Back on June 17, I had the chance to speak with Nya Greenstone, clinical supervisor for Axis Health System’s Youth Suicide and Threat Prevention Program.
Editor’s note: what was once known as the Center for Mental Health is now called Axis Health System.
Our conversation, presented below, has been edited for clarity and length.
Trigger Warning: This interview contains discussion around suicide. A list of local and national mental health resources is available at the bottom of this story.
Brian Wagenaar: I wanted to start by asking you about your background, and how you got into this work?
Nya Greenstone, MSW, LCSW: I moved out to Colorado because my partner was starting at Western in a graduate program. My clinical background is actually in early childhood and infant mental health, but I had provided mental health treatment in schools and provided them consultation around trauma-informed practices and suicide prevention.
When I came out to Colorado, I took a job at the Center for Mental Health as a school-based mental health consultant. I pretty quickly learned that suicide prevention is one of the most important things we can do in schools in the state Colorado, because we have such high suicide rates.
I started during COVID and we were trying to see if the rates of suicide in the state and on the western slope were matching the national rates for youth, which in general have been going up.
We learned that there were high levels of suicide attempts and ongoing suicidal ideation in our young people and that we needed increased prevention and education, as well as suicide specific treatment. There are many joys as well as stressors living in small, rural mountain towns.
BW: How long have you been doing this work around youth suicide and threat prevention?
NG: Professionally, about a year and a half.
BW: Examining our local college-aged population — we know Western has had a number of suicide deaths in recent years. What signs should people be on the lookout for, and what advice would you give to students who are heading into college to protect themselves and others?
NG: College is a transformative experience. Moving away from home comes with many joys and challenges. Remember that everyone is going through a similar transition but they might manage it differently. It’s normal to have bad days and need help at times, it’s important to take risks and explore, it’s also important to speak up when you aren’t comfortable, and it’s important to check in with those around you.
Specific to suicide prevention, what we’re learning in the research around suicide prevention is that while there are groups who are at higher risk for experiencing suicidal ideation, focusing on life stressors and protective factors helps us to engage with folks better. Stressors are things that impact a person’s nervous system, functioning, and perspective.
They can be things like a breakup with a significant other, developments like a loss of a job or loved one, as well as experiencing stress or discrimination by just holding minority identities and experiencing a traumatizing event.
Most individuals with stressors do not experience suicidal ideation, but when stressors pile up and someone doesn’t have enough support or protective factors, it can lead to an emotional crisis. It’s important to check in with folks no matter what and I will explain how to do that.
The research also asks us to think about “warning signs.” These are signs that indicate someone is further downstream and could benefit from a check in or intervention.
For example, one might notice a change in behavior (especially if it may be related to a recent stressor) — whether it’s a significant increase in outwardness to the world, or a decrease —internalizing and isolating. Other warning signs include, concerning statements made in person or online that may be indirect in nature, increased risk taking behaviors, increased substance use.
What to do when you are concerned about someone, it’s important to (1) share with them what you are concerned about, and (2) directly ask them if they are having thoughts of suicide or if they are thinking about killing themselves. This direct approach is important. We learn that for someone who is struggling but not suicidal, they are able to share what they are struggling with.
For a person who is suicidal, they often feel relief that someone was able to ask them about a topic that is highly stigmatized and always hard to approach someone about. To ask, takes the burden off of the person who is already burdened with suicidal thoughts.
Next, (3) keep them safe. We know that an emotional crisis can last only five minutes. That’s how long it can take to make a life-changing decision and make an attempt on their life. While this is not always easy, asking if the at-risk person has a plan and removing or disabling lethal means can make a difference.
Finally, (4) be there and help them connect. Listen carefully to what the individual is thinking and feeling before helping them connect. Ask the person if you can call a suicide prevention line together to get help (can always call 911 for urgent concerns). You can always make attempts to stay connected to a person you speak with to let them know you are there. It can make a difference.
BW: Most people, including myself, would be apprehensive to ask someone directly about suicide. Do you have any pro tips for having that conversation?
NG: One of the things we practice in classes like Question, Persuade, Refer is to really regulate yourself, and prepare for any response. That might mean doing some anchor breathing, where you breathe in and then try to do a longer exhale than an inhale — which then activates your parasympathetic nervous system, and calms your body.
Really try to get grounded — feel your feet on the ground, and just really try to be present. Difficult conversations are supposed to be messy. And just in the back of your head know that asking someone is better than the alternative.
You can start the conversation by sharing with the person what you are concerned about and that you want to be a support for them. It’s helpful to describe what you have objectively noticed about their communication or behavior.
It might sound like this: “you know, I’m concerned about you. You haven’t been responding to my calls or texts like you usually do, and you’ve been spending a lot of time in your room alone. I also noticed a lot of empty beer cans in your room. All of these things make me feel worried about you and I want to be a support for you. Can you talk to me about what’s been going on for you lately?”
You can then follow up by asking “have you been having thoughts about suicide?”
Remember, you are not acting as a professional, just a support person. A person’s calm presence and care really goes a long way and can be an anchor for someone who feels as though they are caught in a storm. And then make sure you have your own support network to check in with after.
BW: Is that just the National Suicide Hotline, or what other crisis lines are available to people?
NG: For folks in Gunnison County if you have an immediate concern, call 911 for the fastest response. Gunnison County also has a mobile crisis team that can respond to mental health crises in person as well, or can just talk you through a tricky situation, (1-844-493-TALK).
For folks who may be closer to Montrose, Axis Health System (formally The Center for Mental Health) also has a crisis line (970-252-6220) — and operates the closest Crisis Walk-In Clinic that accepts young people ages 12+ in their short term stabilization unit.
SAMHSA is coming out with the 988 number in July which will replace the National Suicide Prevention Hotline. We will need to see what that looks like before referring folks there.
(Editor’s note from Colorado’s Behavioral Health Administration: “The Behavioral Health Administration (BHA) recognizes that many people in Colorado do not have a phone number with a Colorado area code. We want to ensure a safe, immediate connection to local resources and support. While Colorado works to build 988 staffing capacity and address call routing, we will continue to promote our statewide crisis line at 1-844-493-8255 or text TALK to 38255.”)
BW: Do you work much in crisis response after traumatic events? Can you talk about how you approach those scenarios?
BW: You’ve been doing this work for close to two years now — have you seen substantive changes in the approaches to mental health and suicide prevention?
NG: The first one is the shift away from talking about risk factors to focusing on preventive and protective factors — what do folks have in their life that brings them strength? A lot of times, folks have thoughts of suicide but don’t act on those thoughts. How can we increase their protective factors? That often comes with community.
I’ve noticed a shift in language away from phrases such as “committed suicide” or “unsuccessful suicide” to “died by suicide” or “attempted suicide”. A suicide loss survivor once reminded me “my friend did not commit a crime.” (Editor’s note: for more on this, you can explore the Words matter campaign)
There’s also a false idea that everyone that attempts suicide has a mental health condition. While we know that many folks with suicidal ideation or behavior also have untreated mental health conditions, we also know that suicide spans across demographics, age, race, and socioeconomic status and that typical treatment for a mental health disorder that may not exist, is not best practice.
We now have new evidence-based interventions to specifically treat suicidality, and if there is a diagnosable mental health condition, it comes second. For example, if someone came to the ER for a life threatening condition, we would treat that before anything else. For us in the mental health field, we need to specifically treat suicidality which is life threatening before we treat anything else.
And it’s important for communities to know that there are suicide-specific treatments. At AHS, our clinicians are trained in CAMS — the Collaborative Assessment and Management of Suicidality. DBT (Dialectical Behavioral Therapy) is another evidence based treatment for suicidality with the goal of giving someone a life worth living. There are new brief interventions such as safety planning, and Cognitive Behavioral Therapy for Suicide Prevention is another new one as well (CBT-SP).
BW: These more acute treatments — they focus on relieving stressors and boosting protective factors?
NG: The hope is to treat the drivers of suicide. With CAMS, there’s a comprehensive assessment phase where we’re looking at the factors contributing to suicidal thinking and behavior — rating levels of psychological pain and stress.
We want to dig in to understand someones personal story of suicidality, when they began a relationship with suicidal thinking to understand the factors underlying their suicidality. DBT teaches skills to manage stress, regulate emotions and improve relationships.
BW: What keeps you hopeful in this work? What developments are you optimistic about?
NG: When I look at youth — especially youth here in Gunnison — they’re really advocating for mental health and behavioral health treatment.
There’s a really neat program called Sources of Strength, and they’ve been implementing it in the Gunnison Watershed School District for a few years now. Because this program empowers youth to create campaigns for various topics to improve school climate such as mental health and substance use, I think the young people in Gunnison felt heard and are now able to share and come together about what they need from adults in the community. They worked with Juvenile Services and GCSAPP to come up with The Gunnison Project and Youth Wellness. This inspires me and I think the youth voice is so important at the table.
BW: Is there anything else you’d like a college audience to know?
NG: I’d like them to know that there are people in this community that care a lot about suicide prevention, and about their safety and sense of belonging. The University has the CARE Team who is available for any student concerns and I would encourage students to make reports to that team for help if they are worried about themselves or someone else. It takes a lot of courage to reach out for help, and it is also incredibly meaningful and life changing.
List of mental health resources for the Western community:
- You or someone you know In Crisis? (FREE)
- Call 970-252-6220, the 24/7 Crisis Talk line
- You can also text TALK to 38255 or 741741
- Use the new national 988 number beginning July 16, 2022
- LGBTQ+ 24/7 National Hotline
- 1-888-843-4564
- Peer Support Specialists (FREE, people with lived experience in mental health or substance use):
- Contact 970-596-0127 or 970-596-8182
- Timely Care (FREE): Free mental health resources for western students, health coaching, 24/7 crisis text line, psychiatry (medication prescription for mental stability) and counseling:
- Go to timelycare.com/western
- Click sign in or make an account
- Use your western email and a password
- Fill in the required medical info
- Utilize the resources!
- Western Counseling Center (FREE): Unlimited therapy for Western students:
- Go to Crystal 104 and tell them you would like to make an appointment or call 970-642-4615 to make an appointment
- Fill out the required paperwork
- Make several appointments in a row if you prefer to secure your schedule!
- Crested Butte State of Mind Therapy Scholarships (FREE)
- Go to https://cbstateofmind.org/learn-more/therapy-scholarships/Therapy Scholarships – Crested Butte State of Mind
- CB State of Mind is committed to making sure that our residents have access to mental health care and that means eliminating the barriers of cost, navigating the system, and connecting to the right service.cbstateofmind.org
- Click on Application Form
- Fill out an application
- Let Meghan Dougherty (mdougherty@cbstateofmind.org) know if you have any issues or need help applying
- Get paired with a good fit for a therapist
- Enjoy your therapy scholarship!
- Axis Health System (formally the Center for Mental Health) (Not always free, can cost $):
- Call 970-252-3200 to set up an appointment
- Let them know you live in Gunnison
- Ask about insurance coverage and pricing
- Accepts medicaid
- Suicide Prevention Program Referrals: youthsuicideprevention@axishealthsystem.org
- Gunnison Valley Health Behavioral Health (Not always free, can cost $):
- Call 970-648-7128 to make an appointment or find options
- Project Hope: Domestic Violence and Sexual Assault Resources, including therapy, support and connections:
- Call 970-641-2712 to set up an appointment or simply find out more
- Email info@hope4gv.org
- Additional resources can be found here under the mental health section: