Beyond the Self-Harm Data: Answering the Crisis Hotline — Eric Arseneault

Alex Maheux

In this interview, we’ll be discussing the issue of suicide and self-inflicted injuries. You can reach out for help at any time by calling 911 or by calling your local emergency response centre.

With the COVID-19 pandemic evolving at a rapid pace, it’s possible that circumstances may have changed since this interview was originally recorded, and may not accurately represent the current situation.

Hello, and welcome to the Canadian Health Information Podcast. I’m your host, Alex Maheux. In this program from the Canadian Institute for Health Information, we’ll be taking a look at Canada’s health care systems with the help of some highly qualified experts. Stay with us to hear more about our health policies and systems and the work being done to promote the health of Canadians.

Earlier this year, CIHI released a report about the unintended consequences of the COVID-19 pandemic, which examined the impact of COVID on the mental health of Canadians. The data show decreased emergency department visits and hospitalizations for self-inflicted injuries early in the pandemic. However, at the same time, we also found a significant decline in mental health, and people sought help through community organizations instead. CIHI is still collecting data for a more detailed picture of how COVID has affected our mental health. Meanwhile, to help us get a more complete picture, we’re joined by Éric Arseneault, Coordinator of Intervention Services at the Centre de prévention du suicide de Québec. Éric has over 20 years of intervention experience and consults on various committees in the national capital, a major administrative hub in Québec.

Keep in mind that the opinions and comments of our guests do not necessarily reflect those of the Canadian Institute for Health Information. So let’s get down to business.

So, hello, Éric. Welcome to the CIHI podcast. How are you doing today?

Éric Arseneault

I’m good, thanks. Thank you for inviting me. It’s not often that suicide prevention is discussed in this type of program, and I appreciate the invitation.

Alex Maheux

Mm-hm. It’s our pleasure. I know that the lives of all Canadians and, in fact, the entire world changed really dramatically over the last year. How has your life, both personal and professional, changed in the past year?

Éric Arseneault

It’s changed a lot. At the same time, the work we do is to help people adjust to difficulties. Sometimes, the difficulties depend on the person. One event can be more traumatic for one person than it is for another. We’ve developed a positive view of crisis over the years. We see crisis as a vector for change. Catastrophic events like that have occurred throughout the history of the world, in wars, in pandemics. I haven’t been through many pandemics in my lifetime. But during natural disasters, for instance, historically, the number of suicides doesn’t necessarily go up at the start of these periods, but it doesn’t take anything away from the fact that people had to adapt, and we’ve adopted the position of seeing crisis as a vector of adjustment. So, it helped us accommodate our clients and ourselves during the changes we had to make to our services. We saw an opportunity to... it would be too much to say improve our services — but to adapt our services during a pandemic.

In Quebec, and probably throughout Canada, we saw a number of organizations turn to telecommuting, for example, in an effort to hang onto their employees. Telecommuting is more and more popular. I see it as a sign that people can adapt to all types of situations if they have to.

Alex Maheux

Exactly. So I guess for you personally, that was the big shift in the last year.

Éric Arseneault

Well, let’s just start with March 13. We’re committed to offering service 24 hours a day, 365 days a year, and this is what we have been doing for over 45 years. However, at the same time, there was a lot of pressure from the ministry in March 2020 to stay open no matter what. So that created some tough challenges. I had to work overtime a bit more at the beginning.

Alex Maheux

For sure.

Éric Arseneault

From a personal perspective, it’s interesting, my 2 brothers lost their jobs at the beginning of the pandemic — they’re in different fields — and I was worried about them, “So, how are you doing?” They were like, “Well, look, we don’t have any control over this. Right now, I’m using the time to do some work on the house. We can feel it moving, we feel it’s going to change.” But although I didn’t necessarily speak to them at the same time, my brothers were more worried about me: “Yes, but you, Éric, you’re working so hard these days, what about you?” There was a certain reality of seeing people I was worried about: “Oh, no, they lost their job.” I felt lucky to still have my job, but it was like the roles were reversed: “Yes, but please take care of yourself, Éric, be careful.” And then I had this vision of them: “Hey, how are you doing? How’s it going?” So it was kind of interesting, from a more personal point of view, to see how well everyone was coping.

Alex Maheux

Mm-hm. I definitely think the pandemic created an opportunity for people to pull together and support each other. Recent CIHI data — I don’t know if you’ve seen it — showed that emergency department visits and hospitalizations for self-inflicted injuries declined throughout COVID, especially early on. On the other hand, of course, we know this doesn’t tell the whole story.

Éric Arseneault

Mm-hm.

Alex Maheux

What was it like at your call centres during the pandemic? Was there a sense that the volume of calls and the number of people in crisis increased during that time?

Éric Arseneault

A little of both. At the beginning of the pandemic, like I said earlier, traffic was more or less the same. There was no increase or decrease. In fact, we’ll eventually know more, with coroners’ inquests and so on, but there doesn’t seem to have been a significant increase in suicide rates. I’m talking about Quebec, since I have more access to this data. When schools started to reopen, and people started to go back to work, there was an increase in calls, and requests for assistance. We don’t necessarily see that as a negative thing. I’ve worked in suicide prevention for 20 years. When people would call us, they were usually very, very close to committing suicide. For the last 10 years or so, people have been contacting us almost at the very beginning of their crisis. It’s similar to what we saw during the pandemic: people called because they were worried about a loved one, or worried about themselves, they had just lost their job. It was a period of instability. People seemed to be less hesitant about asking for help.

At the beginning, an area where we saw some growth was professional support, particularly for domestic violence, for example. More and more workers called us, because they were worried about domestic or family violence. The same goes for schools. We saw more calls for schools as well, kids 14 years old and under.

Alex Maheux

What did you hear on the phone? What were the callers worried about during the pandemic?

Éric Arseneault

I think it was isolation, and how to deal with and adjust to the isolation. For example, if a young person called us, he was worried about another young person, usually they’d meet up in the schoolyard, after school. Now, it’s: we talk on MSN, Messenger, we text, but we don’t see each other. So it’s hard to get the feeling. Should I be worried? What questions can I ask to clarify the situation? Often, it was support, to help them understand, which was rather ambiguous in the context of social isolation. For example, in Zoom, you can shut the camera off. Should I be worried? The comments. We would have people call us and ask: am I worried about the wrong things or...? What should I be worried about? What should I not be worried about? What questions should I ask my loved ones to help them understand the situation?

Alex Maheux

There’s no doubt that we experienced isolation in a completely new way. So there are definitely some lingering questions along with it. On the other side, what’s it like when you respond to a distress call? What is it like on the other side of the calls?

Éric Arseneault

Of course, at the suicide prevention centre, we have some expertise in phone intervention. It hasn’t changed that much in terms of how we handle crisis situations. We usually think... in fact, I think that our tools for evaluating the seriousness of an incident have changed a lot over the years. We try to identify, with our clients, the most immediate factors, which could lead us to be concerned. For example, planning to commit suicide or a history of suicidal behaviour. We’re used to asking these questions to evaluate the danger or to estimate the risk of an act. But these tools aren’t any good if we don’t accept the responses we get. We have an approach based on seeing the individual as something more than just their anxieties and fears. We try to help them identify their strengths, what they’ve already managed to do to prevent suicide, or bring up reasons for living that they may have forgotten or changed over time, so they now feel that life isn’t worth living. So the question is how to deal with this.

The philosophy of suicide prevention, or at least the philosophy of intervention is to work with the individual’s ambivalence. For us, ambivalence is the side that wants to die at that moment and, at the same time, the side that wants to live. How do we embrace the side that wants to live, while listening to the side that wants to die? And unfortunately, it’s often counter-intuitive for local health networks to emphasize the side that wants to die, because if we fail, we can’t reach the side that wants to live. It’s our job to embrace both sides. When someone tells us: I just can’t handle it. We use our gentle insistence to remind them that we understand that they have the potential to make it, to achieve something. So we work on these aspects to help the person 1) regain control, and then 2) find a new direction or take baby steps toward problem solving. This is really crisis intervention in the here and now.

Crisis intervention in suicide prevention doesn’t usually end with one contact. We schedule more frequent interventions when we’re worried about someone’s safety, and less frequent contacts for people who may be more in control.

Alex Maheux

Okay. That’s incredibly interesting and really important, the work that you’re doing. I can’t imagine how difficult and overwhelming it can be for you and your team. As a service coordinator, how do you support your team and keep up morale?

Éric Arseneault

I can’t hide the reality that teamwork is key in suicide prevention. At the suicide prevention centre, we work together on every intervention. That’s also what we tell our clients when they call us. You need to be part of the team to help protect your friend, for example. We’ll work together to help you stay safe. That’s a great help to us. We don’t hide it. And humour is also a part of self-care. It’s very important that deep down, we have faith in our client. Sometimes, unfortunately, we have clients who are dealing with extremely painful situations. We also see clients where, sadly, problem solving doesn’t work because their problems simply can’t be solved. I’ll use the example of someone who’s grieving over a suicide. Solving the problem would mean bringing back the loved one they lost, and that’s impossible. There’s no magic wand at the suicide prevention centre to do that, so the solution doesn’t work. The issue is how to accommodate these people and help them, first, to live with the loss of their loved one, but also to reconnect with a reason for living, and reconnect to their strengths.

That’s why we’ve developed other approaches than problem solving, although it doesn’t mean that problem solving isn’t part of our intervention. But sometimes, with mental health or mental illness, problem solving doesn’t work, so we have to find other means.

Alex Maheux

Mm-hm. I like that you talked about giving tools to responders and trying to equip them as best as you can to be flexible with each call. You support your responders, you yourself help respond to difficult crisis calls. Éric, what are you doing for your own mental health?

Éric Arseneault

Well, I think that no matter how good your computers are, the most important tool for intervention is who you are as an individual. So you have to take care of that individual. I mentioned humour earlier. Supervision is the most valuable working tool. So, it means understanding what someone is going through. Sadly, it’s not easy. I’d like to say what happens at work stays at work, and at home we do other stuff. At work, it’s hard to keep things separate, because my tools are always at work. By sharing as a team, we can leave home with a clearer head. But personal life is important too. It’s funny, you were saying to me earlier: “It’s difficult to understand the work you do.” At the same time, we have the tools to do it. I think the same thing when I’m talking to my friend who’s a firefighter: “But how do you do that? What you do is crazy.” He says, “Yeah, but Éric, I’m not a hero. I don’t just jump into the fire any old way, I have all my equipment.”

Alex Maheux

Mm-hm. It’s all planned.

Éric Arseneault

It’s all been planned, it’s all structured. For us, the same applies to suicide prevention. Yes, the intervention is adapted to the client, but it’s structured and planned. We don’t just jump into the intervention unprepared. It helps me to disengage a bit when I get home, and I can say: OK, the work is done, my colleagues can take over from there. So the trust in teamwork and all that is important.

Alex Maheux

Mm-hm, absolutely. At CIHI, our data usually deals with high-level trends, but with your work, you really get a closer look at how it is in the field. Is there something, or maybe some things, that you’d like a policy-maker or a health care official to know, something that may not be in the data?

Éric Arseneault

That’s a good question. I think there are times in... I’m talking about suicide prevention because it’s my area of expertise. When I started in suicide prevention about 20 years ago, there was little or no communication between leadership and the field, the field practitioners and so on. About 10 years ago, there was an important change, people listened to each other more, the basic researchers said this is how suicide prevention works, and the field clinicians who developed intervention strategies, to help approach men, for example. In my day, men didn’t call suicide prevention centres, but in the last 10 years or so, more men have been calling. How do we get decision-makers to listen more closely to the field workers and vice- versa, since the field can also communicate with the decision-makers?

I really don’t have the right answers. I listen to what I’m saying, I just don’t have that many right answers. But the channels of communication are usually much more important. Sometimes, it’s fun to get people talking about statistics and then develop Quebec-wide or Canada-wide mental health or suicide prevention programs. That’s extremely important. In Quebec, about 10 years ago, there was political will for suicide prevention. When the wheel was turned and the policy wasn’t on the front burner, the suicide rate began to rebound a little. So we need our decision-makers to say that suicide prevention is important. At the same time, field workers need adequate support.

Like I said earlier, it’s sad to say that sometimes, it’s still counter-intuitive to accommodate someone who wants to die. It’s not unheard of for the network to immediately hit the emergency button and refer the person to the hospital. Then the patient has a short hospital stay, and leaves without any kind of safety net. We have to equip our field workers to respond to and de-escalate the crisis. And, yes, some situations require hospitalization, but these aren’t the bulk of situations requiring hospitalization. There are other solutions that work better. What we need to do is train our network staff to recognize different stages before telling a client: “I’m not listening to you, you’re talking about suicide, I’m sending you to the hospital.” The client hears, “Well, it doesn’t do me any good to talk about it,” instead of,  “Wow, you did the right thing by calling us, or not staying alone with your suicidal thoughts.”

So, maybe the wheel has started to turn over the last 10 years or so and it’s turning in the direction of the field workers. Unfortunately, it may have stayed too long at the decision-making level, and the information didn’t always reach the field. I don’t always have the right answers when journalists come to see me and say, “Tell me about the statistics.” For me, this crisis is more positive than we might think, and if practitioners can deal with the crisis more positively, we can identify the individual’s resources. That’s the most important thing I want to emphasize in this talk. For us, a suicide crisis doesn’t always have a specific date or event. Suffering is everywhere, it’s always there. When we demystify this suffering or at least give it meaning, we can see how adaptable we can be. That’s what’s most important. No matter the approach, no matter the diagnosis, it’s more important to return dignity to this basic survival instinct that we have or the individual has.

Alex Maheux

Mm-hm. No, I think that’s a great answer. My takeaway is that it’s super important to listen to each other on every level, and that’s really, in essence, what your service offers to people in need. When the pandemic is over, hopefully there is some relief coming, where do you see the impact on your work? Also, as a second question, what makes you feel optimistic about the future?

Éric Arseneault

I’d like to see a lot of positive developments from what we experienced during the pandemic. Preparing for disasters is helpful, and living through disasters is also helpful. The pandemic is a global disaster, but on a smaller scale, the disaster is part of the change. So I hope that the principle of collective work will remain. That’s what’s been so amazing about the pandemic. Maybe all the different fields of activity were paying more attention to each other. So that’s what I’m hoping for. On a smaller scale, I hope that hand washing continues, because I saw fewer gastros, less flu at work this year because people were disinfecting their workstations and so on. So the hygiene issue is also interesting. I think we’re going to grow from this, and we’re already seeing it in several areas of service to the elderly. Even 20 years ago, the elderly were a blind spot when it came to suicide prevention. Suicide among the elderly was considered almost trivial. It’s like we’re updating blind spots that we’ve known about for a long time. To me, it’s interesting that we’re focusing on it.

At the same time, I hope we don’t forget, post-pandemic, that we have to retain this clientele. What keeps me going in suicide prevention, what gives us hope? I’ve had the chance to talk to people who lost hope, who have given their 4% to humanity, saying “I give up on the world, I want to disappear,” by listening to them, accepting them, finding reasons to live, seeing them regain hope. To me, it’s a sign of progress, and I saw it during the pandemic. I saw it before the pandemic, I read about it in books written during the great wars. I’m really confident that we’ll learn from this, and continue to evolve.

Alex Maheux

Mm-hm, certainly Éric, thank you for giving us some hope. Thank you for your important work every day, you and your contributors, and thank you for shedding light on such an important topic today.

Éric Arseneault

Thanks again for inviting me.

Alex Maheux

Thank you for listening. We hope you enjoyed this episode. Join us again soon as we continue to present interesting perspectives and dive into health-related topics that interest you. To learn more about CIHI, visit our website at cihi.ca. If you enjoyed our discussion today, subscribe to our podcast, leave us a comment and follow us on social media. This episode was produced by Jonathan Kuehlein, with assistance from Amie Chant, Marisa Duncan, Shraddha Sankhe and Ramon Syyap. Thank you for listening to the Canadian Health Information Podcast. Until next time!

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