The topic of suicide is heavy, but also one that is very important in the context of employee mental health. What does HR do when an employee threatens suicide? What if they attempt it? What if they succeed? These troubling circumstances are more than a “maybe.” Suicide is the tenth leading cause of death in the United States with over 47,000 Americans dying of suicide in 2017. For every successful suicide there are many attempts, and odds are that HR professionals will have to deal with a situation like this at their workplace at some point.
In this episode, we feature two guests to discuss this important topic. The first is Andrew Adams, an attorney at Skoler Abbott, which operates out of Springfield, Massachusetts. After receiving his undergraduate degree in marine biology Andrew enlisted in the United States Navy before eventually returning back home to Hampden County. For the next 6 years and throughout law school Andrew worked as a Correctional Officer for the Hampden County Sheriff’s Department until he left to pursue his passion for the law. In his final year of law school, Andrew was a law clerk at a premier tort litigation firm in Connecticut, before finding his home at Skoler, Abbott.
We also have with us Jamie Vinck, MC, LPC, NCC, and Group Chief Executive Officer at Sierra Tucson, a residential treatment center for drug and alcohol addiction as well as behavioral health located in Arizona. Successfully operating Acadia Healthcare’s flagship behavioral health facility, Jaime, is the second female CEO at Sierra Tucson. Jaime has introduced groundbreaking outcomes measurement and recovery programs that have earned the facility top recognition within and outside the industry. The program, which provides support through an industry-leading app, helps individuals stay connected and engaged, while also providing one-on-one access to their own personal nationally-certified recovery coach.
This episode was originally released on May 12, 2020 and the audio can be listened to here.
James Davis: Though not often talked about, suicide is a major cause of death in the United States, as we discussed, and is often considered preventable. People who may decide to attempt to take their own lives often have friends, family, and coworkers that could be positioned to help them if they knew what to look for. Jaime, do you have a sense of how prepared HR or employers are to handle an attempted or, God forbid, a successful suicide of an employee?
Jaime Vinck: Well, that’s a great question. And unfortunately, I believe that HR executives and people in general are ill-prepared, given the depth and the scope of this suicide epidemic that we’re in right now.
James Davis: Can you talk a little bit more about why you use the word “epidemic”?
Jaime Vinck: Yes. You talked about the statistics that are staggering, and that one that you mentioned—the 47,000 deaths annually—that’s the one that gets quoted oftentimes. But the thing that isn’t widely understood is that only 1 in 25 attempts is lethal. And so if you think about it, we have 24 people walking around—the walking wounded I call them. They’re returning to their workplace. They’re often returning to their lives. And if they’re unable to get treatment, they’re just going right back to the same old, same old. And they may be your coworker. They may be the guy in the next cubicle. Who knows?
The other thing that’s very interesting to me is the number of people that are impacted by suicide. There’s all sorts of different statistics that people look at, but the one that I like is that for everyone that dies by suicide, there are at least 130 people that say, “I knew them.” That leaves over a million people that are impacted by suicide. And the numbers say about 250,000 that knew the person well or even love them. And so if you think about the impact of those numbers—again, the size of the walking wounded in the workplace—I feel that it’s incumbent upon all of us to understand more and to have a conversation about suicide openly and honestly.
James Davis: And that really is the issue, isn’t it? It’s hard to talk about. We run into the same issue with other things like sexual harassment and violence and abuse. People just don’t want to talk about it. I mean, it’s uncomfortable. And if you don’t have the tools necessary to talk about it, if you haven’t been prepared when someone says something about wanting to kill themselves because not everyone’s silent about it, it’s really a problem if people just don’t know what to do because what I know, I’ve experienced that before in my life, and without having experienced it before the next time, I had a better idea of what to do, but you just don’t know. And you add a professional setting to that, and it gets even harder.
Jaime Vinck: Absolutely.
James Davis: The trouble with this is that it’s a universal issue. It’s one that affects families. And as you mentioned, Jaime, all these people have to deal with it. And then when we put it in the confines of the workplace, it gets very narrow, and it can be a little bit troubling to understand whose job it is to be ready for this. And unfortunately for HR, that usually falls on them. When there’s an employee death, typically that’s an HR role that has to handle all kinds of complicated tasks. And we’ve covered that in the past. So, Andrew, to what extent, legally, can HR get involved? Let’s say an employee was heard saying they want to kill themselves or they heard that somebody was thinking about it. What rights does that employee have? What rights do the employers have to intervene, if any?
Andrew Adams: So, it’s kind of a two-phase interaction here. And so the employee does have some privacy rights regarding what can be considered disabilities under the ADA. So you have to take that into account. And in no way should threats ever not be taken seriously, however. And there are certain rules that you have to follow when you’re inquiring into these kinds of workplace disabilities and things that can be considered disabilities under the ADA. A Human Resources professional usually is going to be the first person that has to address the situation, besides the supervisor, or if an employee notices some potentially dangerous behavior. So it’s important that they be able to recognize warning signs and encourage these employees to seek help. If it’s an immediate threat, it’s always emergency services that should be contacted. Otherwise, the HR professional should put the employee in touch with their other local services, such as an employee assistance program, suicide hotline, or local hospital.
And if the threat becomes known to you through what’s called secondhand information, like if an employee brings concerns to you in HR about another employee, it may be necessary to get a little more additional information before you take action. So you always want to assure the person who brought that information to you that the employee that they’re concerned about, their safety’s important and that it’s more important than maintaining the confidentiality in this circumstance. And if you’re unable to determine if the threat’s actual or not, you want to stay on the safe side and contact those local services. Well, so in that vein, you have to be careful, very careful, about making disability-related inquiries and be aware that someone who is suicidal is definitely going to be considered to have a disability under the ADA. However, you can make those inquiries when they’re job-related and consistent with business necessities. And that’s including a situation where there’s a direct threat based on observations or some objective evidence that you’ve seen.
And so basically, only if you have a real reasonable belief that the employee’s ability to perform their essential job functions are impaired by a medical condition or that employee is going to pose a direct threat to themselves or others because of that, then you’re able to inquire a little bit into that condition. And you need to always be careful if someone comes to you with a concern regarding suicide or a concern about another employee’s safety in the workplace; you’re on notice at that point, and you need to be aware of any possible negligence claims that could arise if you’re aware of suicidal threats and do nothing.
It’s best not to offer advice, but always let the employee know that counseling is available if you have your employee assistance programs; if there’s a local crisis intervention or suicide prevention resource in your community or a suicide prevention hotline, you want to put them in touch with those resources, as well.
James Davis: Thank you. I do want to talk about the efficacy of the hotlines and crisis centers a little bit down the road because I’ve always been curious about that. But before we get into that, you mentioned knowing the warning signs. Jaime, is there a set of warning signs that are, I don’t know, consistent across people that are contemplating suicide?
Jaime Vinck: Yes, there are. And it’s very important. Oftentimes, people mistake risk factors and warning signs, and they’re very different. And I think it’s important that HR people know the difference. And a risk factor is something in the individual that means they’re at risk, but they’re not in imminent danger. It means it’s more likely that they’ll consider suicide, attempt it, or die by suicide. The other thing about warning signs, though, that means there’s imminent danger. And those are the things that are really important that we be able to act on. If you think about risk factors, a lot of them are things that you’re not necessarily going to know about your coworkers. And so those are nice to know but not imperative.
The warning signs are things that we all get to be aware of. And those are things like talking about wanting to die or kill themselves or looking for a way to kill themselves—if we see a coworker researching guns or ways to die by suicide online, talking about not having a reason to live, talking about being in unbearable pain, or talking about being a burden. That’s a huge one. Feeling like one is a burden is a huge contributing factor to suicide. The other thing, warning sign, if we see someone is drinking or drugging, that’s a big one. And feeling anxious, agitated, withdrawing, or isolated, extreme mood swings, rage—those are all the sorts of things where I believe we spring into action and see what’s going on.
James Davis: Thank you for identifying those. I want to jump back to the intervention programs and the suicide hotline. I’ll tell a brief anecdote, which is that, where I live, we’re very close to a high-speed train, and it’s in a very quiet area in Connecticut, but from time to time, somebody will go and step in front of a train right down the road from here. And since then, since the last two, they put up these signs anywhere that you can get on the tracks—a big, huge sign with the suicide prevention hotline phone number on it. And that is a kind of disturbing thing to see, but obviously, you can see where they’re coming from. I mean, the hope is that someone, as they’re climbing up that embankment, sees the sign. That’s the moment that they would say, “Oh, maybe I should rethink this, or maybe I need help.” Do you have any sense of how effective these programs are—things like the National Suicide Prevention Hotline?
Jaime Vinck: Well, those are two different things. The notion of interrupting someone’s imminent attempt—that’s very, very effective. And oftentimes, all they need is, in that moment, something to flip the script, something to interrupt the action, and that has been proven to be very effective. And there’s many studies; Thomas Joiner is a leading suicide expert in the country, and he has a number of studies about people that have been going to jump off a bridge and something interrupts it, and they do not go on to die by suicide. So I love that there’s those signs on the tracks. I think that’s fabulous.
In terms of the hotlines themselves, they are effective, and they’re staffed by very compassionate people. And also, there’s local crisis lines, where if someone is in imminent danger, they will send a van to your home. And so I’m a huge fan of those. I have that on my personal cell phone because I am a therapist and still do private practice from time to time. But if you are in danger, call this Maricopa County Crisis Line, and it’s very effective.
James Davis: Oh, that’s great to know. Listeners, I’m definitely going to post as many relevant links as I can, at least the Suicide Prevention Hotline number, down in the description. Is there a website that has all the local resources? Or is that something that people would have to find on their own?
Jaime Vinck: So the 1-800-273-TALK (1-800-273-8255) is the National Suicide Crisis Hotline. And then depending on one’s location, they can find the county typically has a mobile crisis unit, as well.
James Davis: OK. All right. Great. We were talking a little bit about the privacy issue, and Andrew, I think you were very careful to say that the privacy might not be as important as the intervention. Do you mind just digging a little bit more into, I don’t know if it would be best to do it through a specific scenario? Is it worth risking getting it wrong, like approaching somebody that you think maybe is going down that route and offending them or maybe even causing some legal trouble for yourself, versus not doing something?
Andrew Adams: I mean, from a human perspective, you always want to ensure your employees’ safety, just from a personal level. But speaking from the legal side, there’s ways to approach circumstances, which aren’t going to be beyond what you can do legally. So under the ADA, you’re not allowed to make what’s called a disability-related inquiry into an employee’s medical condition or potential, essentially, suicidal behavior ideation. It may fall under these disabilities; it may fall under disability-related inquiry. So it’s OK to approach the situation and just ask generally how somebody is doing and keep your questions … if you’re not sure or if you’re not certain of the information brought to you or you don’t really fully have stock in its reliability, it’s OK to approach somebody and just ask generalities. And that’s the way I would approach it. If you weren’t fully certain or it came from a source that you don’t know if it’s been fully vetted for trustworthiness, it’s better to come and ask an employee out of the blue how they’re doing, how everything’s going, rather than to ignore it and something happen down the road, either from a legal standpoint or just at a personal level, too.
James Davis: We’re kind of talking in generalities about suicide. These things can happen kind of anywhere. And there’s always the possibility that someone may try and take their life at work. I think the most common one that I’ve read about is overdose, which, did they intend it or not is maybe an important distinction. But what is HR’s responsibilities and employers’ responsibilities should someone try something like that at work?
Jaime Vinck: I believe that from an ethical standpoint, in terms of the human dimension of it, obviously if someone makes an attempt, we get the person to safety, call 911, and then we approach the individual’s work group. We have to protect the privacy of the individual—that’s essential, as well—but we need to make the work group feel safe, and we need to be respectful, and we need to be careful about the things that we say and how we describe what’s just occurred.
In the rare event of a suicide in the workplace, something that we get to be careful about also is the contagion effect. The contagion effect is real. And if we have vulnerable employees that aren’t sharing, that we don’t know that they carry that darkness of the suicidal thoughts—if we, in any way, memorialize the individual on too large of a scale or if they, in any way, think, “Oh wow, this person gets more attention in death than in life,” then we are perhaps putting ourselves at risk at an organizational level for contagion or copycat, if you will. We even see that when celebrities die by suicide. There are those vulnerable adults that become obsessed with it. We see that when people come into treatment, they come in because their families are concerned that they’re obsessed with celebrity A’s, B’s, or C’s recent suicide. So that’s something that we have to be careful of as leaders and HR people, as well, when something, God forbid, happens in our workplace.
James Davis: Yeah, that’s a really good point. I remember when Kurt Cobain killed himself, there was a string of suicides by the exact same method. Andrew, do you have anything to add?
Andrew Adams: So it’s a little more difficult for an HR professional or for the employer in this situation because they’re both tasked with, if they know the employee personally, personally grieving with the issue of the attempt occurring, whether it’s an attempted suicide or a completed suicide. But in employing this situation, an HR professional has to recognize it is almost guaranteed to be covered by the FMLA if they’re an eligible employer and if the employee is eligible under the FMLA. If not, or if the FMLA leave runs out, if an employee requires leave, the employer needs to engage in an interactive dialogue with that employee to see if there’s a reasonable accommodation, such as a block leave of absence or something that would be more prudent under the circumstances, so the employee can really get the treatment that they need.
So from a legal perspective, there’s things that you need to put in place and recognize that just hearing about an employee-attempted suicide is putting the employer on notice, even if that employee is not coming to you to talk about it. So there are steps you need to take as soon as you become aware of what’s happening.
James Davis: We have an added dimension now. I didn’t want to make the coronavirus the basis of this discussion, but a new reality is that those of us that are still employed are almost all of us working from home. And if coworkers, employers, family, and friends are having trouble getting a handle on someone that maybe was showing signs of becoming suicidal or attempting suicide is now going to be 10 times harder to see that happening because they’re at home. And then there’s an added dimension of the stress of just the coronavirus in general, of potentially loved ones getting sick, and of being isolated and stranded. I think that we’re probably in a position right now that makes those that were already at risk at additional risk. Jaime, do you have any thoughts about what employers can do to get ahead of this before something terrible happens?
Jaime Vinck: I do. I believe it’s important at this moment in time that we really leverage the use of telemental health and to ensure as HR people that our EAPs have telemental health services and so that our employees that are out there working from home and social distancing and potentially isolating that they have the support. The other thing that’s very important, however a bit trickier, is to assess the access to lethal means. And to understand, I mean, if we know that one of our employees is, let’s say, a hunter, and I will be interested in what my legal colleague will say about this, Andrew. But my thinking is that if we’ve got someone that we know has access to firearms and, through working at home, we hear from coworkers that they’re increasingly isolated and they appear depressed, we suspect very strongly that they’re drinking more than usual, and we know that there’s guns in their home. Those are the sorts of things where access to lethal means can be a huge, huge risk factor in someone dying by suicide, especially now.
And so that’s one important component to this and also as employers to reinforce the fact that we do have physical distancing, but it doesn’t have to be social distancing. So we can create opportunities, coffee groups, journal groups, and those kinds of things to keep our employees engaged, even though we’re scattered across the country at times, because yes, this absolutely has all the ingredients for a perfect storm if we’re not careful.
James Davis: Andrew, your thoughts?
Andrew Adams: I agree with Jaime on this. So it does add that layer of complexity of situation for employers, at least from a legal standpoint, because normally in the workplace, you’d be in a position where you could at least observe behavior or get information from employees who had observed behavior. So the whole issue is exacerbated by the fact that you can’t see the employee, and you can’t talk to the employee outside of your normal communication. So we really would suggest scheduling those Zoom meetings with everybody, being able to interact with your employees more, and staying in contact with everybody as much as possible throughout the day and throughout the week. And if there is a situation where other employees are coming to you and telling you about something they think could be an immediate or imminent threat to someone’s health or safety, there’s no legal issue with contacting either the emergency contact to the employee or calling those local services if there’s an idea that there’s some sort of imminent threat or danger to that employee’s safety and well-being.
James Davis: Thank you. I was speaking about this briefly when I was talking to an individual about another mental health episode. And I know I mentioned to him a statistic that I’d read once, which is that something like 9 out of 10 people that try and kill themselves but fail don’t regret failing. I think that’s really important for people to hear because when you’re driven to the point where you think that the only solution is to end your life, it seems heavy on the mind at that time and really important. And if you can just get past that for a little while, you might find, on the other side of it, maybe not a purely happy rest of your life but happy moments, something worth living for. And getting that across to somebody at that time is critical—that you’re going to get through this and you’re going to be OK if you don’t make it permanent.
Jaime Vinck: Absolutely.
James Davis: What are we missing? What have we not talked about that’s important?
Jaime Vinck: What employers can do in terms of creating a culture that provides the protective factors for suicide risk.
James Davis: Well, let’s talk about that then.
Jaime Vinck: So evidence supports that if we have support services, an open dialogue about suicide, and access to family, those are things that an organization can create. And it ends up being more of a culture of safety, if you will, where employees can openly come to their supervisor and say, “Hey, you know, I’m feeling really dark, and I’ve got some thoughts of suicide.” And they will do that because they feel safe. They know that there won’t be retaliation. And they know that it’s a space where they can honestly share because again, there’s been support services, a flyer on the wall for the National Suicide Hotline, and there has been events where they know that their supervisor knows their family. And at that point, it’s easy to pick up the phone and just say, “Hey, does your mom know that you’re feeling like that? How would you feel about getting her on the phone to talk about it?” Those kinds of things.
And also, protective factors for suicide are things like a sense of belonging and connectedness; those are huge. And I mentioned earlier about someone feeling like a burden. When someone has purpose, when someone has a reason to get up the next day, or when someone belongs, that’s enough of a protective factor to make them think otherwise and to keep going another day. And that’s really what we want—for people to, as you suggest, just say, “OK, I don’t feel very good, but I’m going to just keep motoring on. I’m going to make it to my next day.” And that may be because they’ve got a work softball game that night. It may be because they’re going with their coworkers to, I don’t know, work at a soup kitchen. It may be they’ve got a card game. It doesn’t have to be anything monumental. It’s simply a place to belong.
I can’t tell you how many people … I’m an essential healthcare worker; our treatment center is still open, and thank goodness because there are people wanting to come in for help. When it all came out—the shelter in place—I had so many employees come forward to me and say, “Jaime, please don’t make me work at home. This is my place. I come here to connect, to serve, to feel better about things.” And I believe that’s so important in the workplace that we can create that culture.
James Davis: Great. Thank you for adding that. Andrew, is there anything else that you wanted to add?
Andrew Adams: Just from a legal perspective, touching on one of Jaime’s points, it’s so essential on the employer side of it to provide training to your Human Resources professionals and to your supervisors because they’re going to be the first line of defense for your employees when these situations arise if they can recognize warning signs and if they’re aware of what you have. If you have an employee assistance program in place or if you have a crisis response team for your organization or some other group or form like that, it’s very important that your supervisors and your HR professionals are trained properly on it. And you conduct the training on an annual basis or an as-needed basis to give an annual refresher of what resources you have and keep it up to date.
Including in this process, as well, is … it always helps in a situation if there’s some sort of policy or procedure in place for somebody to rely on because when you’re making these split-second decisions in the moment when something’s actually occurring or when you first get the news, it’s going to be very difficult for anybody, especially someone who has personal knowledge of the employee, to make these decisions and think rationally in a perspective of what I need to do or what I need to put in place to help this employee or my employees in general. So we always recommend annual training on these kinds of subjects, as well as policies and procedures in place so that you can rely on them in the time that you, as the HR professional, need it.
James Davis: Well, thank you very much. And thanks again to both of you for taking the time to join us today.
Andrew Adams: Thank you for having us on.
Jaime Vinck: Thank you.
James Davis: Absolutely. Listeners, we’re always interested in suggestions you might have for what HR Works should cover next. Feel free to reach out to us on Twitter at @HRWorksPodcast with any thoughts or concerns you have about the podcast in general. Thank you for listening. This is Jim Davis with HR Works.