"Don't Give Up Hope!" with Dr. Stevan Lahr

Dr. Steven Lahr, Medical Director of Family and Children's Services in Tulsa, discusses the importance of openly discussing suicide to reduce stigma, and common root causes of suicide. Dr. Lahr shares insights on the protective role of faith and community engagement in preventing suicide. The episode also addresses the unique challenges faced by those who have lost loved ones to suicide and offers advice on how to support them.

Transcript

TOPIC: Suicide Awareness – “Don’t Lose Hope!”

GUEST: Stevan Lahr, D.O.

Season 4, Episode 8

Ric Shields (00:00):

It seems that suicide is not something people feel comfortable talking about. Should we be talking about it? Are there ways we should discuss suicide with family or with friends?

Stevan Lahr (00:11):

I think talking about suicide probably ranks amongst the, you know, top like awkward conversations that nobody really wants to have. Suicide, mental illness is not going to go away just because we just pretend that it doesn't exist.

Ric Shields (00:35):

Thank you for joining us on the DoorWays® Ministry Network podcast. I'm your host, Ric Shields. We're currently in a series of episodes with a focus on mental health. As a reminder, maybe it's a disclaimer. I am not a mental health professional, but I am lucky enough to speak with those who are.

(00:54):

My guest today is Dr. Steven Lahr, the Medical Director of Family and Children's Services that serves the Tulsa metro area. It's the mission of Family and Children's Services to promote, support, and strengthen the wellbeing and behavioral health of adults, children, and families. Thank you, Dr. Lahr, for joining me today.

Stevan Lahr (01:13):

Thank you, Ric, for having me. I mean, you know, it may not be the best thing to say that I'm excited to be here, but I, it is a very important topic that we need to talk more about and I'm glad you reached out for this conversation.

Ric Shields (01:32):

A couple of questions come to mind. I've been asking these same questions to all of our mental health experts. First, how did you decide to get started down this path as a psychiatrist? And second, do you consider this as a job or a career, or do you find it more like a calling?

Stevan Lahr (01:50):

Those are great questions. I definitely did not set out to become a psychiatrist, you know, graduated from high school and think this is what I'm going to do with my life. When I went to medical school, my first kind of goal was actually to be an OB GYN and anyone who knows my family knows I have a lot of siblings, so I spent a lot of time with OB GYNs, so it just kind of made sense. So that's really what I thought I was going to do.

(02:16):

And then during our clinical rotations my fourth rotation was in psychiatry. And I would definitely say I didn't really have a great understanding of what psychiatry looked like until I was on that rotation. And being able to see people who presented just such severe symptoms, psychosis, trauma, and in a very short amount of time, be able to function in their daily life with either therapy or medication intervention, or both, was really eye-opening and it was really rewarding or kind of opened my eyes to just kind of the power of relationship.

(03:00):

So, after that rotation, I started really considering psychiatry. And honestly, I wasn't convinced even after that. When I graduated medical school, I actually did family practice and psychiatry, a combined residency thinking I'd probably do mostly family practice, but really within that first year after medical school really committed to psychiatry.

(03:22):

On the, you know, the question of career, job calling. I think in the beginning it was definitely career. I mean, it's all encompassing. It's not just psychiatry. Medicine in general is really not something that you can just do a 9-5 and turn your mind off at five o'clock. It is 24/7, 365. It's all consuming, and you really have to take a lot of focus to get started. And then, you know, over the years you realize that to keep going, it really needs to kind of become a calling. There has to be a purpose higher than just doing your medical practice.

Ric Shields (04:01):

I cannot imagine having a series of episodes about mental health without addressing the issue of suicide. And again, I'm no expert on the issue, but I'm not hard of hearing or blind to the issue of suicide. It's one of the leading causes of death in the United States with nearly 50,000 reported cases last year. I read that someone in the US dies from suicide every 11 minutes, and over 1.5 million people actually attempt suicide each year.

(04:33):

So, Dr. Lahr, what are some of the common root causes of this issue of suicide?

Stevan Lahr (04:40):

Of all the causes of death, suicide is one of the only causes of death that continue to increase despite treatment and research. So, you have heart disease, you have cancer, and in general, a lot of those are going down. But in the United States and around the world, we continue to see suicide increase, especially over the last five years post COVID.

(05:06):

So, we'll focus on, we'll just say three main causes of suicide. By far, the number one cause of suicide is going to be a result of some form of mental illness. And so that could be depression, bipolar disorder, and any substance use disorder. Having any of those disorders is going to greatly increase your risk of suicide. And, you know, you could do a whole podcast, multiple podcasts on mental illness, what that looks like and how it affects. But just in general, from having untreated or undertreated psychiatric illness, but yet the highest risk of suicide.

(05:48):

And you kind of have this grouping that we, you can sum it up as a loss of hope. A lot of research behind the importance of having hope and how hope can prevent suicide. And some of the most common things that we see are going to be a dramatic loss in someone's life. Most commonly, that's going to be a relationship or some financial loss. So, losing money, losing a job, a major stressor like that.

(06:16):

And then the third category, I kind of sum it up is just a breakdown of life coping skills. And so sometimes just like little pressures in life start adding up and we have not been taking good care of our mental health or sometimes even our physical health. Or we're starting to engage in coping skills that are not helpful. So, substance use, gambling, those kinds of escape things that feel good for just a very brief amount of time, but in the long run, they don't provide us good relief from our mental and emotional stress.

(06:52):

So, kind of those three groups, or the combination of those increases your risk of suicide.

Ric Shields (07:00):

I saw some statistics from Harvard University's World Population Review. A couple of things stood out to me. One, some of our least populated states are among the highest in suicide rates. And number two, 10 states with the highest suicide rates are west of the Mississippi River. It makes one wonder if somehow geography is related to suicide.

Stevan Lahr (07:24):

No, I'll put a disclaimer on this answer, and that's mental health is not a linear equation. So, if you do X or remove X, it's not guaranteed that you're going to get it a certain outcome. And so, life is messy. And we would like to believe that if we change just one factor, then we're going to get a different outcome. And that's just not guaranteed. But when you look at the highest rates of suicides, let's just talk specifically about the United States location and response to, like geography, weather probably has a really minor impact on it. There is a tie between mood and sunlight. You're going to have more likely, you're going to have a higher rate of at least seasonal depression and more northern climates that you go to. And there could be some increased risk of thoughts of suicide with that.

(08:23):

But the factors in those states that are more likely to contribute to the higher suicide rate is rural. Rural areas always seem to have a higher suicide rate than urban areas. And that the one thought behind that is just isolation. You just have less contact with people and not only just like social contact, but you have less access to healthcare. And so, if you look at those states, they're going to have limited mental health structure in their communities, you're going to have a higher rate of poverty.

(08:59):

 One of the quotes I saw is that “poverty kills” because it's just that lack of resources. So, when something does go wrong, who do you go to help? If you look around, there's no one around to help, and that's going to increase. Another is just the population makeup. The highest rates of suicide are going to be in the Native American, native Alaskan population.

(09:21):

So when you look at a lot of those states on the list you're going to have greater concentration of those populations. And then also access to firearms. Over 55% of all suicides are completed by a firearm. And you know, nobody is saying having a gun causes suicide ideation. What we're saying is it's less likely that you're going to recover from a gunshot than other forms of attempting to harm yourself. And so, it's just a fact. Everywhere where you have easy access or higher access to firearms the completed suicide rate is going to go up because of the means.

Ric Shields (10:05):

I understand you're a member of a crisis team with Family and Children's services. I assume that means you're called upon to help someone who is contemplating or has attempted to commit suicide. How can you intervene in a time like that?

Stevan Lahr (10:20):

It is very overwhelming. Definitely if you've never had the opportunity to engage with someone who's actively having thoughts of suicide, who's actively harming themselves or have attempted, but in those crisis situations, you know, the first thing I do is active listening. So, I'm just there to kind of figure out what's going on and making sure that that person feels heard and has a safe place to tell me what's happening and forming that relationship with them.

(10:51):

And then as we're moving along, I'm making my you know mental differential diagnosis of where is this intervention needed? Is this due to mental illness, substance use, or some type of social factor that we need to help get help with? And then as I'm talking with them, I'm reviewing their strengths and I trying to come up with where's that spark of hope going to be for that person because oftentimes, and you, when you're having thoughts of suicide, your ability to have problem solving and those kind of rational decision making skills are compromised.

(11:32):

And so having someone that is listening to you and then able to kind of remind you about maybe family support, social support, or the help that is available can start relieving some of that pressure and we'll see a release and or a kind of a decrease in that motivation to end their life.

Ric Shields (11:53):

I know that you're a believer, and so I thought of this question and I don't know if there's a good answer to this. You'll know better than me I. I'm thinking about suicide rates among believers versus nonbelievers, Christian versus non-Christian, especially when you just now spoke about hope. It would be my great hope that believers have more to look forward to. But what are those rates? Are they similar to the general population or not?

Stevan Lahr (12:23):

I wish I could say, hey, here's the study, right, that I could quote a number to you. Some of the universal truth here is that mental illness, thoughts of suicide, they're non-discriminatory. So, it does not matter your, you know, race, gender, religious belief. You have the potential being at risk.

(12:43):

Now, when we're doing an inventory for safety, I can tell you that one of the things that we are taught, regardless of if you're a person of faith or not, is that there are certain religions, certain faiths that can be protective against suicide. And then there's ones that we refer to as restraining forces against suicide. And so, in that protective category is going be Catholicism. And that is because of the rigid belief that if you commit suicide, then you go to hell, right? And so, it's not uncommon for us to hear that as a reason why someone is not going to complete suicide because they don't, they don't want to be punished for it.

(13:26):

Then Protestantism is going to, as a general category, is going to be in that restraining force because the unbelief of what happens if you die by suicide kind of varies amongst denominations. Now, one reason it's hard to kind of directly answer that question is that being a believer, there's no, you can mark a box or you can, how engaged are you with that faith? And that's really what our job is, is we're trying, whenever we are trying to determine that safety level is do you just call yourself a Christian or are you engaged in that community? And the more engagement you have in your faith community, the more protection you're going to have against thoughts of suicide and being at risk for suicide. So, it is a protective factor. Being a person of faith and being engaged in that faith is something that we routinely screen for and encourage our patients to engage in.

Ric Shields (14:27):

You're listening to the DoorWays® Ministry Network podcast. My name is Ric Shields and I'm joined on this episode by Dr. Steven Lahr. Dr. Lahr is the Medical Director of Family and Children's services that serves the Tulsa metro area. We're talking about mental health specifically as it relates to suicidal ideations or those thoughts about committing suicide.

(14:48):

Dr. Lahr, it seems that suicide is not something people feel comfortable talking about. Should we be talking about it? Are there ways we should discuss suicide with family or with friends?

Stevan Lahr (15:00):

I think talking about suicide probably ranks amongst the, you know, top like awkward conversations that nobody really wants to have. And traditionally or historically, however you want to frame it, it's something that is just kind of in the shadows. People don't really talk, they don't want to bring light to it. It's definitely something that should not be because suicide mental illness is not going to go away just because we just pretend that it doesn't exist. So, listening to podcasts like this talking about it helps reduce the stigma of, of having mental illness or having thoughts of suicide.

(15:39):

Some of the misconceptions people have is that if you talk about suicide, you're somehow going to cause it to happen. We'll hear it all the time where we're like, well, I did not want to ask because I don't want to put that idea in their head. I don't want to cause them to harm themselves. And you know, if you just kind of think logically, like if that's really how it worked, the brain worked, I mean, parenting would be so easy because you could just say, “I want you to clean your room” or talk about cleaning your room. And all of a sudden, the child will be like, “Oh yeah, I never even thought about cleaning my room, but now you said it, so I'm going to go do it.”

Ric Shields (16:11):

Well, and for that matter, if we don't talk about it, like we traditionally haven't, then the rates of suicide would be even higher. So obviously talking about suicide is not something that promotes it.

Stevan Lahr (16:24):

Yeah, it, but this is still a common misconception that we have. So, you have to talk about it. Then also, you know, kind of framing with don't promise to keep things secret before you know what's going on, because one, it's not shameful or wrong to have thoughts of suicide.

(16:46):

 And also, if someone tells you and you're not a mental health professional, you're going to want to get help for that person. So, you're probably going to have to tell somebody about that.

Ric Shields (16:54):

And sooner rather than later.

Stevan Lahr (16:56):

Exactly. Immediately. You know, there are multiple crisis lines, so people get nervous because it's, “If I ask about it and they say yes, what do I do?” In the Tulsa area, we have COPES and we also nationwide have 988.

(17:12):

And so, you know, partnering with that person say, “Hey, we're going to get you help. We're going to talk to somebody. I'll stay here with you. Let's just figure out what our next steps are,” because it could just be talking on the phone with someone. It could be that then they need to get someone else for help.

(17:27):

So not being afraid to ask about it, making sure that the person knows that you're going to support them and help them you know, get to the next step. And, you know, just like preview, as much as we can kind of normalize it. In my world, it's just a symptom. It'd be no different if I was primary care treating diabetes or talking about your high blood sugar. I know it's a possibility with everything that I treat, and so I will, I ask about it frequently.

Ric Shields (17:58):

What about some treatment options? What options are available to those who are contemplating or have attempted suicide?

Stevan Lahr (18:06):

The number one thing to know is that there is treatment and that this, you know, like I mentioned before, it's a symptom. And so, like all symptoms, they can get better. And so, there are, in the immediate, that first step is the hardest. That is asking for help. So that could look like: ask your family, primary care doctor or calling a crisis line or showing up to somewhere like the crisis center to see what those next steps are.

(18:35):

 There are medications, there's some newer medications for people who have just persistent chronic suicide ideation that helps take that away. But then also getting treatment and appropriate level of treatment for any underlying health mental health conditions that you have, have been shown to help decrease suicide thoughts and rates.

Ric Shields (18:58):

I know too many people who have lost loved ones who completed suicide and it seems to be a really dark place for them. How can we help those family members or friends?

Stevan Lahr (19:12):

There is something different about losing a loved one to suicide. It looks different and it feels different. And so, my first piece of advice is, if you are someone who has lost someone to suicide, don't try to go through it alone. This is a time to kind of bring in those support systems, whether that is a pastoral support or support group or reaching out to a mental health professional to kind of partner with you to go through this.

(19:44):

And then, as you know, maybe a family or friends of somebody who has lost a loved one through suicide making sure that you are engaging that person, reaching out to them. How would you, ask yourself, what would you, if it wasn't suicide, if it was any other type of death, what would you be doing? So, a lot of times what happens is we don't talk about it. We pull back, we don't want, it feels awkward. We don't want to mention the person but giving that family or friend the opportunity to talk about their loved one, bringing them a meal. Really just kind of wrapping around them like you would anyone who has lost someone due to, you know, natural death or accident.

(20:31):

And as much as possible, not putting the responsibility on the person who's lost someone to tell you what they need, right? Because it's, death is overwhelming, but losing someone through suicide can often just even feel more overwhelming. So, reaching out, saying, “Here's what I'm going to do, going to bring you a meal, I'm going to take you to church, can I help you get to someone to talk to? Because I don't know what to do right now.” But there are people out there that help.

Ric Shields (21:02):

You're a member of the crisis team with Family and Children's Services in Tulsa. Can you share a success story with us?

Stevan Lahr (21:10):

No, I'll turn around the question a little bit because you know, I don't want to give just a success story. But what shocks a lot of people is that even in severe cases of suicide ideation or attempt, those symptoms relieve with less than 24 hours. Over 70% of the people that I see at the crisis center are able to walk out of the crisis center and then start engaging in outpatient treatment or go on with their daily lives. And so, you know, knowing in the moment it can feel impossible, but if you can just take that first step, the majority of the time, in less than 24 hours, things are going to look a lot different.

Ric Shields (21:58):

As we draw our time to close. I wonder, do you have any special words of encouragement you'd like to share with those? Listening to this podcast,

Stevan Lahr (22:05):

It's going to sound really, really corny, but everything matters. Okay. And so, everything that you do that's positive is going to potentially help yourself or the people around you.

(22:18):

One of the things when I'm teaching and about mental health is reminding everyone that the brain is an organ. And everything that you say, think, do, feel, and experience believe is a chemical reaction. And that, for me is very empowering because that means there's lots of different areas where I can intervene and alter that brain chemistry. That's why therapy works because talking and learning changes your, your neurochemistry. And so, the more nice happy things that you can put out there, it's going to help your brain chemistry. It's going to help someone else's brain chemistry.

(22:58):

There's this study, and I can't remember all the details, but it was very encouraging, but also a little bit also discouraging where we're talking about children feeling heard and valued. And they showed that if a child could get 15 minutes of uninterrupted eye contact and attention from a parent, guardian or teacher, that they felt more valued and had better outcomes in school and mental health.

(23:23):

And so, the, the great thing is like 15 minutes, that should not be very hard to do but just imagine the number of people who are not even getting 15 minutes of eye contact and validation. And so, you know, for me, if I'm at, you know, the grocery store at the store, I'm going to make eye contact with that cashier. I'm saying, “How are you?” I'm engaging in, you don't know what's going on in that person's life but being able to kind of be even just a spark of positivity really makes a huge difference.

Ric Shields (23:57):

When it seems no one wants to discuss an issue, it is an issue that should likely be discussed. What does the Bible say about suicide? Well, you can find different opinions based upon your theological persuasion. Some say it is an unpardonable sin, others suggest it may not be the unpardonable sin, but it breaks the sixth commandment, "Thou shall not kill." And if you commit suicide, which ends in death, you'll be unable to confess your sin and receive forgiveness. Not quite the unpardonable sin, but one where forgiveness may be out of reach. And there are others who hold that emotionally healthy people did not commit suicide. And a God of limitless grace and infinite knowledge sees and knows more than we ever will.

(24:46):

The DoorWays® Ministry Network values life. Life is sacred, and our credentialed ministers are committed to protecting the vulnerable of all ages. In Psalm 139:16, David wrote, "all the days ordained for me were written in your book before one of them came to be."

(25:05):

God has ordained each day, or in other words, God has filled each of our days with purpose. We may not understand how it all works, but we are given the opportunity to experience every one of those days and thereby fulfill God's purpose in our life.

(25:23):

If you or somebody you know is contemplating suicide, please talk with someone and get help. Pick up your phone and dial 988. You'll be connected with a trained counselor who can help. You may be unable to see it right now, but you are a valuable friend and family member. You are valuable to your community and you are valuable to God who created you in your mother's womb. He loves you. Even if you don't feel it or cannot fathom it.

(25:56):

Life can be hard and I promise you are not alone. Others have walked a remarkably similar path to the one you are walking on now. Don't give up hope. Ask for help. Open your heart, if even a little bit, and allow others to come alongside and walk with you while you get your feet on a solid path.

(26:16):

I'm glad you joined us on this episode and I hope you found it to be helpful. Until next week, may God's grace and peace be with you and those you hold dear to your heart.