops them from seeking it at all. Ask how we’re feeling like how you would ask someone who has pneumonia how they’re feeling. Ask genuine and honest questions with interest. Sometimes questions are all that’s needed for us to open up. Again, just simply talking about mental illness normalizes it. We don’t want our condition to be swept under the rug it when it flares up. We want to talk about it with the people we trust. And finally… 8. Do treat mental illness the same as physical illness! After all mental illness is a physical illness – it just occurs in the brain. If you treat the patient with compassion, unwavering love and support, humor (again, gauge the situation) and show genuine, non-judgmental interest in what they’re experiencing, they’ll feel supported and loved. And in the end, that’s what we all want when we’re unwell. Sally, during one of her hospitalizations. This piece originally appeared on the International Bipolar Foundation’s blog. The Mighty is asking the following: Create a list-style story of your choice in regards to disability, disease or illness. It can be lighthearted and funny or more serious — whatever inspires you. Be sure to include at least one intro paragraph for your list. If you’d like to participate, please send a blog post to community@themighty.com. Please include a photo for the piece, a photo of yourself and 1-2 sentence bio. Check out our Submit a Story page for more about our submission guidelines.

Mental Illness Is Not a Trend

There is one thing that really makes me angry, and that is how mental illness is wrongly portrayed in the media. Usually people with mental illness are painted as incapable of living a “normal” life, that they’re a bit odd and don’t fit in with society. Most commonly and most dangerously, people with mental illness are depicted as frightening and violent. Of course, this makes me frustrated because I know these portrayals are untrue and add to the stigma we fight hard to eliminate. But recently, new depictions of those with mental illness show movie and TV characters as eccentric geniuses, desirably quirky, cute and vulnerable, or that their mental illness is a trendy fashion accessory. While this is better than stereotyping people with mental illness as violent, this still makes me angry because it trivializes mental illness. It’s also dangerous, but in a different way — it makes an undesirable health condition seem desirable and even an advantageous trait. Though I live a “normal” and successful life as someone with a mental illness, I can tell you, mental illness is not desirable. Mental illness is not trendy or glamorous. Mental illness is devastating, debilitating and deadly. I have bipolar affective disorder, which means I have episodes of depression and episodes of mania. I have periods of stability in-between episodes. I’m only 25, but I have had a tumultuous few years thanks to my mental illness, involving suicidal depressions, psychotic manias, long hospital stays and electroconvulsive therapy. I would give anything to have a life without these interruptions and to not have to worry about how my illness may impact my future. Mental illness is not something to be desired. There is nothing trendy in not washing for days or not being able to get out of bed. There is nothing to be desired when your thoughts are going so fast it is scary and you cannot concentrate, or when you talk with such speed that no one can understand you. It is not attractive when the only legal thing that immediately slows you down is a cigarette. Neither is waking up hung-over because you drank yourself into oblivion the night before. The hospital is not trendy. It is a facility to keep people from intentionally or unintentionally harming themselves. It is not glamorous to spend weeks in hospital; it is upsetting because you have to put everything on hold. The public breakdowns are not cute; they’re embarrassing. During various hospitalizations I have been so agitated I tried to break windows, tried to escape, paced for hours, cried hysterically, lay comatose on the floor and was sedated and put in seclusion. I assure you the distress I felt was not trendy. The constant fighting with family when unwell is not glamorous and neither is feeling alone. As hard as loved ones try, no one can completely understand how hard it is to live with mental illness. This loneliness can feel like isolation at times. The crying is not cute. Crying so hard that your eyes become puffy, that you have snot pouring down your chin, that your sobs turn into grunts and your body uncontrollably shakes is unattractive. And this crying can go on for days and nights. Having to take medications to function is not “hip.” It can take years to find the right medication and the side effects can be terrible. It is not trendy to be unable to walk straight, to have double vision, to have vivid nightmares, to always have a dry mouth, to feel sedated, to wake-up every night drenched in sweat, to have wild tremors and to have your head down a toilet continuously vomiting. Being talked down from the edge of a cliff is not trendy; it is soul-destroying for everyone involved. It is not cute to lose touch with reality. It was not cute to see things nobody else could; it was confusing and disturbing to say the least. The paranoia is not quirky; it is downright scary when you think people are following you, so you don’t trust anyone – especially those who are trying to help. Those times were not fun and I was not being eccentric, I was severely unwell. The terror that mental illness brings is not trendy; it is real. There are no words that can describe what it is like to be in the suffocating grips of an acute episode of a mental illness. There is nothing trendy for family members who have to care for loved ones struggling with mental illness. There is nothing glamorous about the destruction that mental illness brings. The reality of mental illness is destroyed relationships, job losses, financial losses, disrupted studies, lost futures and lost lives. There is nothing trendy in the stigma and discrimination sufferers of mental illness still face; it is unfair and a disgrace. Portraying people with mental illness as dangerous only contributes to the stigma and makes the fight for fairness harder. But portraying mental illness as trendy or as a cute quirk trivializes the damaging experiences of suffers — it’s an untrue representation of the devastation mental illness can cause. Mental illness has the potential to kill, and there’s nothing trendy about that. The Mighty is asking the following: Tell us a story about a time you encountered a commonly held misconception about your mental illness. How did you react, and what do you want to tell people who hold his misconception? If you’d like to participate, please send a blog post to community@themighty.com. Please include a photo for the piece, a photo of yourself and 1-2 sentence bio. Check out our Submit a Story page for more about our submission guidelines.

What It's Really Like to Experience Psychosis

It started off as fun. Everything was easy, everything was magical and everything was glorious. It was this magnificent euphoria that clouded my decent into a furious psychosis. I found myself in a psychiatric hospital, where I remained for two months. That was my first psychotic manic episode. I have bipolar affective disorder, a psychiatric condition characterized by uncontrollable and extreme mood swings. Typically sufferers swing from mania to depression and some, like me, can become psychotic when experiencing these extreme moods. Psychosis causes people to lose touch with reality, resulting in confused thinking, delusions (false beliefs) and hallucinations (seeing, hearing, smelling and tasting things that aren’t really there). Three in 100 people will experience psychosis at some point in their lives. Psychosis doesn’t discriminate. *Sign up for our Mental Health Newsletter* I have been psychotic three times: twice when manic and once when depressed. Although each time was extremely different from one another, they were all frightening. The psychosis crept up on me during each manic episode. Both times, everything was exhilarating and fast-paced — I felt like I was on top of the world, and I believed it, too. My euphoria was uncontainable and most of the time it felt like my chest would explode to sweep everyone up in my unbridled elation. I was unstoppable and no one could tell me otherwise. I thought I was incredibly intelligent, funny, creative and brilliant. I started to believe I was a creative genius. I spent all night filling book after book with poems, lyrics and drawings and spent all day writing music. I was obsessed with the mysteries of the universe and was convinced I could solve them all. The beauty and wonder of the night sky would make my mind boggle unbearably. However, these delusions of grandiosity soon turned menacing and deadly. During my first manic episode, I thought nothing was real and that everything was a dream. I started to hallucinate and could see each individual atom. I could also see a middle-aged man dressed in a tattered suit that no one else could. He looked like he had come right out of the 1920’s and I thought he was my ghost of a guardian angel. At the time I didn’t know they were hallucinations. I felt so confused, isolated, misunderstood and out of control I became suicidal. It wasn’t long before I was hospitalized. Very soon after being admitted and treated the psychosis thankfully cleared up. Recently, I had a second manic episode that also included psychosis. This time I thought I could see people’s auras and that I could heal people if their auras seemed “sick.” A voice told me wonderful things, one of them was that I could fly and to do this I had to jump from a great height. I believed this. Needless to say I was hospitalized for five weeks. I wish I could say I have only experienced hallucinations twice, but I haven’t. During one particularly severe episode of depression I had visual hallucinations and though they were awful and revolved around death, I knew they were hallucinations. The hallucinations also came on suddenly. However, I was delusional and paranoid. I thought people could hear my thoughts. Again, I was admitted into hospital and again, the psychosis quickly cleared. Psychosis is poorly understood by the general public and this leads sufferers to experience stigma and discrimination. Adding to the stigma, films and TV shows often misrepresent what psychosis is really like, making it something to be feared. I was guilty of not having an accurate understanding of psychosis. However, that quickly changed after my first psychotic episode. Although for a small portion of that time I may have been feared, I can guarantee I was the one who was terrified. Terrified of the unpredictable turmoil in my head, I would have harmed myself well before harming others. Unfortunately the stigma attached to psychosis can prevent people seeking help because they are too embarrassed or ashamed. Untreated psychosis can cause further psychological decline, and in some cases, people may become depressed and suicidal, like I did. The longer psychosis continues, the harder it becomes to treat. However that’s not say it can’t be, and with proper help most  cases can be effectively treated. It was awful to experience psychosis and I wouldn’t wish it upon my worst enemy. However, because I was treated quickly and effectively, the psychosis was fleeting and hasn’t troubled me since. There are many who have had similar experiences and you probably wouldn’t know it. So next time you see someone who might be experiencing psychotic symptoms, put yourself in their shoes. They’re probably scared and confused and in need of care, not judgement. If you or someone you know needs help, please visit the National Suicide Prevention Lifeline. You can also reach the Crisis Text Line by texting “START” to 741-741. Head here for a list of crisis centers around the world. The Crisis Text Line is looking for volunteers! If you’re interesting in becoming a Crisis Counselor, you can learn more information here. The Mighty is asking the following: For someone who doesn’t understand what it’s like to have your mental illness, describe what it’s like to be in your head for a day. If you’d like to participate, please send a blog post to mentalhealth@themighty.com. Please include a photo for the piece, a photo of yourself and 1-2 sentence bio. Check out our Submit a Story page for more about our submission guidelines.

When Having a Mental Illness Is a Full-Time Job

Growing up, I had plenty of aspirations — and it looked like I would achieve them all. I was going to complete my bachelor of nursing, do an honor’s degree, do post-graduate studies in critical care and eventually move into academia and education. Now, my only aspiration is to remain well. Let me tell you a bit about myself: I’m 25. I have a bachelor’s degree in nursing. I’ve worked as a nurse for four years and I’m currently completing an honor’s degree. I write for several blogs and online magazines. I volunteer as a Youth Presenter and Community Presenter for a mental health organization. I also receive a disability pension for my mental illness. 2013 was a big year for me. I landed my dream job in the emergency department, was doing well with my studies and was on track with my career plans. That year, I was also diagnosed with bipolar disorder and my world turned upside down. I was 22. Bipolar disorder had taken over my entire life. My career was not only put on hold, but it crumbled before my eyes. I was hospitalized three times due to episodes of mania and depression. In a 14-month period, I had spent roughly five months in a psychiatric hospital. In between my hospitalizations I did return to work, but the work wasn’t good for my mental health. The late nights, early starts and night-shifts either fuelled my mania during times of elevation or were impossible when I was depressed. I was constantly swinging from one mood state to another. Eventually I had to resign from my position because my work couldn’t accommodate my health needs. I worked casually as a nurse, but I didn’t get many shifts. My mental health still suffered. At the start of this year I ran out of money and had no choice but to apply for a disability pension. When I was first diagnosed with bipolar disorder, it was suggested I go on a disability pension. I refused because I didn’t want to be a societal burden (the stigma attached to receiving government payments); I wanted to contribute to my community by working. But managing a mental illness is a full-time job — only you can’t clock-out and don’t get weekends off. It’s around the clock, seven days a week. I can’t hand off my symptoms to someone else after eight hours. My bipolar keeps me up at night or keeps me bed-bound. It can make me psychotic, paranoid and suicidal. Keeping myself well and working hard to avoid the deadly consequences my disease can bring takes a huge amount of my energy and time. Believe me, I would love to be able to work like most people. It would mean there was nothing wrong. The application process for a disability pension was not easy. It took over 100 days before my paperwork was reviewed. It took many more weeks of degrading meetings and appointments so they could assess my “level of disability” (despite many medical certificates from my psychiatrist, psychologist and general practitioner) until it was approved. If it weren’t for my parents I would probably be homeless. They provided me with a roof over my head and food (and continue to do so). I’m in financial debt to them because they made my necessary payments when I didn’t have the money. They did a lot of the groundwork for my disability pension because most of the time I was too unwell to deal with it myself. I shudder to think how people without support systems cope. I’m not sure they do. So what do I do with my time? I keep myself busy by working on my thesis, volunteering and writing for online sources. Most importantly, I keep myself well so I can become independent. I just recently stopped grieving the career I had planned. Though I’m fortunate receiving government payments will probably only be temporary for me, many others can’t say the same. Relying on government payments is not fun. It’s a hard battle to stay afloat, and I’m sure many would agree they’d rather be making their own money. For me, being on a disability pension reminds me of my mental illness and my lost of potential. Still, I work hard everyday to establish a new future – a future where I won’t be on a disability pension. And I’m grateful to say that future is probably not far off. Note: Since time of writing, I’ve returned to do weekly/fortnightly casual shifts as a nurse in my emergency department. However, I’m still dependant on my disability pension for financial support.

Nurse Speaks Up About How Suicide Is Discussed in the ER

As a nurse working in the emergency department, I frequently see people come in for suicide attempts. I’ve noticed there’s a stigma surrounding some attempts, and many colleagues agree there’s a difference in the way patients are treated depending on the type of attempt. From what I’ve seen, a patient whose attempt is more “serious,” with visible life-threatening injuries or potentially deadly pathology results, is more likely to be treated with understanding, compassion and patience. It’s as if serious injuries validate the mental illness, making the inner turmoil visible to the outside world. But the “less serious” the attempt is (for example, taking a non-lethal amount of medication or self-inflicted injuries that aren’t fatal), the less sympathy I’ve seen patients receive. This can also be said for patients who have repeat suicide attempts. I’ve heard these patients referred to as “ time-wasters,” “attention-seekers,” “ t aking up beds,” and they’re described as “crying out for help.” Although it’s acknowledged as wrong, there’s still anger and frustration felt towards the patient. I’ve heard many question the reason for their behavior. But I believe anyone who intentionally puts themselves in harm’s way needs help, regardless of the intended outcome, and are still entitled to be treated with dignity, understanding and kindness. When I was 23, I tried to jump off a cliff after being discharged from a psychiatric hospital. I have bipolar affective disorder . I rarely call this a suicide attempt, although I would’ve jumped if it weren’t for a person walking past. If that person didn’t talk me down from the edge I wouldn’t be here today. I didn’t end up in an emergency department that night; instead the person called the local psychiatric triage team for advice and made sure I got home safely. The next morning my psychiatrist arranged for me to have electroconvulsive therapy (ECT). I was determined to take my life. However, just because I didn’t end up in the emergency department didn’t make my determination to kill myself less serious. For weeks afterwards I remained suicidal. It’s because of my wonderful family and excellent psychiatrist I got through those weeks alive. According to the World Health Organization,  800,000 people die by suicide every year, and for every successful suicide there are many more people who attempt it. About 20 percent of people who die by suicide have made a prior suicide attempt. But the  stigma attached to suicide can be isolating and discourages help-seeking behaviors. When I was suicidal I was too embarrassed to ask for help from emergency services because I thought I would be judged. That night I stood on the cliff, dying seemed like the only way out. Like a lot of suicidal behaviors, the decision was driven by desperation and impulsivity. The method didn’t matter — only the end result. I was only seconds from death. By complete luck I survived that depression. In seems people are fearful if we talk about suicide we’ll trigger risky behaviors. But if we don’t talk about it, how are we going to understand it? If we don’t understand it, how can we be compassionate and empathetic? And if we don’t treat those at risk with compassion and empathy, how do we expect them to seek help? Most importantly, we need to make it known reaching out for help is one of the bravest and best things someone can do. I’ve heard nurses say it’s “heartbreaking” when patients die from a suicide attempt. But what’s more heartbreaking is how often I hear families say the person they lost had been “been unhappy for a long time’” or that “they tried suicide before.” We need to talk about suicide to offer people hope. The courage it takes to reach out must be recognized. Every suicide attempt needs to be taken seriously. People don’t kill themselves, mental illness does. The sooner we start understanding this, the sooner we can combat the stigma surrounding suicide. Decreasing stigma encourages help-seeking behaviors and leads to more widespread and compassionate treatment for those who need it. And this treatment needs to be available for everyone however long they need, not just for the people who end up with serious injuries in the emergency department. If you or someone you know needs help, see our suicide prevention resources. If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.