- Good evening.

I'm Dr. Carrie Brown, chief psychiatrist for North Carolina's Department of Health and Human Services.

I am truly honored to be here this evening and I wanna thank PBS of North Carolina for daring us to truly face suicide and also to for gathering us together because this is truly a community solution.

The data is startling.

In 2020, one suicide death occurred in the US every 11 minutes.

That's essentially losing our entire panel once an hour.

But tonight is about hope because suicide is preventable and talking about suicide saves lives.

I want us to create an open place for discussion this evening.

One that's respectful and community driven.

I also want us to acknowledge that talking about suicide is difficult.

And so, if any of us need a moment, feel free to take a moment for yourself this evening and then join us when you are ready.

We have a great group of panelists this evening and I'd like to introduce them to you.

So, we have Dr. Vivian Barnette, who is executive director for Counseling Services at North Carolina's A&T University.

We have Ms. Charnequa Kennedy, who is a director of our Counseling Center at North Carolina Central University.

We have Bobby Peters, a Peer-to-Peer student counselor at the University of North Carolina at Chapel Hill.

Mr. Ashish George, who is director of Public Policy for North Carolina's National Alliance on Mental Illness and last but definitely not least, we have Ms. Fonda Bryant.

She is a certified QPR suicide prevention instructor, which we'll get to a little bit later and one of the stars of the, "Facing Suicide," documentary.

So, thank you all for coming tonight and let's dive right in.

Dr. Barnette, let's start with you.

Why is raising awareness about suicide and mental illness, in general, so important?

- Well, raising awareness will impact millions of people and that are impacted by mental health.

Now, NAMI, the National Alliance on Mental Illness talks about there are one in five people that have had or have symptoms of mental health disorders.

What we want is that people shouldn't suffer in silence.

We want people to know that they're not alone in this, in their struggle, as well as we want people to seek treatment.

Because we believe that if a person seeks treatment, then things can work out for them.

Suicide is preventable.

And so, we know that awareness provides information to people so that they can actually do their own risk assessment and find out some things about themselves.

But it also teaches you about mental health and what those disorders are.

It teaches you about resources that are available to you, in your community or nationally, those kinds of things.

But it also helps primarily with reducing that stigma that surrounds mental health.

And so, that's why we're pretty much here tonight, just to talk about some of those kinds of things but it provides information for people to know what's out there and what's available.

Awareness not only helps you as a person that's coming in or looking for information but it can help your family, your friends, your coworkers, your neighbors 'cause you know now some of those signs and symptoms to look for so you can actually help other people in terms of working with them.

The other point that I wanted to make is about if mental health is left untreated, it could lead into a number of problems in terms of fewer opportunities like for employment, poor performance at work or at school and that it could also lead to the increased risk for suicide.

So, we know that we definitely want people to know what's out there and what's available.

So, as we raise awareness, like we do on our campus at North Carolina A&T State University, I work with student groups and those groups help us to spread this information about what's out there.

What are some mental health concerns?

What are some of the things that your peers are struggling with?

And so, we wanna make sure that they have that information that's available to them.

So, we are increasing their knowledge about mental health issues and where they can get the help that they need.

So, raising awareness is very key.

It's a great initiative to have and for our communities to really work with other people.

- Thank you.

And to Ms. Kennedy, as she's known on campus, you work for one of North Carolina's great HBCUs and there has been an alarming increase in suicide among Black adolescents in the past several years.

Can you share your perspective on this trend?

- Sure and I am Charnequa Kennedy, my pronouns are she-her and I do work at North Carolina Central University, one of the great HBCUs, along with North Carolina A&T State University.

I think one of the things that we have to consider when we look at the trends that we're seeing, is what opportunities do we have to normalize conversations that we have about mental health wellness.

Where we're not being as clinical in our approach to having those conversations.

But how do we just normalize it as if we're talking about everyday things that come up in conversation.

How do we really lean in and ensure that people know that they can be open and honest about what they're experiencing.

They know that there're not only listening ears but there are people who are not going to judge whatever they present when they do share, when they do feel open.

And it's not just an assumption that I'm not equipped to handle it because I'm not a therapist because it's not always going to be a mental health professional that someone reaches out to.

They're more likely gonna reach out to someone that they feel comfortable with, being open with, whether that's a professor, a mentor, a family member, a friend.

And then thinking about that, do students, individuals if they're not students, really have an opportunity to be that open and honest without fear of being judged?

Do they know that they can really have someone who's going to listen in and not be dismissive or invalidating of what they share?

Because those are opportunities where people can have the support that's needed and know that they're going to be, not only supported by the person that they've opened up to but the support that comes next if it is a mental health professional that they're connected to.

That person that they first started with is not gonna go away, they're still a part of that person's support system.

And that's important for people to know when they are open and honest about what they're experiencing.

It also helps, I think, to have conversations just about normalizing mental health wellness.

How do we keep it just in general?

Because mental health is something that we all have.

It's a part of who we are.

It's a part of our wellbeing.

And when we normalize the conversation, it becomes, "How are you doing?

What are you doing that's helping you to stay well?

What are you doing to manage stress?"

In addition to when there is a disruption, when there is something that is indicative of a mental health illness, then we have a buy-in already because we've opened that door, we've provided that safe space for people to have those conversations.

And I think not having those opportunities is part of what we're seeing as that trend.

And you also have to consider the intersecting identities people may hold, whether they're a person of color.

Does that also include someone who identifies as LGBTQIA as a part of their identity?

Is there a shared identity where there is cultural or linguistic diversity that is a barrier?

And also considering too, what role does faith play?

Because sometimes that in itself is a barrier.

As much as faith can be something that's grounding and supportive, it can also be a barrier in that people don't feel like, "I'm strong enough."

"I'm not praying enough."

"I'm not as faithful as maybe I should be because I'm experiencing this issue," or even hearing, "If you just pray about it, it goes away," instead of knowing that those opportunities to connect, if someone has or holds those faith beliefs, whatever they may be, that becomes a part of the support and it doesn't replace the opportunity to still be connected with a mental health professional, if that's what's most important or any other support that someone's already connected to.

- Great, I love how you brought up mental wellness and reminded us that we all have it.

One of the things in the medical field that comes up is really talking about how do we integrate behavioral health and physical health care?

So, the analogy I like to say is that finally, we, as a society, are trying to put the head back on the body and really truly treat the whole person.

Mr. George, researchers have demonstrated decreased suicide deaths among non-elderly adults in states that have expanded Medicaid.

What do you think are the most important policies that North Carolina's legislature could implement?

- Yeah, well, Medicaid expansion would affect 600,000 people in the state and that's a staggering number, 600,000.

So, a typical large football stadium holds about 100,000 people, multiply that by six.

It's astonishing.

And, of course, at NAMI North Carolina, we're focused on underserved populations to a significant extent and rural populations, populations of color, young people would benefit from Medicaid expansions significantly and the most invisible population of them all, probably, in North Carolina is the prison population, the population you don't know where they even are.

No one gives directions and says, "Well, if you're looking for the Walmart, just go past the Barnes & Noble, turn left at the Jimmie Johnson and it's right past the prison."

It's not like that.

Prisons are tucked away for a reason because we're not supposed to think about them.

But unfortunately, prisons and jails are the first point of contact for many young people when it comes to mental health treatment because they don't have it in schools, they don't have it in their communities.

And so, they're not given any attempt to work on themselves until they're in trouble with the law.

And, of course, a prison or jail is no place to recuperate, pretty far from it.

And so, prison populations, incidentally, they're a population we should keep in mind for Medicaid expansion because when you're released from prison, your recidivism rate is much lower if you have access to Medicaid.

This is why the North Carolina's Sheriffs' Association has endorsed Medicaid expansion because they realize, number one, they'll have fewer problems in terms of potential law breakers when you have Medicaid expansion for people who are released from prison and thus have more resources when they are able to access Medicaid.

Plus the resources we would spend on incarceration and putting people back into a carceral facility could be used for diversionary programs.

So, the suicide rate, you can feel pretty desperate when you come out of prison and you don't have resources, especially if you have a longer sentence, you can feel like life has passed you by.

We've all seen movies like, "The Shawshank Redemption," which so beautifully illustrate what it's like to feel like the world around you has changed and you haven't had access to modify yourself in response and then you're like, "What do I do with myself when I'm out?"

And, of course, young people are key.

So, all the evidence suggests early intervention for young people in mental health treatment improves life outcomes when it comes to mental health.

So, that itself, your brain isn't fully developed.

You're still working on yourself.

Having access to Medicaid is a source of real comfort, I think, for people when they're struggling.

And so, that 600,000 number is probably undercounting, honestly because when you think about the knock-on effects, suicide, let's remember is a contagion.

In other words, if you have someone in your community, someone you love, someone you care about who has committed suicide, then that slightly increases the risk that you might, if you're struggling in some way, think about it as well.

So, when we have Medicaid expansion, which I hope we will one day soon, I think that it will help, not just people who are directly affected but people who are indirectly affected as well.

So, the effects, as you can see in that documentary, the effects on the community of suicide reduction, suicide prevention are hard to measure because they just ripple out like a pebble in a lake.

And I think that Medicaid expansion would go a long way towards softening the blow of the ongoing pandemic repercussions, the ongoing effect, perhaps, of social media and too much time online for many young people, as well as the effect of incarceration on people who feel hopeless when they're back into the community and trying to re-acclimatize themselves to a society that they might otherwise feel has left them behind.

- I'm so glad that you mentioned our carceral system.

It's one of my passions, is making sure that we really have appropriate pre-arrest diversion programs, that we have expanded CIT training for law enforcement and that when individuals are incarcerated, that we provide treatment.

And it reminds me of a young man that I had the privilege of working with who was facing a life sentence and had very serious depression, had a very serious attempt and honestly, was trying to convince physicians to make him DNR, do not resuscitate.

That's how hopeless he was.

Through treatment and it does take time but through treatment he's doing great.

And now, is able to talk about how intent he was on committing suicide and is able to say Dr. Brown, "I don't feel that way anymore."

And if an individual under those extraordinary circumstances can find hope and hold onto hope, then I truly believe it's available for all of us.

So, speaking of hope, I wanna move on to Bobby Peters here.

So, what you're doing for your classmates is truly remarkable.

Can you share a little bit about what led you to take on this important role?

- Yeah, absolutely.

So, I'm Bobby, I'm a sophomore at the University of North Carolina at Chapel Hill and I volunteer as part of Peer-to-Peer, which is a student organization where we have a dozen and a half or so students who have signed up to be peer responders.

We have a website where you can find each of our bios, we have identities we hold, tough experiences we have experienced.

And what students can do is go onto the webpage, find someone they relate to and then sign up for an hour or so chat that can be anonymous, can be non-anonymous, whatever they want.

And we're really just there to listen and be a social support system.

This was not something that I knew I would do when I first came to UNC Chapel Hill.

Unfortunately, as some of you may know, our campus was really rocked by a series of deaths by suicide last year that left our campus speechless, which is something that I had not seen before.

And I think for me and for many other students, words just completely failed the moment and that's when I knew it was time to act and I didn't really know what to do, I just knew I had to show up.

So, I joined Peer-to-Peer as a way to offer time, which was what I could give, just to listen, to support, to find those people who didn't have a social support network that was carrying them and try to fill those gaps.

We know we're not counselors.

We can't provide professional training but hopefully, our goal is to fill those gaps in the most basic social support structure because that's really what we can do and that's what we need.

- Wonderful, I find your commitment and your enthusiasm at just acting to be very inspiring.

So, appreciate you Fonda.

Thank you for being so brave and honestly, generous in terms of sharing your story.

Why was it so important to you to be part of this documentary?

- Well, it was important because of the culture that I come from, the Black culture, where we were always raised to pray about it.

Don't claim it, give it to God, it's a sign of weakness.

And when you're raised like that, you definitely don't embrace it.

And the thing with me is, is that when I went through what I went through February 14th, 1995, a day of love, a day of people giving flowers and candy, I was in so much pain and people just don't realize how much pain we're in.

It's not just in our brain, it's our entire body.

It's excruciating.

And when I train people in how to look out for the signs of suicide through QPR training, I tell them I'm gonna take you in my brain that day and what it felt like.

So, I have had two children.

I have had wisdom teeth removed, abscess tooth, open heart surgery, knee surgery and a hysterectomy.

And we all know how we feel when we wake up from surgery, you're in so much pain or if you have a toothache.

You can put all that pain together and it wouldn't touch the pain that I felt on February 14th, 1995.

It felt like a bear was squeezing the life outta me.

And I knew, excuse me...

I knew I was a good mom.

My son was 12 at the time.

I knew I was a good mother and I knew I was doing the best that I could but my brain, the most powerful organ in our bodies, was telling me, "You're a loser, kill yourself.

Nobody's gonna care."

We don't wanna die but that pain is so great.

But if someone can come and tell us, "I will help you, let me help you get help.

We can get through this.

You're not alone."

It can make all the difference.

And the thing is why we don't come to y'all when we're in crisis or suicidal because in that moment, we think no one cares and no one understands.

And the biggest reason we don't come to y'all is because of that judgment factor.

We feel like you gonna say, for instance, people ask me all the time.

"Why did I go to my aunt's Spanky, my aunt Kelly, instead of going to my mother?"

And it was very simple, I knew if I went to my mother, I was gonna hear, "Suck it up."

'Cause when I called her from the psychiatric hospital, she told me, "You just need to be stronger."

But when I went to my aunt Spanky, she asked me straight, I called her and told her, "You could have my shoes."

She called me back, she said, "Are you gonna kill yourself?"

And I said, "Yes," and she went into superhero mode.

And even though it was a worst day of my life, she saved my life.

And here I am going on 27 years as a survivor.

Has it been easy?

No, I have to fight every day.

It's when I get up in the morning, depression, anxiety on my shoulders and I have to put in the work every single day.

Mental health is not a quick fix.

It's an ongoing journey.

So, for me, I wanted to show people that as low as I was on February 14th, 1995, I rose up through it.

And even though my birthday is November 23rd, 1960, I put my birthday is February 14th, 1995 because that's when my aunt Spanky helped me to get on the road to wellness and I never will forget that and I'll always be grateful to her because I was mad at her.

And I tell people all the time, you've got two choices.

We might be mad at you but we're alive.

You gotta help us.

And we might be alive, we might not ever speak to you again but we're alive.

And even if we might get over it but if we don't, we're alive or you can do nothing and you can live with the fact that you could have helped us.

So, my aunt Spanky's a hero.

Everybody needs to be like aunt Spanky.

Everybody needs a aunt Spanky.

[applause] - Wholeheartedly agree.

- Yes.

- And what a wonderful demonstration of asking the question.

This is why we have to ask the question.

This is why we have to talk about it.

For so long, there's been this myth that if you talk about suicide, somehow you're gonna put that thought in someone's brain.

That's not how it works.

[chuckles] We have to talk about suicide, that's what saves lives.

So, speaking about talking about suicide, Dr. Barnett, what are some of the best ways to engage individuals in conversation about suicide and then, how does culture age, race, ethnicity, gender impact those discussions?

- Well, great question and I'm thinking about some of the ways that I engage people.

One, is acceptance and just being there with that person, walking them through it, being honest about what's going on in that room and that space.

And then thinking about who is this person because our wellbeing is affected many aspects of our lives in terms of it could be a financial or physical or social or emotional issue.

And so, I don't just dive in and start talking about mental health issues but I'm trying to figure out what is impacting that person right now.

And so, once I learn that information, it makes it much easier to move through that process and engage that person about what's happening because whatever they're feeling from any of those areas of their lives, it really is impacting how they experience life.

And so, I know that the pandemic happened and so, a lot of the mental health issues were increased so to speak.

There was a lot of things that were happening but for African Americans prior to the pandemic, they may not have come forward and talked about some of that.

But now that the pandemic has happened, more people are stepping forward and talking about that.

And so, what I am encouraging people to do is continue that conversation with them and talk about access to services because we can talk about it but if you don't have a place or a space for that person, then it really is not helpful.

And so, I think we can do those things by not just waiting for people to come to us but we go to them.

That's why I talk about outreach a lot.

That's critical because if we wait, they may not ever come.

But we can go to their institutions.

We can go to those places of their community organizations and talk about mental health and what that means and give them that information and like what Fonda was talking about, teaching them about QPR and so that they can be gatekeepers because we want people to know that there's help and there are resources but if we stay in a silo and we suffer in silence, then we never really get the help.

So, I think just learning to be honest and accepting and just being there with that person, listening to them talk about what's going on.

I think it's just so important that we show respect and that we think about what are their values, what are their beliefs, what are their strengths?

A lot of African Americans are pretty much resilient, build upon that strength base, be culturally informed about what's happening to them or what has happened so that we can be there and listening to what's going on in their lives.

But just that culturally informed aspect, some positive psychology building up on that space will help people to engage and talk more about what's happening to them.

- Thank you.

Ms. Kennedy.

So, we talked some about stigma.

So, to what extent do you think stigma impacts access to mental health treatment and how does that maybe vary across communities, cultures, populations of color, et cetera?

- Sure.

Stigma can definitely be a barrier to access for individuals.

And so, it's important, similar to what Dr. Barnett was sharing about outreach, is one of the most beneficial opportunities to provide psycho education or just awareness, increased education and awareness about what it looks like to be well, as well as being able to know what it looks like when there are disruptions, even when they're minor.

Being able to notice those small things that are indicators, that something is changing with a person.

It may not mean that they're necessarily thinking about ending their lives but it is an indication that there is some type of disruption that's impacting how they function and it's helpful to know what to do when that happens.

I think that also helps to lessen the stigma as well when we are able to be able to recognize those signs and indicators, as well as being able to provide outreach opportunities, whether that is on a campus community, partnering with different student organizations and departments, going into residence halls because our resident hall assistants are required to do programming.

And so, being able to support those opportunities where we're having the open, honest conversations, where we're in a sense, I had a staff member frame it this way earlier today, was edutainment.

Meaning that we present in a way where it's palatable for people.

They're able to receive and accept what we're sharing about what wellness looks like, what disruptions look like and knowing how to support people when they are expressing there is some type of disruption that's impacting their functionality.

Being able to be comfortable approaching them.

And again, really leaning in and listening to what somebody has to say, validating their concerns.

You don't have to have the same perspective about what they're experiencing but whatever it is that's disruptive to them, it's important to them and it's causing them some type of impact in a way that they're not able to do things that they normally would do.

And so, it's helpful to be able to know that it's okay for them to have those experiences.

It's okay for whatever that is, that stressor to be disruptive to them but also letting them know there is an opportunity for them to have support, to be able to resume or establish a sense of wellness in a way that is representative of what works for them.

And that may be different from other people and that's okay.

- And do you mind if I add something?

- Absolutely.

- Because we have not discussed words.

We have not discussed words and that's something real big with me.

One of the things I always tell people when I speak, I walk in a room and I ask people, "How many of you would know that I have clinical depression?"

Everybody's shaking their head, no.

Then I ask 'em, "How many of you would know because of my depression, I almost died by suicide?"

You wouldn't know and just like you don't know I have it, you have no idea who you're standing around calling people crazy, nuts, psycho, cray-cray, every time there's a mass shooting or mass killing, what's up under that liner?

Mental health.

And I make sure to make sure that people know that the stats say only 5% of people with a mental health condition are violent and more people with mental health issues have more violence perpetrated against them than the other way around but the media portrays it as that we're all crazy and we're all nuts.

Even simply saying, "Committed suicide."

You commit a crime, you commit a robbery.

You do not commit suicide.

Because before 1971, it was a crime to even attempt suicide or take your own life.

So, they criminalized suicide.

So, you will never hear me say, "Commit suicide."

I will say, "Died by suicide, taking their own life or completed," and I hate all of it because that's why I'm working so hard now and that's why we need all your help.

But remember those words because especially when I'm working with Black parents and they say, "Will you please talk to my son about mental health?"

And they'll call him or I'll call them, first thing they say is, "Ms. Fonda, I'm not crazy."

So, think before you speak because to you, it's no big deal.

You wouldn't make fun of somebody who had breast cancer and lost one of their breasts.

You wouldn't call 'em, "Lopsided."

You wouldn't call someone who lost both of their breasts, "Flat chested."

So, why does society think it's okay to sit up and call us loony and crazy?

Those words hurt.

So, remember what you say because when you say those words, you're helping to fuel the suicide rate and you're keeping people from getting the help that they need.

[applause] - Can't add anything to that, it was perfect.

[laughter] - Mr. George, I noticed that you are a specialist in psychiatric advanced directives.

I'm a big fan.

Could you talk to the audience a little bit about what is a psychiatric advanced directive, how individuals can create one and maybe how you think that relates to suicide prevention?

- Sure.

So, my elevator pitch for psychiatric advanced directives is always, "It's a way to preserve your freedom at a time when you're not free."

So, what that means in practice is that suppose you have a severe mental health crisis and you're not capable.

Capable in this sense is a legal and medical term, meaning unable to process information and express yourself articulately enough to show that you comprehend what's going on around you.

So, you don't understand cause and effect.

Maybe you're hallucinating.

Maybe you're just unable to communicate for whatever reason.

So, a psychiatric events directive, when you are institutionalized, it's a document you can fill out beforehand, before you're institutionalized, before you're judged to be incapable by a doctor or psychiatrist and you can document what sort of medications you prefer, how you feel about electroconvulsive therapy, how you want hospital admission to be handled.

You can make it as detailed as you want and it's a legal document.

We all know that doctors can be territorial sometimes.

So, I'm not guaranteeing that a psychiatric advanced directive will wave a magic wand over your treatment and make it all go smoothly because we all know our healthcare system is rough, let's just say, to used a euphemistic term.

But a psychiatric advanced directive is a way to, perhaps, soften the harshness of what's going to be a difficult process anyway.

So, there are two parts to a psychiatric advanced directive.

There's the advanced directive where you can fill out the information I just mentioned like how you feel about medications.

Maybe you can say, "I don't like this medication, it makes me grind my teeth at night.

I prefer this other medication."

Maybe you could say, "I prefer not to have electroconvulsive therapy," or you can say, "I do prefer electroconvulsive therapy," whatever the case may be.

It's not something you scroll on the back of an napkin though.

It's something you have to think about.

Do some research with.

Talk to the people in your life, especially your medical professionals concerning so that you can make it as thorough and as conducive to your wellbeing as possible.

The second part of a psychiatric events directive is the healthcare power of attorney.

And this is where you can appoint someone to basically act as your advocate in the event of a hospitalization where you're not able to make decisions for yourself anymore.

So, this could be a spouse.

It could be a friend, a sibling, a child, as long as they're over the age of 18 and as long as they're capable as well.

So, this person can act as a advocate for you and hold doctors accountable.

Basically say, "Well, my sibling," let's say, "really didn't want this kind of treatment.

Please think twice before doing this unless it's absolutely necessary."

So, a psychiatric advance directive can really help you at a time when you might genuinely be scared for good reasons.

Hospitalization is scary and it's state to state, so a PAD in North Carolina is not the same as a PAD in South Carolina, let's say but you can look up lots of resources on our website, NAMI North Carolina.

You can also contact me.

My email address is ageorge@naminc.org, I'd be happy to help you fill out a PAD, confidentially of course.

And I also offer trainings about how to complete a PAD.

It sounds more intimidating than it is, people hear legal document and they think, "Well, I'm not a lawyer, I don't really know what it would take to fill out a PAD," but we have simplified forms that are quite intuitive and straightforward.

And I think they really help people because they get you thinking, at the very least, about what you are like.

And that's something a lot of people who have mental health conditions don't do often enough because as we've talked about earlier, stigma or their social environment.

But you can think about what your body is like, what your mind is like, how you have dealt with doctors in the past.

And once you file a PAD, you can only revoke it once you regain capability.

So, in other words, if you are filling out a PAD and then you file it with a Secretary of State's Office on a Monday and then you're institutionalized on a Friday, you have to regain capability before you revoke a PAD.

But if you have the healthcare power of attorney, if you have an advocate, maybe that person knows you well enough that they can use their common sense to say, "Well, this doesn't feel right."

So, like I said, please get in touch if you'd like more information about PADs, ageorge@naminc.org and of course, my contact info is on our website along with plenty of resources and the the presentation I give is always well received.

I get plenty of good feedback from people who are completely new to the idea that they might be able to take control of their own treatment at a time when they would otherwise imagine that they would be at the mercy of doctors.

So, yeah, spread the word.

- Thank you for that.

As a physician, one of my core beliefs is embracing shared decision making and a PAD is just one other way to help promote that process and really encourage medical professionals to take an extra beat, think about the individual that they're working with and what their history might be.

And we all have preferences and we all have individualities in terms of our response to medications and this is just an excellent communication tool and can be very empowering.

Fonda.

- Yes.

[chuckles] - You are a...

I just love your name, sorry.

[laughter] - Thank you.

- You are a certified QPR instructor.

- Yes.

- And that stands for question, persuade and refer.

- Yes.

- Can you educate us all some more about QPR?

- QPR is a great, great training.

In two hours, I can train anyone how to recognize someone in crisis or suicidal, talk and listen to them in a non-judgmental way and get help.

So, thanks to Mental Health America of Central Carolinas giving me a scholarship.

I became a QPR suicide prevention instructor.

Once you get finished with the training, two hours, I do it online and I can do it in person, you get a PDF form.

You get the QPR booklet.

You get a certificate that lasts for three years and you get a resource card.

I'll always tell people, "Print out that resource card and know your resources in your area because if someone's in crisis, you don't have time and it's gonna make you panic.

If you're like, 'Oh my God, what do I do?

What do I do?'"

So, one of the first things I tell everyone is, "Print that resource card out, type in mental health resources in my area," you can ask them, "Do you have insurance?'

You can ask them, do they have a EAP, an employee assistance program?

You can know who your LME is.

In Charlotte, it's Alliance but we also have in Gaston County, Partners.

So, you need to know your resource, know about CIT officers, crisis intervention team officers, crisis mobile unit.

Know those resources.

When I train college students, I say "Go to your counseling center, ask them what is the criteria if somebody goes into crisis during working hours?

Where do we need to go after hours if someone goes in crisis?"

So, for me, it's very personal.

I share my story.

I always acknowledge people who take the training, who have lost someone to suicide or attempted themselves.

And it has been such a blessing because I always tell people, "I hope you never have to use this training but more than likely you do."

And one of the things I have really loved is that I train students and people don't give students enough credit, high school students, middle school students.

I trained, in 2020 when the pandemic hit, I started training online to help my own mental health because volunteering helps me so much.

And I started training on March 26th.

I took a break in June.

Started back training in July.

And when I finished on December 19th, 2020, I had trained over 1,000 people from 25 states and five countries.

One of the students that I trained at Hopewell High School was a young man who was in the marching band.

His classmate was suicidal.

He wanted to talk to me after training but I had to run out.

He didn't wait.

He called the school and told his principal, "This young lady was gonna kill herself."

The principal called me back and she said, "Fonda, was this young man in your class?"

I said, "Yes."

She said, "He just saved somebody's life."

That training, it's like it gives you spider-sense.

You're empowered and just to expand it just a little bit more.

In 2020, there was a young man in Provo, Utah.

Did not know him.

Complete stranger.

Played football for BYU.

And by a simple tweet, he did not say, "I'm suicidal."

He did not say, "I'm in crisis."

I knew something was wrong because they did a video called, "Be The Change," and something just told me something was wrong.

As great as QPR training is and it is great, the best way to say someone's life is not even QPR training, simply caring, checking on people.

"How are you doing today?"

"Are you right?"

"Are you okay?"

And if you ask somebody that and you text them and they text you back and they say, "I'm straight, I'm all right," pick up the phone, pick up the phone.

That is the best way to save someone's life.

So, this young man in Utah, that's exactly what I did after people were just jumping on him for the Tweet that he tweeted.

And I reached out to him and I said, "Hey, young man, are you all right?

Are you okay?"

He responded back hours later, he said, "Yes, ma'am, I'm fine."

In the QPR training, it says, if you think someone is suicidal, you don't hesitate, you ask 'em straight out.

I asked him straight out.

I said, "Are you suicidal?

Do you have a plan?"

He disappeared for two weeks.

The next part of the QPR training says, "If the person is reluctant, you be persistent."

For two weeks, "Are you okay?

Are you all right?

Let me help you get help."

He came back two weeks later, he said, "Let me ask you something.

Did my parents put you up to this?"

I said, "No, I don't know your parents," and at the time I didn't.

He said, "Did the coach put you up to it?"

I said, "No, I knew you were in trouble and I wanted to help."

He said, "Well, I could use your help.

I'm dealing with depression and anxiety."

And he told me when we started texting offline, two weeks before I reached out to him, he was gonna kill himself.

That's what QPR training does.

It gives you this spider-sense.

Everybody needs to take it because unfortunately, when you look at the suicide stats, 130 Americans a day, over 17 veterans, close to 4,000 people attempt every single day.

We're in a crisis.

Suicide is not a personal character flaw.

It is a global health crisis.

So, I urge you all.

I do one free training a month online.

Anybody can take it from all across the country, all across the world.

And then as I said, I do in person training but everybody needs to take that training.

It saves lives.

You do not have to be a professional to save somebody's life.

That's what I love about it.

You don't have to be a professional, no offense.

- None taken, none taken.

[audience laughs] No 'cause honestly, that's the thing about suicide, is we have to embrace it as an entire population, as a human race and we all have a role.

We just have to ask the question.

- Agreed.

- And use our Spidey-sense.

- Yes, yes.

- So, I think now we have the opportunity to talk with our members of the audience.

We have many people here in the studio and then I think I was told we have well over 300 individuals online.

And so, don't worry, we're gonna get to as many as we can.

And so, I'm going to turn it over to Lou Ann, who I think is going to find our first audience member with a question.

- [Lou Ann] I think we saw someone right here.

Yes, go ahead.

- [Audience Member 1] I was just gonna say that it was good that you said it doesn't have to be a mental health professional because I thought about asking earlier, I find it that, I'm a mental health professional and a lot of my family members, they shy away from it more than anything, which you would think, well, they would call.

I think they're used to just hearing it.

I'm not sure what it is just in general and things but I like that you highlighted that the middle schoolers and the high schoolers 'cause in the video, it was saying that they're great resources.

Their friends normally talk to them but they don't know how to help.

So, I will be sending this training information to all of the teenagers, for their friends.

Thank you.

- [Audience Member 2] I was encouraged to see, "The New York Times Sunday," had a front page article about teenage mental health.

And I was wondering if you could comment on a word I had never heard of, which was polypharmacy.

So, the rise of the use of medication and I thought the journalist did a really good job, also juxtaposing treatment that we actually know works like DBT and how hard it is to find that kind of payment for those kind of treatment, whereas medication is much easier to fund.

- That's a wonderful question.

Maybe I'll take a stab and then see if my fellow panelists want to add to that.

So, I'm gonna just throw my own profession under the bus for a moment and say that unfortunately, we as psychiatrists and it's often out of wonderful intention in terms of really wanting to ensure that you're addressing all sources of pain and suffering.

But what can happen and particularly because we work in a fractured healthcare system, is an individual can be put on one medicine and then maybe another one is added.

And then they go to a different physician who adds a third medicine.

And so, polypharmacy is this concept of essentially overprescribing.

And honestly, I consider, in my clinical practice, one of my tenants is the most important thing is that I look at the medication list and I only want someone to be taking a medication because one, there's more benefit than harm.

And two, I firmly believe in the lowest effective dose and that can be tricky to find and requires a lot of attention to detail and time.

But I can't tell you how many individuals that I've had the privilege to work with, who have gotten better simply because I discontinued their medicine and that's not to say that medicines are bad.

They are not.

They are life saving.

I have witnessed that but everything has to be done in context.

So, I don't know if anyone else on the panel wants to add to that.

- I'll add to that.

I'll just say 27 years ago, all I knew was medication and therapy.

And we had so many things to help us now.

Who would've thought that coloring is great for anxiety?

I read a report that said, "Black people do not get enough Vitamin D." Where's vitamin D found?

In the sun.

Go out and go for a walk.

There's exercise.

I work out three to four times a week.

You have music therapy, you have art therapy, you have all these things.

So, in our culture, especially, people say, "I'm not taking medication," whatever their vision is, if you take it, they don't wanna take it.

But I tell people all the time and especially in my culture where diabetes and hypertension are rampant, I ask 'em, I say, "Okay, so if you had diabetes or hypertension, would you take medication?"

"Oh yeah, I'd take it."

And I tell 'em, I said, "Mental health medication is no different."

Not saying, like you said, we're gonna have to be on it forever but I was diagnosed with clinical depression.

I have a chemical imbalance.

So, if I have to take it, I'll take it.

And that's the thing, we might not have to take it forever but if we have to take it, we have to take it.

But one thing I realized when working in a mental health facility, I think they overload youth with way too many medications.

I've seen youth come back from a home visit with 10, 12 medications and you know they interact.

So, for me personally, I think if medication's gonna help us, then we need to take it but now we have so many other things that help us too.

And I don't think it's one specific thing that's gonna help us because at the end of the day, we gotta put into work every single day and find those good coping skills.

As I have a imaginary mental health toolbox, you have to have those good coping skills to put in your mental health toolbox on those days when depression and anxiety are kicking your butt, that you have 'em and it doesn't have to just be medication or it really doesn't have to be medication at all.

It's what is going to help you.

- And I'm glad you mentioned dialectical behavioral therapy because it has a incredibly robust evidence base in terms of reducing self-harm and suicidal behaviors.

And it's probably more effective than medication in some circumstances.

And you're right, we don't have enough clinicians that are trained in formal dialectical behavioral therapy.

So, if any young people out there that are in school or training to become a mental health professional, check it out, it's definitely a life saving therapy.

I think, now, we wanna maybe go online 'cause we don't wanna leave you guys out.

- [Lou Ann] First, I'd like to just mention, Ms. Bryant, you have a huge fan base in our virtual audience and they really appreciate your comments and everything that you're sharing.

So, thank you very much on their behalf.

Question to you all.

Isn't there something about copycat syndrome in schools, that is when a student goes through suicide, sometimes others follow.

So, the question is how do you navigate being open and reducing stigma when there are concerns that others might feel compelled to follow suit?

- Great question, I might go to one of our educators.

- I think that's the concept of contagion that was mentioned earlier.

It is helpful to notice that if there is one person who has died by suicide, that you wanna make sure that you really check in on the people that are closest to them, family, friends, people who are connected to them because there is a window of time in which there is an increased likelihood that a subsequent death by suicide may follow.

That doesn't mean that you stop checking in on them.

You continue to have those opportunities to check in where you reduce the likelihood that there is that subsequent suicide or suicides by contagion but really wrapping around a community of individuals when there has been one death so that you are providing support.

You're providing opportunities to build some coping skills and some self-management opportunities where people know, not only what they can internally have as a resource but they also know external resources to reach out to as well.

- And I just wanted to add a little bit.

That suicide, one suicide, can impact several people, not just your family and your friends but so many other people.

And that's why it's so important to really talk about it and to get people to really think about what's going on and really explain to them what is suicide and what are some resources out there to help because it goes beyond just that immediate family.

It's a big effect on so many people.

- [Lou Ann] Another question from our virtual audience.

Could the panel discuss the treatment that those who are actively suicidal receive versus the treatment of those people after they've completed?

- Can you repeat that, please?

- [Lou Ann] Discuss the differences in the way that an individual is treated when they are actively suicidal versus the treatment of those people after they've completed?

- Are they talking about how people treat us?

- Yeah.

So, that a couple concepts come to mind in terms of someone who's actively suicidal versus someone immediately post-attempt.

And then also, how do we remember individuals that have suffered death by suicide?

And I think as a culture, we've got a long way to go.

So, I'm gonna throw it to the panel here and who wants to take the first comment?

- You mean how we were treated as a person who survived suicide?

- Go for it.

- For me, I never would forget when I went back to work, the same person who sent me across the street to the EAP, my assistant director of pharmacy knew something was wrong and thank goodness they did.

But when I came back to work, I never will forget this, she came and whispered in my ear, "Fonda, no one has to know that you were in a psychiatric hospital."

I was very taken aback by that because I think somebody mentioned earlier about, I can't take my head off and set it on the counter when I'm struggling, it's with me.

So, when she said that to me, that's when I really realized that there's such a big difference between mental health and physical health.

And I was like, "I gotta help other people."

And so, the treatment, like I said, what my mom said.

My mom was remarried, lives in Savannah, Georgia.

If I would've had a heart attack or stroke, she'd been on the first thing smoking to North Carolina.

But because it was a suicide attempt because it was mental health, she didn't come.

She didn't even come see me after I got out and believe it or not, it has been 27 years since my suicide attempt, my mom and I still haven't discussed it.

She knows what I do.

She knows this documentary's getting ready to come out.

And when I told her, I said, "Mother," I said, "this documentary's get ready to come out," and she's very uncomfortable.

I can hear it in her voice.

So, there is a big difference of how we're treated with a mental health condition with a suicide attempt because I remember Dorothy Hamel said when she was dealing with cancer, I think it was Dorothy Hamel, she said she got flowers and cards and people were calling her, the minute she said she was dealing with clinical depression, crickets.

And that's how it is because the thing is we can lose our jobs, even though we're protected by the American Disability Act, we can lose our job.

And me looking back on it, I truly believe that some of the jobs that I didn't get was because I'm such a advocate and that's the truth and that's what the real big difference is between you being in the hospital for a physical condition, which mental health is physical, to going in the hospital for mental health.

And one other thing I will tell y'all, in the QPR training, it says at the end, "Follow up with a phone call, a card or visit, whatever feels comfortable to you."

So, if you're gonna check on a friend who's been in a psychiatric hospital, please don't walk on eggshells with us.

Like, "Oh my God, if I ask Fonda, how's she doing, she might have a meltdown."

Treat us no differently than if we've been in the hospital for a heart attack, a stroke, having a baby because by sitting up, treating us as fragile, that is very disrespectful and that's stigma.

That's stigma.

- Bobby, did you have something else you wanted to add?

- Yes.

I was just going to address the flip side of that question, which is how do we treat people after they have died by suicide, which I was wondering if maybe that was part of the question?

And I think that is something that we have a lot of room to grow, just because oftentimes, what we see is, obviously, people had a lack of social support before they died by suicide.

And then once there's a death, people's initial response can be, "They're in a better place," things like that.

Sometimes memorializing the loss, even if they weren't close.

Then I guess I was wondering if anyone has anything to add but it's my impression after going through last year's event or events at UNC, that can actually be perhaps putting other folks who may be suicidal themselves, at risk by memorializing it.

So, definitely changing that response so that you're thinking about those things before someone dies by suicide and we need to be really conscious that we're checking in on people, really shifting towards prevention because that's our role as folks who aren't mental health professionals, is just being there first.

So, yeah.

- Yeah.

- That's true.

- I think everyone on this panel probably has a wishlist of things they would like to change about society in general, that would probably reduce the suicide rate that's only tangentially related to direct mental health policy.

So, for example, I was talking about Medicaid expansion and obviously, I strongly support Medicaid expansion but there's a long list of things that American society fails at that leads people into mental health challenges and not just American society.

So, my family is Indian American and 37% of the world's female suicides are in India, even though India only has 18% of the world's female population.

So, that's not just a coincidence, that's because of patriarchy and sexism and limited opportunities.

So, when we look at what it means that someone completed suicide, it's rarely just an individual set of difficulties.

It's a confluence of circumstances that contributed to their sense of despair, whether it's like we were saying, unemployment in the documentary that was brought up, I think, a lack of friendship.

So, for example, American society, for men, is very touch averse, if you've noticed that?

Young men are averse to touching each other affectionately.

Young women are a little better about this but compared to other societies like France, for example, young men are less likely to touch each other affectionately and be like, "Good job.

Great.

You're awesome."

So, that kind of social environment that's conducive to flourishing is made up of a million things that I'm sure everyone on this panel thinks about every day.

And in my role as public policy director, I'm sometimes frustrated because even if my wishlist of NAMI North Carolina public policy priorities were fulfilled, I would still have another very long list of things that I would like to see happen that I think would be necessary, not nice to have but necessary, in order to really address the mental challenges facing America.

- I think we have some more questions from the audience.

- [Audience Member 3] Hi, I'm wondering if anyone has advice about when the stigma of mental health gets in the way of somebody's own treatment?

For example, I have a friend who has acknowledged that he's probably depressed.

He took the questionnaire and was like, "It says severe to moderate depression," and then has had trauma.

And I asked him like, "What would you like to do about it?"

And he said, "Nothing, I'm fine."

And so, it's a lot of people think that they're weak for going to therapy or for taking medication and I just wonder if there's anything we can do besides waiting for them to change their mind or supporting them?

What's your advice on that?

- You wanna go first, Bobby?

- I would like to go first.

[chuckles] Sorry.

I think the number one thing that anyone can do is if you think that someone in your life is struggling with stigma around mental health, be the one to break that stigma.

Talk about your own struggles.

Talk about mental health openly, honestly and try to show them that it's possible to just not think of mental health as something that is a character flaw because it's really not.

But the other thing is that's something that there was a confluence of factors that led up to your friend feeling that way.

And your friend is not alone, there's tons of other people.

So, we can not only do that for our own friends but really try to make that a broader change and just speak out, even in situations where we're not deeply connected to those around us, still making sure that we're trying to break the stigma, talk openly about mental health challenges is super important, I think.

- And the conversation doesn't have to be so professional.

You can just be going for a walk but just make sure when you have that conversation, you don't have it in front of other people.

Make sure that you're in a secure place and I will also say is sometimes, we're still trying to figure out ourselves what we're dealing with.

So, you just plant that seed and say, "Hey, I'm here to help you when you're ready to talk."

And sometimes, we don't need y'all to talk back.

We just need you to listen and hear us.

But the more that you let us know that you care and we can trust you, the more we can open up but you have to realize we're still trying to figure out what's going on with us too and if we can trust you.

So, just plant that seed and let 'em know, "Hey, whenever you are ready, I'm here for you and I'm willing to listen," because that means so much to us that we can come to you and talk to you and you'll listen to us and not judge us.

So, just plant that seed and keep letting that person know, "I care about you and whenever you're ready to talk, I'm here."

- And that seed can be a seed of hope.

- Exactly.

- That there is help and it's available when you are ready.

- I think in addition to meeting that person where they are presently, continue to have the conversation, also exploring what they are willing to do.

It may not be therapy to start off with.

It may be an activity that you can do together or something that they're willing to do on their own that will help lift mood, that can be an open door, to being able to direct them from there to some additional supports.

But continue to having the conversation and let them know that you're available and you're there and you're meeting them where they are.

I think it's important.

- That's some very useful and important advice.

So, thank you all for sharing.

I think we'll go back to our online friends.

Oh, I'm sorry.

It was two and two.

Oh, well.

[laughter] - [Audience Member 4] I just wanted to ask a quick question related to health insurance.

It's the bleak reality that we all live in, that health insurance dictates the amount of healthcare that we're all able to receive.

What would you say to people, maybe, who aren't seeking out mental health resources because they think that they are financially prohibited from such?

What would be your recommendation?

- Well, I would say that there are a lot of sliding skills out there for people.

There are some free services that are available and then some therapists, I'm a psychologist and sometimes people provide pro bono work just to help that person get through what's happening to them.

So, there are some services that are available that are free.

- And you also have mental health organizations that are now helping, like in Charlotte, with Mental Health America Central Carolinas.

If you live in Mecklenburg or Cabarrus county, they have it where they either, depending on your insurance or no insurance, you can go see a therapist or your child can go see a therapist up to six times.

And this is something I was talking about with them in the break room.

Most people now, if you're working, have an EAP, an employee assistance program, please use it if you have it.

It helps with grief, finances, marital issues and mental health.

And depending on the company you work for, you can go see a therapist three, six, 9 times, anybody who lives in your household can go visit someone.

And if you have children in college, they are able to use it as well.

So, not everybody has it but a lot of companies now are going to that EAP because if you come to work and you're not doing well, as I always tell people, "If you don't take care of your mental health, it's not gonna take care of you and it is gonna wreak havoc in your life like that little commercial with Mountain Dew and you had that little gremlin and then they give him the Mountain Dew and he's just all over the place.

That's what mental health would do to you."

So, if you have those resources, take advantage of it because we do have a lot of resources.

And then, like I said, type in mental health resources in my area but go to the NAMI website.

Mental Health America.

American Foundation for Suicide Prevention and go to resources.

You'd be surprised how many resources they have free of charge and will be able to help you.

- And from the government perspective, one of the things that we're doing here in North Carolina and nationally, is really trying to push parody and we've come a long way.

We have a long way to go.

And so, the more we talk about the importance of parity and what I mean by that is that we reimburse providers at the same rate, whether they are behavioral health professional or physical health professional, that we don't have out of pocket costs that are different between physical health and behavioral health.

That is changing.

We have much more parody than we did five years ago, 10 years ago, 20 years ago and something that we all need to be talking to our legislators and those that represent us about what are you doing as a public servant to really enforce parody?

Okay, that was two, [audience laughs] so now I think we go to the online folks.

- [Lou Ann] Staying in that same theme of the stigma of your workplace.

There is a question about the impact of one's disclosing and concerns about disclosing a diagnosis in the workplace.

That many people are reluctant to do that because of that stigma that mental health can place and the concern of losing their job and the impacts of that on their livelihood and how do we navigate that in society?

- I just always say, no one has to know.

You wouldn't know that I have a mental health condition unless I told you.

So, just like, if you go use your EAP.

I hear a lot of people saying, "Oh, I can't go use it 'cause they're gonna tell my employer and I'm gonna lose my job."

Well, unless you are gonna hurt yourself or someone else, no one has to know.

And that's the thing, no one has to know because we don't have a look.

So, to me, I just feel like that it's not something you have to share.

Most people don't run around and say, "Oh my God, I got high blood pressure."

"I got diabetes."

So, it's the same thing, you don't have to say it but we're working hard to change that where you should be able to talk about your mental health condition because it's physical health.

But again, you don't have to talk about it.

But one of the things I always tell people, if you have a mental health condition and you're at work, make sure you do the best you can to take care of yourself.

Make sure you put in the work every day.

My therapist told me, "You gotta make a conscious, deliberate effort every day."

So, the more that we take ownership in our mental health and the more we stay on top of it, the less likely that we'll go into crisis at work or we'll be out a lot because we're taking care of our mental health.

And that's the thing, it's no difference and I think that's the biggest issue.

People look at mental health and physical health as they're separate but they're together.

So, again, the better we take care of ourselves with mental health, the better we'll be able to perform in our job because when I was suicidal and hadn't gotten the help, my work suffered.

And I was a pharmacist tech, I worked with anything from aspirin to Delalutin to Oxycontin, so you had to be on point.

So, again, take care of your mental health and it will take care of you and help you to do better at your job.

- And I think there are some workplaces that are really trying to set the stage for talking about behavioral health conditions and really trying to normalize that it's the same as any other medical condition.

And I think people have to do what they're comfortable with.

You can always say, "I have a medical condition."

It's a medical condition.

"I have a medical appointment I need to go to."

And I don't know if others have other suggestions about how to approach it.

- I think it is about being comfortable and who you work for, how much you might wanna disclose about that because you can say, "I just have an appointment," or, "I need to take a mental day."

It doesn't have to be a mental health day but I think people take mental health days anyways, just to have a break or something.

So, I think it's becoming more normalized that most people, I talked about it earlier, one in five people have some type of mental health condition.

So, it's not like folks don't have it.

It's just how comfortable do you feel with sharing this information with someone?

And as she said, you don't have to share it at all.

- And maybe I could just add one thing and this is funny 'cause it's coming from a student but I think power dynamics are important.

And if you're an employer, you may not even realize that your employees feel uncomfortable talking about their mental health challenges because of stigma in the workroom.

So, really, whoever has that power, the employer should really take the responsibility to put in practice something around the workroom that attacks the stigma directly.

Make it known that it's okay to have mental health challenges in this workspace, we're accepting of that.

And start the conversation from the top as opposed to struggling from the bottom.

- I agree.

- [Lou Ann] Another question asked by our virtual audience is what are some ways that we can improve the hospitalization process?

From this person's experience, most people refuse to get help for fear of being hospitalized and what then about after care, after you've been released from the hospital and the days and weeks beyond that?

- Anyone wanna start?

- Well, I can talk about from a college standpoint.

I think it's important that we have memorandums of understanding and talking to those providers about the types of students that may be entering into your organization and how to best serve them.

I think having some open and candid conversations about that is helpful.

So, whenever we do have to hospitalize someone, then that hospital is aware of maybe their schedules or understanding that this is a college student, it's not someone that just can take off or I don't think anybody really can just take off but at least they have some understanding about who this person is.

And particularly, I work for a historical Black college university and how that person may be treated in that hospital, I think is important too.

So, that's why having these conversations are very important that we do and then after they get out, making sure that that person who's treating them, the discharge person connects with the counseling center so that we can make provisions for that person, whether it might be making sure that their schedules or we've contacted the professors form or if they need medication.

Making sure that that's available for them and that they can smoothly transition back into that college setting.

So, we try to make it easier.

Hospitalization sometimes is necessary because the person could be in a serious crisis.

And often, we don't know what the person has taken, some medication or maybe they've done harm to themselves that they actually need the attention of the hospital.

But while they're there, we can reach out and check in and make sure that they're okay.

And so, that when they come back to school, they can feel like we can start over.

We can get our classes back and feel like we're in place again.

So, things will happen.

We will hospitalize people if it's needed but not all the time.

Sometimes just a deescalation or just helping that person understand what's going on with them and them getting into the counseling center to have individualized appointments, then go to student health.

Those types of things, I think, are critical.

- From age 18 to 80 and onwards, post-hospitalization would be a great time to fill out a PAD because that's when you have, if it's your first hospitalization or your fifth, whatever, you have more of a foundation on which to judge your own body, your own mind, your own sense of your relationship to other people and your medical professionals.

So, if you had a lousy experience, if you had a harrowing experience that you would not care to repeat, document what happened in your PAD and say like, "Well, these medications turned out not to work out so well for me, these medications did but this could have been better, this could have been worse."

So, you can make a PAD as detailed as you want.

And it's also a good time to perhaps talk to the people in your life who could be your advocate.

So, take something from the experience, whether it was relatively good, as good as a hospitalization could be, of course no one wants to be in the hospital or if it was terrible, take something from that too, so that the next time around is a little easier.

I think sometimes when you're out of an institution, out of the hospital, you might think that that's just behind you and that you're never going back and that no matter what, you're never going back.

You just hated the experience and you don't want that again.

But unfortunately, involuntary commitment in North Carolina has skyrocketed.

Involuntary commitment is necessary sometimes but the numbers are quite startling if you look at this, I don't remember the exact percentage increase but we've had a significant percentage increase in North Carolina over the last 12 years or so.

So, even if you don't plan on going back to a hospital setting, there might be instances where you need to plan for what could happen and a PAD is not super useful for involuntary commitment but the experience of being hospitalized is useful because you can talk to the medical professionals in your life about what happened, as difficult as that might be and help yourself go through something a little easier next time around.

- Thank you.

And unfortunately we are almost out of time.

I do wanna ask one last question to our panelists and that is if you want the audience to take away one thing from tonight, what would that be?

And maybe we can just go and order quickly?

- Medicaid expansion.

It should happen.

The hospital lobby is strongly against it as the website Axios reported recently.

But Phil Berger, the Republican leader of the Senate came around and he himself said, I'm paraphrasing him but he really said this.

He said, "If I can come around on Medicaid expansion, then it's time basically."

So, talk to people in your life about this, make it an issue when you vote.

We're a nonpartisan organization and this should not be a partisan issue by any means.

And I think that it could really benefit the most vulnerable people in our state.

- I would say you are not alone in your struggle and that resources are available.

Talk to a professional.

Talk to your peers.

Talk to someone but get the help that you need.

- Yeah.

I would say, first of all, try to show up for those around you.

Ask the question.

Listen actively.

And the other thing is that changing stigma and larger issues around mental health isn't just a struggle activism in that sense, isn't just a struggle that persons with mental illness should go through, it's on all of us because we're all affected.

So, really making that a priority in our lives to speak up for change in whatever setting that may be, in schools, in your workplace, state, local, national level but really speaking up and making that a priority.

- My one thing is let's talk about suicide.

It is one thing where every single human being has the opportunity to save a life by talking about suicide and help is literally three digits away.

You can dial, text 988, 24-7.

- I would say awareness of self, awareness of others, really leaning into conversations and not only providing support through your words and being mindful of what they are but also encouraging someone to feel empowered, to be a part of what is going to help them.

Helping them identify what that looks like and if it's you, finding ways to empower self and be an advocate for self and for others, I think are gonna be the important takeaways that I would share.

- I would say that for me, there's help, there's hope and there's recovery.

We don't see recovery enough.

And that's one of the reasons why I did the documentary.

I want people to see that we can be at our lowest point but through help, through putting in the work and people around us that support us and love us, that we can recover, we can get on the road of wellness and we can stay on it.

So, there is hope as long as we are willing to fight.

- And then, since we are out of time, I really wanna thank everyone.

I wanna thank the audience for showing up in person.

I wanna thank those online for showing up to this really hard conversation.

I wanna thank my brilliant colleagues here who have done a beautiful job with this panel.

And then I really wanna thank PBS of North Carolina for raising this issue, for helping us, as a society, face suicide and to their community partner, NAMI, for helping make tonight's event possible.

You all can watch the entire broadcast, "Facing Suicide," on September 13th at 9:00 pm on your PBS channel or anytime on the PBS video app.

And please be on the lookout for an email in your inbox in the next few days with additional resources and information about our panelists.

PBS North Carolina also has a dedicated webpage to mental health awareness and suicide awareness.

And so, those of you, the folks in the audience, I hope we can stay for a minute and enjoy each other's company and everyone online, please stay safe and be well.

Goodnight.

[audience applauds]