Members Only | 10.03.24
For NAMSS Past President Michelle Stultz, National Suicide Prevention Month Is Beyond Personal
By Teddy Durgin
Disclaimer: This article contains mentions of and personal stories about suicide.
When you are assigned to do an article on September being National Suicide Prevention Month, you can’t help but draw on your own personal experience. I am a Generation Xer who was raised by my maternal grandma. When I hit my teen years in the 1980s, she started to have a number of health problems. Fortunately, she and I had the most wonderful general practitioner. He’d been our family doctor for many years — well before I came along — and he was so kind to my grandma and helped her in so many ways.
But one day, we learned that he had been accused of inappropriately touching a patient. He denied the allegations and vowed to clear his name. The charges weighed on him, and he ultimately took his own life. Not long after his suicide, it was proven that he was innocent.
I was only 17 when this happened. But I have never forgotten that period of time where I watched a good man falter after a distinguished career of helping people. Years later, his loss helped me deal with an incident where my own daughter, at age 17, tried to take her own life amid struggles with depression and an eating disorder. Fortunately, her mom and I were able to intervene, and she is still with us today.
So, I take this article very seriously. And so does my main interviewee, NAMSS Immediate Past President Michelle Stultz, RN, CPMSM, CPCS, FMSP. “The brain is an organ,” she says. “You can’t tell your pancreas to make more insulin so you’re not a diabetic any more than you can tell your brain to not have these thoughts. The brain can’t be told, ‘Just make me happier!’”
A year ago this month, researchers from Columbia University and other institutions released the results of a study on suicide across the various professions. Compared with people who don’t work in the medical field, the research found that healthcare workers face an increased risk of suicide, particularly registered nurses, health technicians, and healthcare support workers.
The study estimates that the annual suicide rate in the United States among healthcare workers alone is about 14 per 100,000 person-years versus about 13 per 100,000 person-years among non-healthcare workers. Person-years is a measurement that represents the number of people in a study multiplied by the years following them.
Stultz, who currently serves as Vice President, Delegated Credentialing & Provider Enrollment at Bon Secours Mercy Health Inc. in Cincinnati, says, “[Medical service professionals, or MSPs] are not removed from that. Healthcare workers always take care of others before they take care of themselves. They’re not always putting the oxygen mask on first before they help others like you’re supposed to do when traveling in an airplane. Some of our MSPs are experiencing issues in their own personal lives, not necessarily issues in the workplace, that have affected them. I definitely hear colleagues who will come right out and say, ‘I am experiencing PTSD’ or, at the very least, ‘I am struggling.’”
Stultz warns that those MSPs who do not seek help will only see things get worse. “Relationships will start to suffer. Your finances may start to suffer. Your work performance will start to suffer. MSPs are very much like their physician-colleagues in that their work is the last thing that does suffer. Everything else goes to pot first. It goes back to the whole sensibility of ‘I have to take care of others. That is my job!’”
Stultz’s sensibilities and answers to my questions are colored by her own past experience. Her son, Zachary, was a United States Marine right out of high school who returned from Afghanistan with severe PTSD and ended up taking his own life in August 2016 at the age of 25.
The Marines early on found that the young man was excellent with firearms, so he was trained as a sniper. “He did things that I won’t go into,” Stultz says. “In six short years, he got a lot of PTSD. A lot of targets. I remember his younger brother, Logan, asking him how hard it must have been to hide in the mountains and shoot people. And Zach got real firm, looked at Logan and said, ‘I shoot targets, and I’m damn good at it!’”
She continued, “Zach had to come live with us, because he couldn’t live alone. He would wake my husband and me up in the middle of the night to tell us the perimeter of the house was secure. One night, he had a stick he had found outside that he was holding as a gun.”
The family eventually put Zachary in the VA system, and he received inpatient care for the agency maximum 30 days. He needed more. “The very young man we gave the United States Marines was not the man we got back,” Stultz laments. “I will say the Cincinnati VA system where Zach was has some of the best research into PTSD going on. … He was getting outpatient therapy toward the end almost every day. But he knew. He would tell us, ‘I am not getting better.’”
Zach did not keep his struggles quiet, and he fought until the end. So, why would a NAMSS member keep their mental health struggles quiet? What prevents many in the healthcare profession from seeking help? “Because I think we still live in an age where it’s taboo,” Stultz replies. “We must get out of this stigma that we caused our own depression, that we caused the state that we’re in. We need help.”
And help is available. There is, of course, the 988 National Suicide and Crisis Lifeline. That can be used by those in an emergency and/or those who lack the knowledge of where to turn to for help in their geographic area. Prescription medication administered by a primary-care physician or a psychiatrist is also frequently an option.
Stultz adds, “We can do more as colleagues, too. We can ask, ‘How are you? And I’m not talking about the job. Just … how are you?’ And be prepared to devote more than a few minutes once you get that answer. Sometimes just talking and getting it out with a friend, a confidante, maybe someone who is also experiencing what you’re going through can be such a big help. It’s amazing that once that conversation starts, we find we have so much more in common than we think we did. And, of course, talk to a mental health care provider. Many of us are fortunate that we work in environments where there are plenty of providers, and they want to help.”
But let’s say the worst has happened. A colleague has committed suicide. Such a tragic act can certainly cause trauma for those left behind, including co-workers and colleagues. “Twenty years ago, I had an experience where we had a physician take his life,” Stultz recalls. “Back then, it was still somewhat taboo. We wanted to be respectful to the family, and many of us went into silence. That was the worst thing to do. Twenty years later, there is now a rush to help when something like that happens. Counselors are provided, and more people want to talk. Early on, though, people might not know what to say. The grief actually comes much later.”
And for Stultz and her family, the grief continues. But don’t mistake it for an absolute negative. Tearfully, she concluded, “Zach will come up in conversation, I’ll react, and people will say, ‘I’m sorry I upset you.’ You didn’t upset me. This is just part of the grieving process and how I handle it. People want to talk about their loved ones. It’s how we memorialize them. You were a complete stranger until 10 minutes ago, Teddy. But you shared with me, and I am fine sharing with you. Some days I can talk about him, and I don’t shed a tear. But there are other days like this one where I have to prepare to talk about him, and the emotions come out. My grief eight years later is the profound love that I had for Zach, that I still do. I just can’t share it with him.”