Suicide Awareness Webinar, 2014-06-26

Good afternoon. Welcome all of you to this on site webinar. We want you to know that Paul, Shye, Cliff and I are glad to have you join us. There's going to be three parts to today's presentation. I will do the first one, first part. Which I will give an introduction to the overall introduction and answer the question how is suicide a public health problem for those who work in agriculture in the rural communities. Shye will present what are the strategies to assist someone that might be in a risk for suicide. Then we're going to open it up to questions. We welcome your questions. First let's start with farm/ranch stress. In one of the studies we looked at they looked at 130 occupations and identified farming is one of the top 12 high stress occupations. According to NIOSH, farm owners were second only to laborers in rate of death for stress relatedd illnesses. We know that it's dangerous. Farming and mining are the two most dangerous occupation in the U.S. financial stress and depression are related and we know that our farmers and ranchers and rural community members experience financial stress. We need to watch for their depression levels as well. In a study of 425 students, poverty and unemployment significantly predicted depressive symptoms. So depression can be long lasting and long-term in many of the people in our country. Many farmers and ranchers struggle with depression. It's not really clear whether they experience lower or higher levels of depression and other mental health issues than the general population. The research is mixed on that. North Dakota farmer depression levels are almost twice that of other rural area population in the past. In an Iowa study of farm men, they were more likely to experience depression if in the past year -- now take a look at this. You probably have some of the farmers and ranchers you know that experienced some of these. They lost something of sentimental value, they experience income decline, gone deeply into debt, faced legal problems or an increase in health problems. If you see that in some of your inclines, take note and see if you can spot some signs of depression or suicidal thinking. Unemployment individuals were more likely to experience chronic depression than employed individuals. Participants with no funded health insurance were more likely to experience chronic episodes than individuals with private insurance. What is the common cold of modern psychology? The common cold of modern psychology is depression. A major depression interfere with our positive experience and dramatically affects our life. This is more than the normal blues that most of us experience at one time or another. Every year, 1 out of 10 Americans experience a major depression. So depression is pretty common. They might say the common cold of modern psychology is depression. What is the best, most affective cure for depression? It's a combination from the research that's been done, taking good care of ourselves, counseling and medication. If we find ourselves or someone we know is clinically depressed it's best if we refer them to professionals to listen to them. And provide them with counseling and provide them with antidepressant medication. What do you think the leading external causes of deaths in Colorado farms has been in the past several years? First is suicide. This surprises some of the people that haven't been in my workshops. The second is large animals, and the third is machine or tractor turnovers. The leading external cause of death on Colorado farms and ranches is suicide. Then animal incidents and then tractor rollovers. Financial stress has historically been reported as a leading factor. Financial loss, and depressive symptom are characteristics of individuals. So we find a high percentage of people who are suicidal are depressed. Another problem is that difficulty with money has been reported as one of the leading causes of marital stress and divorce. So if we have financial problems, it's likely that our spouse are going to be arguing about it. Higher rates of suicide among farmers and ranchers have been report in the united kingdom, Australia, Canada, Scotland, and U.S. there was a foot and mouth disease and there was a spice in -- a real spike in farm and ranch suicides. So suicide rates by state. If you take a set of data like the 50 states, suicide rates and cut it into 4 parts, those are called quartiles. You have the first quartile in red, then blue, and gray, and then the fourth one is white. So the fourth quartile are those with the lowest suicide rates in 2010. What you see, I have slides back here for about 15 or 20 years. What you see is they consistently in the mountain, the western mountain states including Alaska that the suicide rates are often among the top quartile. For Montana down to Nevada and Arizona and the other different states will be the top quartile in different years. It varies in terms of economic situations and other situations. Western mountain states have the highest suicide death rates. The rate increases among older men and is especially high for 75 years plus, especially if they lose their spouse. I'll tell you one experience, when I was giving a workshop in one setting, a man came up to me during the break and said I want to tell you my story. I said I'm listening, I like to hear.

I have this friend for maybe 30 years and I wondered what happened to him and the next day I saw in the paper an obituary for him. He said well, he lost his wife two years ago, and then he lost his farm recently. So he went into a gun shop, and he asked for a handgun, and he bought a handgun and then they said you want to buy a box of shells? He said I only need one. He said I can't sell you a whole box -- I mean I can't sell you one shell, you have to buy a whole box. That should have been a tip off to the guy not to sell it to him. If you're just going to buy one shell, you have a good hunch on what he's going to do. This guy was over 75, he lost his wife and farm and many men when they lose their sense of identity on who I am and he no longer was a farmer and a husband, he saw only one way out and that was suicide. This slide is an older suicide, but I like it because of what it shows us demographically. This is the suicide rate for African-American women. You see they spike at 2 per 100,000. And they spike again, and they have few bumps on the way. White women peek at 45-49. They said that probably spikes there because of menopause and empty nests. Now look at white men, here's where your biggest risk is. You see white men when they get to 75 to 79 they have a suicide rate of 40 per 100,000 and then it goes up to 56 per 100,000. There you see the white males suicide rate is 52 per 100,000. When you get to above age 85. We need to pay attention to that. The overall suicide rate was 12.4 in 2010. That's down here. Now I have a recent article from news week from the April 10th issue. If you happen to see that article, I do recommend that to you. My friend and colleague Mike was quoted there. Here's a quote from that article. Since the crisis of the 1980 farm crisis, the suicide rate for male farmers has remained high, just under 2 times that of the general population. Now that would be at about 28 to 30 per 100,000 right in this range here. That's a little over twice as high as the -- a little under twice as high as the national average. Now I want to mention about -- I want to mention about the veterans rate of suicide as well. Records from 48 states shows that the rate is about 30 for every 100,000 for the population compared to a civilian rate of 12 per 100,000. It's risen from 2005 to 2011. Why do farmers and ranchers commit suicides at higher rates? It's not increased levels of mental health issues. They don't have a higher rate than others. It may have to do with demands of family farms, the culture of farming communities, the shortage of healthcare, high accessibility to firearms, occupational stress, financial difficulties, family problems, and of course retirement is a trying transition for farmers. When we looked at trying to figure out why is it that 3 out of 4 suicides in the United States are committed by men and only 1 out of 4 are committed by women in the U.S., versus in china where 2 out of 3 suicide are committed by women and 1 out of 3 are committed by men. We think it has to do with messages we get when we're little boys as we're growing up. David and Brandon wrote -- they came up with the first four. We raise our boys differently than our little girls. We tell our boys, no sissy stuff. Men are expected to distance themselves from anything feminine. Men should be occupationally and financially successful. Be a study oak. Give them hell. Men should do what is necessary to make it. I added a fifth one to this based on my years working with farmers and ranchers. When you're hurting, keep it inside and tell no one. That seems to be a message that many men have. They're much more vulnerable. I think it's striking in our list of participants today, about 2 out of 3 are female and about 1 out of 3 are male. Assuming that the names are associated with gender. I think it has to do with my workshops when we have men and women there, women seemed more tuned in to signs of depression and suicide and they seemed to be more tuned in to that kind of thing. So when they see that in their spouses or brothers or father, they will know what signs to look for as Shye will talk more about later. They can be helpful people to get the guy who commits 3 out of 4 suicides in Colorado and the U.S., committed by men, to get him to professional help. So being an older white male is with risk, increasing with age, about half of the suicide deaths are by white males. Work problems an unemployment are very much associate with this. I want to share some facts about veterans suicide as my last slide before I turn it over to my klieg. colleague. There's no evidence for increased rates in OEF or OIF veterans relative to sex, age, and race matched people in the population as a whole. Veterans are more likely to use firearms as a means. These are some of the things we need to be aware of as we work with people that might be at risk. At this point, I want to turn it over to my colleague Shye Louis.

Hi, I'm just working to get my web cam started. Okay, so I think we're going now. I just wanted to give you a little more background on myself and my experience in working on suicide intervention. Some of it was in the notice for today's webinar. I just want to let you know where I'm coming from. I've been working with suicide hot line services since 1989. I direct the operation at the lifeline program. We operate regional crisis services and information services in the Finger Lakes of New York. It's through our relationship with the National Suicide Prevention Lifeline. We work for a back up center. We handle calls from veterans and their families all over the country. We operate live chat services where people can instant message, through their computer, they tried sometimes from their smart phones and it doesn't work out as well as we like it to. We operate those national chat services, we do that through The Lifeline web page. And we do that with targeted services. We also back up the veteran's crisis line chat program. For my background, I have a Master's Degree in counseling and I'm an assist and I'm a master training through living works. The national association of crisis center director, and a board member of -- I want to let you know that information to let you know I have a lot of experience and the most important thing that I want to share is that it's not that hard to help someone. I want to give you some tools to be able for a person that doesn't have a specialty to let you know there are things you can do. There are ways that you can recognize and be supportive and help connect that person to other resources. The information I'm going to show you is really just a brief primer. It's not everything you can learn about working with someone at risk of suicide. The material is based on my training, research in the field of suicidology and my experience with working with suicidal individuals. The concepts are universal for those of us who work in suicide prevention. I encourage anyone that's interest in seeking out a two day train in your area for that assist program. You can Google Living Works to get information and get a list of training in your area. There's other training like the QPR model like if you want to Google that and you'll find information on that type of training program if you're interested in learning more after this webinar. The most important thing regardless of training and helping a person, is your willingness to look for signs of concern and talking honestly with the person. So we're going to talk about what that looks like right now and then move into -- sorry for that. Okay, so how do you recognize suicide risks? Robert gave you a lot of helpful information on who might be a risk for suicide. We talked about people who worked in agricultural, older white males, who have been shown statistically to be more at risk for suicide. I want to point out that it's important to remember that anyone could be at risk for suicide. That includes those of us signed in at this webinar. We could fine ourselves in circumstances where thing are really tough where through a combination, predisposition through various factors and we can be at a risk of suicide. All of the statistics are incredibly helpful for us. Learning who to target, they're very helpful to get us thinking about the people that we're working with and if they fall into any of those categories, but also don't put people in boxes to think they're only suicidal if they're in one of these categories we talked about. People aren't statistics and think about maybe not the farmer or the veteran that you're working with, but think about their wife, a child, someone else in that family that would be at risk that you're coming into contact with, that may not fit one of those groups. How do you know? How are you going to recognize that? How do you know if someone is thinking of suicide? We talked about the invitations. They're going to give you an invitation to talk. Sometimes those invitations are conscious. They may say I'm thinking of suicide but sometimes they're unconscious. Maybe it's something that the person isn't aware of. There's some kind of signal that the person at risk is distressed. Those signals are going to be an invitation to you to explore whether suicide is on their mind. Sometimes again, it's very overt. I am -- I wish I could go to sleep and never wake up. Those are things that someone that's thinking of suicide may say to you. That's an overt statement. More subtle invitations we can think about is giving away possessions. Some of those types of things could be happening. So, excuse me, so those invitations could come in more subtle forms. They could come in a way that maybe only a specific person would recognize. Sometimes those invitations can be physical changes and behaviors. You may see a change in a person's physical appearance, their taking care of their hygiene, sometimes you may see a person that's social become more isolated. Sometimes you may see a person who is acting out and taking more risks. Again, that happens -- a lot of people take risks, we're not going to assume that everybody that's a loner is at risk. We're going to look for changes in behavior. Look at how the person is acting that would help you to think that something is different, something is going on here. You need to explore that risk. Be respectful and sincere and say what you see. Too many times we're worried about opening a door that we don't know how to go through, finding out information that we don't feel like we have the tools to take the person to the next step. That's what we want to do today is to give you those tools. The first step is to be respectful and sincere. Tell the person what you saw or what they said that was concerning. You know Bob, -- you know when you said you would sleep and never wake up. I would be concerned and wonder if you're thinking about suicide. Listen to what Bob says in response to why he's feeling that way. Ask open ended questions to hear more of the story. Be interested and genuine. Understand what's going on with that person without offering too many solutions. You can use reflective statements, like it sounds like you're feeling pretty isolated or you're feeling lonely. It feels like you're feeling hopeless. If the person is agreeing with you and you're hearing those direct statements, you should ask, ask directly. The person may say something direct about suicide or if you're getting that indication that they're feeling helpless about their situation. They had some of these significant losses that Bob talked about. Any kind of loss can be a trigger. Again, many people who have significant losses in their life don't think about suicide. If you're getting that lost in combination of hopelessness, inability to change the situation, we need to ask about suicide. The best way to ask about suicide is directly. Let me tell you L right now, you're not going to put the thought of suicide in anyone's head by asking. That simply does not happen. The thought is probably already there. A person might have evaluated the thought of suicide, and already decided that's not an option for me. The best way to find out is to ask. If the person is considering suicide as a way to deal with their stress and the pain they're feeling, the best way to find out is to ask. We need to ask and we need to ask directly. We need to ask with context if possible. So if you can say something along the lines of you know, when you -- a lot of people that experienced losses like these. And they're feeling hopeless about things never changing, they're thinking of suicide, is that something you're thinking about? It helps to normalize and value Dade that suicide is a thought that other people think of. A lot of people who think they're isolated or no one could possibly understand. So to ask directly about suicide, giving that context give it is person at risk understand that you're ready to talk about it and you get how a person could be feeling that way. It doesn't mean you support them doing it but it shows you're understanding. It's important to be able to ask that. Ask it concretely. Are you thinking of suicide? Are you thinking of killing yourself? Are you thinking of ending your life? Be careful about asking a question of suicide in case you don't want to know the answer. You're not thinking about suicide are you? That's not a good way of asking that question. So please be careful about that. Or you're not thinking about doing something stupid are you? Those are well meaning intentions and ways of asking that I heard but please be careful to do that. It's much better to ask directly and with that context. People remarkably do not lie. They will tell you the truth. It helps you to determine what next steps you need to take. A person that answers no to that question, still may need additional help, services, you may take for them. And a person that answers yes, will give you an action on what you can do for them. Start by listening, open that door again and listen to what the person has to say. Ask to hear about -- say something like I hear about how all these losses may mean suicide may be an option. It doesn't mean you're validating their acts of suicide, but the pain they're feeling when you're listening, be careful not to rush too quickly. Listen to what the person has to say. You don't have to be a therapist or a counselor. We're not talking about that at all. What we're really talking about is hearing their pain. For a lot of people, just telling their story is a huge sense of relief and it helps to diminish some of the negative feels. It doesn't solve everything, but being heard is a major part of that. Some people have been keeping these thoughts and feels inside. As you're listening, be careful not to judge or minimize or to say things like it's going to get better. You have to hope, I promise. I promise things will get better. Those statement are difficult. You don't know that. Resist the urge of saying that. A lot of us heard those statements and it's a dangerous statement. A mental health concern is a concern they're going to deal with their whole life or the loss they're facing or the grief they're feeling. It may stick with them for some time. So hopefully you can give them some tool to cope with that grief. It's minimizing and disrupts your connection to the person at risk and the likelihood they're going to be connected to other help if you rush a person through to a solution, telling them all the answers right away or telling them all the reasons they have to live. You get to do that, but just not yet. Here, just spend time listening. Use those reflective statements, hearing the story. Let the person tell you why they want to die. As they are telling you why they want to die, why they want to end their life, listen for ambivalence. Listen for that person not being 100% sure. You may hear a but. I really think that there's no other solution but suicide, but I'm worried about my pets, but I'm worried about my children, that but is the part of the person that wants to live talking. We need to listen for that but, we need to listen for that ambivalence or that turning point of when they bring that up. It's so much more powerful when the person at risk finds their own ambivalence and you reflect it back to them instead of you telling the person you need to stay alive for your children or you have these things that could happen. It's much more powerful for the person to uncover them while they're telling their story. The ambivalence will come out and you can point it out to them and explore those reasons to live. It sounds like your pet are really important to you. It sounds like you really like to be here to see your children grow up. It sounds like it's not so much you want to die, but you don't know any other way for the pain to end. If we can talk about ways for the pain to end, would you be willing to try to stay alive and safe? So as you hear those things, point that out, reflect it back, and work together to create a safety plan with the person at risk. A safety plan isn't complicated. It's very simple. I have some stuff we're going to talk about in just a moment. It's not you telling the person that is struggling what to do. It won't work as affectively if it's not a collaborative plan. We want it to be directed by the person at risk whenever possible so it's their plan and you help guide it. Again, it's very simple. It's not too many lets. Let's take a look at what they are in just a second. I also want to stop and say your safety plan should address any risks. As you're creating that plan, think about what you know. Are they thinking of using a firearm? Do they have a history of suicide attempts? Do they have a lack of resources or support? If you don't know about these risks already, this is the part where you can ask, after you have that agreement. So it's not so much that you want to die, it's that you're in pain. If we can create a plan to help you deal with some of that pain, you would want to stay alive. The person will usually say yes. And at that point, you can move together and say let's talk about what that plan would look like. Then you can ask about some of those risk elements, and while you are creating the safety plan, you can address those safe elements through these 6 steps. The first thing you want to talk about is any triggers or warning signs. It's super helpful if you can write this down if you're face to face or if you're working with someone remotely, have them write this down. Are there signs that trigger that person to having thoughts of suicide or having those thoughts feel more intense? A lot of people think about suicide in the back of their minds a lot but there's triggers or other things that happen, other feels they know -- the likelihood of acting on the thoughts of suicide could be more intense. If the person can identify those, then they can plan for them. Maybe avoiding a specific event or situation that's triggering. Maybe it's practicing some common techniques for an emotion. Maybe they know that a fight with a spouse is a trigger. Maybe they know it's time to pay the monthly bills and that's a trigger. For it to be more mindful to handle those events. You can explore internal coping strategies. That's a way to talk about the activities that address negative feels. What helps us feel better? What makes you feel better may help the person that you're working with feel better. We are talking about general strategies. A lot of people find exercise helpful. If you're working with a person that's able-bodied and can do some exercise, that could be helpful. Some people like to write in a journal. Other people like to take a long walk, take a hot shower, there are all different kinds of internal coping strategies that people can use to feel calmer. If you think about a terrible day you had, you come home depress, stressed, whatever those feels may be, what do you do to destress? What do you do to cope with negative feels? You can brainstorm with the person some internal coping strategies. You can ask them to write those things down and have that on a piece of paper in their wallet or back pocket that they're going to pull this out and think about did I just have a triggering event? What are the internal coping strategies I can use? You also want them to think about their social contacts that can distract them from feeling the crisis. Distraction is an important element in staying safe. If all we do is distraction, it's not a good long-term solution but it's a tool to have in our tool kit. What will make you feel happier? Are there positive influences? You don't want to disclose that you're thinking of suicide but you could call that person up and you could go watch a movie or have them over for a cup of coffee. There's a lot of value in distraction in helping to keep you safe. Have that person write that down in their safety plan as well. We should also identify family members, friends, who's in the support network? Identify those connections. Talk to them about finding someone else they can tell. A lot of people, and we talked earlier with Bob about keeping it to yourself. Especially with men not willing to share, it's across the board with men and women when it comes to talking about suicide. It's really difficult to tell that to someone else. Maybe you're the first person because you picked up on those warning signs. You picked up on those invitations, you may be the first person they told. How could we bring other people in the supportive circle that know what's at stake? Could it be a spouse? A friend? A coworker? Who could you bring in to say could you be someone I can call. Could you be my safety contact. I like to lean on you -- it's identifying those contacts. If the person doesn't have safety contacts, then we can move to the next step. Professionals or agencies to contact for help. That's important to think about. You know the community and what the services are that are available. As you're talking to the person that's at risk you can listen to signs and symptoms. It might not always be mental health services. It could be financial services as well as those mental health services. As you're identifying what agency or community resource would be appropriate to address the person's problems, you can write those down and put those on a safety plan. If you don't know what resources they need, you don't have access to them, that's not in your personal listing, what you can do is think about using two and one. That's an agency I work for. They coverer 90% of the country in terms of population. They provide referables on all kind of health services information. You can reach out to them and I'll tell you how to do that in the next slide. You can call the national suicide prevention hot line. That's a great place to start. So you can dial that national number and it will get you to the closest certified crisis line in your part of the country. And those two resources, two and one and the national suicide prevention hotline know a lot about the service in their given communities and can help you navigate to where resources are available. That might be outside the bounds of your knowledge. You can discuss the referable with the person or their family member, thinking about making that referable. It sounds like you're feeling depressed. I like to connect you to some resources, and introduce resources that way. You could have them write them down, make calls, maybe with you there or if they're going to make the calls on their own, and you feel confident for them to do that, plan any barriers to connect to the resources. Maybe someone is not able to get away from work, talk about when you're going to call and help see past barriers. It's hard to take that step and make the connection call you need to make as a person at risk and any little barrier is easy to see it's not going to work. Put that down and not make the call and not follow up. So help them plan around potential barriers and make a plan to follow up on the resources s -- and referables. Talk to people about guns at home. Ask them what they can do about that if a gun has become a plan. Ask them what they're going to do about pills people need pills to control blood pressure, to control diabetes. Could someone hang on to the pills if they're at risk? Can we reduce access to the gun. Think of it as a continuum and try to put as many steps between the person and their plan as possible when we're making the environment more safe. So, if they aren't willing to give their gun to someone else, you can ask them to separate the gun and the bullets or put a gun lock on their gun. There's a lot of different things we can do. You can collaborate with the person on that on making the person safer. We can involve family with that as well and those safety contacts that we talked about. Just a couple of things in case you wanted to write it down. Specially on the finding the 2-1-1. You can put in your zip code, city, state, a variety of information to retrieve the closest center to you. You can dial the national South Side Prevention Lifeline. You can also have people who might be comfortable -- especially younger people, but we receive chats from people age 10 to age 80 through suicide prevention lifeline. There's a web page you can click on there. We talk about circumstances that may not go so well, when are you going to involve emergency services? When might be a time to photo fie EMS that we need someone out there to assist with a situation that is imminent risk or already in progress? So think about asking if a person tells you that they have been thinking of suicide. Maybe you'll hear signs that they sound slurred, it could be a sign of drinking, it could be a sign of complications from the medication, but it could be a sign that they already taken pills that they're thinking of suicide, and you may meet with them face to face if they already taken pills to end their life. Or if you hear somebody who's talking to you about what we call imminent risk, a specific lethal, available plan and there's a timeline on that plan that's in the near future, you're probably going to have to involve someone outside yourself. You can contact emergency services, or if you're not sure which way to go with it, you're not sure it's a emergency, call that 1-800 suicide number or the talk number for the national suicide prevention hotline and consult with one of the operators that answers the phone. You're not alone in coming into contact with a person that's at risk. Other times you may need to involve emergency services is when that person is unwilling to collaborate for their own safety, perhaps there's a cognitive issue or they're so disupon dent to cooperate or give you information on the plan. You're going to involve someone else and a emergency service of some kind. Ultimately, these are just a few tools we use to get you started on having a conversation. It's really important for you to make those link cages for folks and we want to have you focus on the concept of responsibility and your role in working with a person at risk. It's really important to remember that ultimately, you are only responsible with those people you care about but you can't be responsible for them. Ultimately we can only be responsible to the person. Be careful on thinking you have to save someone or take responsibility for their safety. You alone can't do that. Please seek help if you're feeling overwhelmed with trying to help. You can identify, explore, ask about suicide and make a caring linkage to another qualified individual. You don't have to do it alone. There are folks you can talk to at the hot line. Your community may have a crisis team to get other people out on scene to see someone that's at risk. You can reach out for help to help someone that's at risk. So that's the last thought I wanted to share. It's an important one if you are going to start taking steps to be more active in identifying people who might be at risk suicide. Being more open to talking about it, being more willing and able to start those conversations that are really hard and scary for a lot of us. I hope those are some tools that can help you. I can talk for days about it but I want to be mindful of our time and open for questions. Please remember to be careful out there and take good care of yourself. .

Fantastic. Okay, so with most adults over the age of 25 or so, there's really not a ton of difference. In my opinion -- in your approach -- [ Captioner has lost audio ] [ Captioner cannot get audio <^ > ]

Yes, I think that's a good answer to that good question.

Shye, your audio is breaking up a little bit on that. I want to clarify that you were saying you need to be more directive with younger people than with older people, is that correct? ?

It sounds like we're having audio problem with Shye at this point.

I'm sorry, can you say it again?

I was saying your audio was splitting up a little bit and I wanted to clarify that you were saying that you need to be more directed with younger people.

Yes, I'm sorry.

Okay.

Okay, the next question I see here is the data on farmers was there a region that was the highest.

Yes, more directive, offering power and choice and allowing that person to think a little. .

So Shye, it sounds like possibly we're having problem with your camera being on, so it may be interfering with your audio. If you want to turn your camera off, that might improve our audio a little bit. I'll help you do that. Okay Bob, you can go back to your response on the other question.

Okay, the question is the data on farmers, was there a region that was the highest. I'm assuming highest in suicide rates. I haven't found that data. If it exists, I'm not sure where to find it that one region is worst for farmers and ranchers with suicide rates. What we can predict is that there will be a relationship between tough times or economic hard times, and suicide, depression and suicide. Those are highly related. So, I would just speculate here, and not having good data yet. Because they report lag a bit before it get to the state and the federal level. With the current severe drought that exists in California and parts of New Mexico and Arizona, and Colorado, it's likely that those kinds of places, particularly as pay gets harder to find or it's hard to get enough water and crops because of the irrigation being shut down, those kinds of places where stress gets higher among -- are in a broad base because of drought or flooding or because of fires, or because of severe problems that go on. That's where I would suggest you keep your eyes and ears open for possibilities of people feeling hopeless, and feeling like they don't have any other choice than to take their lives. I haven't found any data that looks for suicidal deaths for farmers and ranchers regionally. As we look for the highest stress point in terms of regions, that could give us a good picture on where we could look.

Are there therapy resources that a person can turn to after therapy sessions exceeds what insurance will pay for? Of course. Many counties across the nation have mental health resources and mental health centers. All of them that I know of are committed to providing a sliding scale. So if financially paying for the mental health services in the counseling and the therapy sessions is a difficult problem, then you might pick up the phone and check with your local mental health services or the one in the next county and ask them what the rate will be. You may be able to negotiate a lower rate so you don't have to pay so much for a therapy session.

Shye, would you want to add to what I have said there?

Yes, I agree we want to investigate low costs or sliding fees, sliding scale fees that are available. Contact the 2-1-1 center or the local crisis lines. That's a great way to find out about therapists. Or other kinds of free counseling that's available as well. There's low cost and some free services. It depends. It's difficult in rural areas to find those services but they do exist in certain places. It's worth looking and not giving up for those services and doing investigations. We hope you're able to connect with some of the resources and be able to find that out. It is possible. .

I'll chime in on this one, I'll mention that there's some great online resources through the Suicide Prevention Resource Center. So if you look that up. Or the American Association of Suicidology. They both have some great programs that are out there. There's a free training right now that we're looking at called COM that's really powerful and available through the SPRC for free. There's also wonderful resources for the American Foundation For Suicide prevention. There's information there that would help you continue your learning.

I would just add that one of our previous AgrAbility webinars dealt with mental health dealing with drought issues but a lot of those principles would be relevant to anyone dealing with mental health issues like suicide. So you may want to check that out on the archive page, on the AgrAbility website. Bob, do you have anything you want to add anything?

No, I think Shye did a great job on answering that question about resources that are available.

Looks like Dale had a good suggestion there. Thank you for providing that. I just want to say one last thing to all of you that have been on this webinar. I'm glad you took the time to be with us today and to be interested. I wanted to tell you, it's important that you take good care of yourself. If you don't take good care of yourself, nobody will. If you don't take good care of yourself, you won't have what it takes to be able to provide the careful, sensitive, respectful listening that Shye did such a wonderful job of describing today and modeling in what she taught us today. So take good care of yourself. As you do that, you will be better able to respond well to be responsible to the people that are suffering in your area. .

Thanks Bob.

Now we're going to turn it back to Paul.

Thank you to our presenters today and all those who participated. You will find the address for the archives up on your screen. Hopefully at this point. And feel free to -- I think we'll have the presentation and the recording up there along with the transcript within the next couple of days, if you like to refer back to that. I will point out our next AgrAbility webinar is schedule for July 23rd at 3:00 p.m.,est earn daylight time. The topic will be significantly different from this time. It will be improving vision while using farming equipment. That could be for somebody that has a visual impairment or someone who has difficulty turning and looking, for example, behind them or just anybody that's using large equipment that would benefit from things like back up cameras, and mirrors and other types of video devices that can improve one's ability while operating large farming equipment. Again, if you have any comments or questions, feel free to leave those in the chat window, the room will be open here for a little while or just e-mail us via the AgrAbility@agrAbility.org website. Thank you for participating and have a good day.

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