Ruth Cassidy, LCSW, MDiv, is the Suicide Prevention Program Manager and Senior Policy Analyst for the US Navy Office of Force Resilience/ OPNAV N17. She is responsible for coordinating and advising on the development and implementation of suicide prevention policy, programs, training, analysis, and communication; providing program guidance and ensuring compliance with existing policies and DoD Directives. Ruth represents the Navy with DoD, DoN and other agencies in development, implementation, quality assurance and evaluation of Navy-wide Suicide Prevention Programs.
 

Prior to joining the Navy she was Lead Suicide Prevention Coordinator at the Central Texas Veterans Health Care System where she coordinated care, case management and outreach to high risk Veterans; speaking, training extensively within the VA, with federal, for profit and non-profit partners as a subject matter expert; as well as local and national social work conferences. Clinically, Ruth has worked extensively with combat, severely injured and high risk for suicide Veterans in case management, program development and coordination, group and individual therapy in both outpatient and residential settings. Currently she practices Equine Assisted Psychotherapy in trauma informed care in private practice.

Ruth received her masters in social work and master of divinity from Baylor University, Waco, Texas.

 

An Interview with Instructor Ruth Cassidy

(Edited for clarity and brevity)

 

Ruth Cassidy: “When I think about suicide prevention, I think about it in terms of which groups are at risk—what groups are we talking about—because what will be effective with helping prevent suicide can be very at-risk-group-specific. There are some overall themes, but, for instance, … with the VA [Veterans Administration], it's men age 55 and older and then combat veterans, who are now a bit older than when I was serving them.

 

“So [in terms of more-at-risk cohorts], it's younger people, then there's a gap, and then there's 55+. And what you do around preventative theory and measures are sometimes different for each of those groups.

 

“The other thing I think about is the very odd statistic that a large percentage of folks who take their life do not have mental health diagnoses, nor when we go back and do a suicide death review, can we in hindsight, attribute a mental health diagnosis to the person who took their life. Those are some conundrums.

 

“The theory would be, if somebody takes their life, they're struggling with depression; they're isolating; their catastrophizing; they have distorted cognitive dissonance, blah, blah, blah. [But] we have to look at the group we're talking about….

 

“Gen Z, which is a chunk of folks who take their lives right now, is very open to mental health care. They're very open to talking about their struggles. But they've never had to wait for anything in their lives, and they don't know that feelings change. They are very impulsive. When they take their life, there often isn't even a note.”

 

What is the first thing you want social workers to know in terms of their role in helping to address suicide rates and to best treat clients at high risk?

 

“I would say, ‘You're never in a session--whether it's intake, whether it's the final termination--where you're not doing safety assessment at some point in the conversation.’ So number one, do the safety assessment and ask the question, ‘Are you feeling suicidal? Are you feeling like you'd like to die?’ Not ‘Are you safe?’ Not ‘Are you going to hurt yourself?’ It is ‘Are you thinking about taking your life?’

 

“And you do a form of that every session and chart it. Then second, you know how to do a safety plan, which is very easy. Third, you know how to comfortably and competently talk to somebody about their firearm storage. Those are all things that sewist that social workers are not taught in school, so I will be covering those gaps in the training.”

 

What do you hope training registrants take away from your course?

 

“…. This is not a standard suicide prevention training for clinicians. It's really a mutual conversation, … like asking how do we make this a conversation amongst clinicians and what do you have to sort out in your own life…. It's a course that is very personal in talking to clinicians about where they are in their life with their faith practices, what their cultural norms are, and [whether] you can be present with a client who is struggling.”

Is there any new research about how to prevent suicide specifically for Gen Z clients?

 

“This is striking. There are two evidence-based practices that decrease suicide. One is CBT for suicide. The other is secure firearms storage. Those continue to be the most effective ways to get at suicide prevention right now--secure firearm storage. [And remember,] suicide is not a diagnosis.”

 

Do you think high suicide rates are due primarily to outcomes traceable to the pandemic?

 

“No, I don't think the pandemic has much to do with it. When you think about suicide and the increased risk factors, you need to pick a specific group to look at, so we can talk about their specific risk factors. Isolation did not help. There's no question. But for instance, the military did not have an increase in suicide during COVID. I'm not an expert on young kids and suicide, so I can't speak intelligently to that, but I don't think that in the areas that I'm skilled in--veterans, the young and the old, as well as Gen Z--I don't think that COVID is one of the reasons, and I don't actually think there was an increase in suicide in the U.S. general population.”

 

What other factors such as maybe social media seem to be playing into suicide trends in the different cohorts?

 

“Social media is a tough one. The role of shame in the Gen Z folks that take their life [is powerful]. They don't know that shame passes, don’t know that feelings change.

 

“Shame absolutely plays a role in military suicides as well. Social media can exacerbate the shame, but most suicide is a result of coping mechanisms being swamped. You have a series of coping mechanisms, whether you know to call them that or not, and any one of us could get into a position where we get swamped, and our coping mechanisms aren't functioning. Unfortunately, with Gen Z, suicide is one of their coping mechanisms…. Some of it is cultural. Some of it is impulsivity. Some of it is a severe lack of emotional intelligence training, both in the home and in school.”

 

And have you been surprised at any recent suicide trends in the past year or why some clients turn to such drastic action?

 

“Again, I don't think the rates have gone up that much in the last year. I think if you've never been to a very dark place, you're like, ‘How could this be the answer? Why a permanent answer to a temporary problem?’

 

“… Well, sometimes your thyroid is off or other things, and your world goes black, and depression lies to you. Depression says to you, ‘You’re never going to be better. You're never going to feel good again. There's nothing you can do. The only way to stop your pain is to take your life.’ So some of it is a mental health challenge….

 

“If you ask some of the older researchers at a conference, they'll say, ‘People, the answer to suicide is relationships, relationships, relationships. Our capacity to connect people and our capacity to know and be known, increases the likelihood that you'll tell someone the truth about how you're feeling, even if it's impulsive.’”

 

Your background is extensively with military families and veterans. Do you find there are certain approaches or treatments that work better with this clientele in terms of suicide prevention?

 

“One of the things Gen Z has taught us is to identify who the influencers are and use them as your communications tool. Gen Z in the military doesn't want to hear from leadership. They certainly don't want to hear from an old Boomer like myself about suicide prevention. But I'm really smart about using my marketing background to find out who influences you to make decisions to form values--who persuades you--and I'll use that person as the mouthpiece.

 

You've touched on the on the next question, which is around why you think it's important for social workers to be trained specifically in this area from an ethics standpoint?

 

“When you take your LCSW exam, what's the first and most important thing it asks you about what you should do? That our first mandate as social workers is safety. So we don't do anything with our clients—like psycho-educate--until we have established their safety…. our own safety as well.

 

[Clinicians] will--almost regardless of what client group they work with or in their own family, unfortunately--all be confronted by death by suicide. And part of their cultural competence around suicide prevention is to know how to ask the questions, know how to provide some safe practices, know how to gather communities…. Social workers are going to have to be really creative in how they bring multiple elements together to keep their clients safe.”

 

Social workers themselves are under tremendous stress with heavy workloads, and they're at risk of suicide, too, in some cases. What self-care do you personally practice, and what do you recommend for other professionals to improve their mental health when they're dealing with clients of extremely high risk of suicide?

 

“It's an overused metaphor, but if you are not putting your oxygen mask on daily, you're not going to have anything to give…. As providers, we have an obligation to be getting after our own mental health, our own issues. There is plenty of research that talks about how people self-select to these career places because we're working out our own stuff, so we have an obligation to work out our own stuff…. We are emotional, physical, intellectual, social, and spiritual. We need to be taking care of ourselves at every one of those levels.

 

“… I went through very serious burnout, and what I've come through with on the other side of that is that it is about us caring for ourselves, about having some humility to ask for help all the time and to build in care when things are going well, so that when things aren't going well, those caring things are already in place…. My expectation for social workers is that they're doing a very sophisticated level of self-care because if they're not, they really don't have business taking clients. I feel super strongly about it.”

 

What do you do for yourself?

 

“I practice meditation. I practice breathing. I practice yoga. I go out and walk, and I absolutely go to counseling, I also will tell you that most of my intense self-care is around meditation.”

 

Learn more from Ruth Cassidy by registering for her training here.