“Please help me before I kill myself.”
“I don’t want to eat; I don’t want to sleep. I don’t want to be social; I don’t want to be here.”
These are words from real people seeking help after an abortion, shared during a recent suicide risk assessment practical hosted by Support After Abortion.
The statements illustrate the depths of emotional distress some women and men experience following the loss of a child to abortion – distress that can sometimes include thoughts of suicide. Support After Abortion seeks to ensure that providers and caregivers who serve this population are well equipped.
The nonprofit is dedicated to bringing hope and healing to women and men impacted by abortion and works on both sides of that equation: connecting individuals with healing resources while training and equipping the providers who serve them. Its hotline offers support by phone, text, email and social media, while its provider programs offer training and resources designed to help professionals and other caregivers respond to those seeking help after an abortion.
That work came into sharp focus during a recent follow-up training on suicide risk assessment hosted by Support After Abortion Communications Manager Michele Mazelin and Dr. Amy Vogel, a licensed counselor who specializes in suicide grief, loss and intervention.
[Click here to subscribe to Pregnancy Help News!]
Vogel holds a Ph.D. in counselor education and supervision and has more than a dozen years of experience in crisis counseling, including service as a crisis counselor with the National Suicide Prevention Lifeline.
The training built on an earlier foundational session addressing suicide risk assessment and safety planning. Among the resources reviewed were the Columbia-Suicide Severity Rating Scale, or C-SSRS, and the Stanley-Brown Safety Plan. Vogel emphasized that assessment should not sound like a checklist.
“You don’t want to ask the questions in a robotic manner,” Vogel said. “You want it to be very calm. You want to be very curious with these questions and be very gentle.”
This time, however, the emphasis was not simply on learning the tools. It was on putting them into practice.
Mazelin presented participants with real, de-identified interactions from the hotline. For each scenario, participants had to decide whether the client’s words called for continued compassionate conversation and care or whether something they heard warranted a suicide risk assessment.
The difference was not always obvious.
One client described feeling stuck, struggling to accomplish everyday tasks and having no one besides her boyfriend to talk to. The scenario contained no significant suicide risk flags, and participants were directed toward continued compassionate care.
Another client, just three days after her abortion, described losing her job and her boyfriend, difficulty eating and sleeping, and struggling to complete everyday tasks. Participants were divided over whether the statements warranted a suicide risk assessment.
Vogel acknowledged the complexity of the scenario as the group discussed it.
“There’s a very gray area when it comes to asking about suicide,” she said. In uncertain situations, Vogel said she asks herself, “Am I gonna regret not asking?”
Vogel told participants that after asking thousands of people whether they were thinking about suicide, she had not experienced someone becoming upset because she asked. Instead, she said, asking could communicate compassion and create an opportunity for greater vulnerability.
“They felt like I was being compassionate, I cared about them, I had the courage to ask,” Vogel said.
Vogel explained that suicidal thoughts can exist without intent, and providers still needed to understand where the client fell on that spectrum. Other scenarios showed providers how to recognize less explicit language.
“Now I’m alone after removing everyone from my life and without my baby,” one client said. “I don’t know how I’m supposed to live with this. I cannot stand this pain. It’s unbearable.”
Vogel pointed to the client’s lack of support, social withdrawal and description of unbearable pain as reasons to ask directly about suicide. Rather than interpreting the client’s words for her, Vogel modeled how a provider could use the client’s own language to open the conversation.
“I’m not saying that this is you, but I want to make sure you’re safe,” Vogel said. “Are you thinking of not being alive anymore?”
The scenarios grew more serious.
One client described guilt, sleeplessness, difficulty eating and concentrating, isolation and a desire to retreat to a dark room. After the After Abortion Line asked directly about suicide, the client disclosed that her suicidal thoughts were “seriously real” and that she struggled most with them at night.
At that point, the role of the provider changed. Vogel explained that the client needed further suicide assessment and safety planning and, depending on the immediacy of the risk, connection to crisis or professional resources. In this particular case, the client was outside the United States in an area without a helpline, and the After Abortion Line continued engaging with her while working to locate support in her area.
The client continued to struggle in subsequent contacts and eventually sought counseling. As her distress and suicidal thoughts resurfaced, Vogel said the pattern demonstrated the need to connect her with professional mental health care capable of addressing trauma.
The words shared throughout the training tell their own story. Women and men reached the After Abortion Line describing children they lost, guilt they could not shake, relationships affected by abortion and emotional pain they were struggling to carry. Some were looking for someone who would simply understand. Others needed someone prepared to recognize that their words signaled something more.
One client who reached the line in a serious crisis later put it simply: “So glad I reached out. Thank you for being there.”
“I’m just thankful that so many of you are here to help more people,” Vogel said, “because this is a very large global problem that we can be the light for people and be with them at that time.”
For pregnancy help organizations committed to walking alongside women and men affected by abortion, that may be the lesson at the heart of the training: compassion opens the conversation, but preparation helps ensure that when someone reaches out in their darkest moment, the person on the other end knows how to respond.
Tweet This: For pregnancy help organizations committed to walking alongside women & men affected by abortion preparation helps ensure adequate response.
Editor's note: Heartbeat International manages Pregnancy Help News.
Sources
- Support After Abortion. “Suicide Risk Assessment: Putting It Into Practice.” Webinar presented by Michele Mazelin and Dr. Amy Vogel.
YouTube webinar - Support After Abortion. Organizational information and After Abortion Line resources.
Support After Abortion - Columbia Lighthouse Project. Columbia-Suicide Severity Rating Scale (C-SSRS).
About the C-SSRS - Stanley-Brown Safety Planning Intervention. Safety planning resources and intervention materials.
Stanley-Brown Safety Planning Intervention
