Sandra Kiume is a mental health writer in Vancouver, BC. She created and maintains the Unsuicide wiki, as well as a corresponding Twitter feed, to disseminate mental health resources from a peer support perspective. She is also a contributing writer for PsychCentral. We met in San Francisco on April 16, 2013. She was 47 when we spoke.
Sandra: I thought about where to start here, because I’ve had nine suicide attempts and many other incidents where I’ve been hospitalized for suicidal thoughts. I’ve been in hospital over 40 times and I’ve been struggling with bipolar for 40 years, so it’s been a long journey, but I thought I would start with my first attempt when I was 11 years old.
I was in school at the time. I was sitting in my class and I was just overwhelmed and had these feelings that I really wanted to die and I couldn’t handle it anymore. I was being bullied and things were rough for me. I was depressed, and so I was in school and I had this idea. You know, I’m 11 years old. I don’t know a lot about methods and lethality and all that, but...
I was trying really, really hard, as hard as I could, to hurt myself, but it wouldn’t even get anywhere so I was just sitting there at my desk... and this kid who was across from me saw me doing this and he said, “Freak.”
When he said that, I just had this awful shame and humiliation and I stopped doing it and that was really—that was it. The teacher never saw. I never told anyone. I never told my parents. I never got any help for it, but that was my first attempt.
And you might say, "Oh. Well... That wasn’t really a serious attempt."
But to me it was. I really wanted to die. So, that was number one. My next was when I was 19 and... I did go to hospital for that, but they didn’t admit me, and this is an issue that happened to me a number of times. Probably, I would say, out of the nine attempts, I was in the emergency room for at least four of them, but they didn’t admit me because they had no beds in the hospital [and turned] me away. And then there were other occasions where I was suicidal and I went to hospital because my psychiatrist told me that’s what to do. You know, "If you’re suicidal, you go to the emergency room, call the hotline."
That’s what they told me. I go to the emergency room and they say, "Sorry, we can’t help you. Go home."
It’s very, very frustrating and [left me] in a worse frame of mind than when I went to the hospital. So, I think that’s a system failure that I really want to highlight. That’s been an issue not just for me, but for many other people I know, where they’ve [attempted suicide] and they’ve had very minimal contact with the mental health system and just been rejected. It’s a horrible, horrible feeling to be rejected by the people who are supposed to help you in the time you’re in the greatest need.
Des: This is in Canada?
Sandra: Yeah, Canada. Three different provinces, forty hospitalizations, many psychiatrists. I had psychotherapy, CBT, DBT…lots of treatment.
Bipolar is a funny thing. Suicidal thoughts are just a natural part of it. Whenever I felt depressed or in a mixed state, the thoughts would just naturally come with it. They would just instantly appear and my self-esteem would evaporate and everything was worthless and I wanted to die. This happened over and over and over, so many times. It was a cyclical thing, but I eventually learned how to deal with it. By having lots of treatment and lots of learning on my own, studying things online, finding self-help materials, I learned what has helped me get through those moments because I learned not only what helps me, but that the people who are supposed to help me are not going to. So, instead of dealing with the hospital and depending on the professionals to help, I had to learn some self-help.
Because I was able to do that, when I went on disability about nine years ago, I started doing some peer advocacy work. One of things I do is a Twitter account called @unsuicide, and I share that peer knowledge now. I share all those coping skills that I learned, as well as other ones that I’ve found online. I'm able to share those things through a peer filter so that I really have empathy for the people that I’m sharing with and who are coming to me and asking me questions.
I’m really careful not to tweet things that are just superficial fluff, that are, "It’ll be all be better, turn that frown upside down," because those things don’t help. They actually, for me, make me feel worse, and I know that’s true for others as well. I stick with the practical—the things that people can do on their own—and finding resources where people can turn to for help offline so they can get help when they’re looking for it, ‘cause often, they don’t know where to turn.
Des: Some people would say that people like you and I are not professionals and that we’re dangerous, that we could be dangerous.
Sandra: Yeah, I’ve heard that.
Des: What are your thoughts on that?
Sandra: I agree and disagree. I think if you’re not careful about how you’re sharing... I’ve studied about trauma-informed care and I know about triggering. I’m very careful about how I share that, but I also see peers on Twitter who are not careful about that, and who have not progressed in their recovery enough to really have the experience to know what helps or who know the resources in the community, so they’re just sharing their own personal experience without really being able to help. There’s a difference there... It’s good to have that kind of sharing and openness and freedom to express yourself, but it also has to be done in a safe way and I’m really careful to do it safely.
Des: Go back to the suicidal feelings and how you deal with them. What works for you?
Sandra: The number one thing that works for me in coping with suicidal thoughts is forcing myself to go to sleep. When I’m staying up at night, I can’t sleep, the thoughts are just plaguing me and torturing me, and I can’t stand it anymore, and I feel like I’m not safe to get through the night, and I know I can’t go to the hospital, I will take some Benadryl or a sedative or anything that’ll make me go to sleep so that I don’t have to deal with those thoughts, because things are always a little different when you wake up. Sleep is a great cure. There are other things, as well. That’s just one tip, but that’s my number one thing that I rely on.
Des: It’s always interesting to hear how other people [cope]. When was your last attempt?
Sandra: It was seven years ago. I’ve been really lucky. I’ve finally managed to find the combo of medications and had enough treatment and progressed well enough that I’ve been stable this long. Before that, attempts were more frequent and the hospitalizations were more frequent. I’m pretty stable right now and in a much safer place. That’s another reason why I’m able to do the peer support. I’m not in a precarious position, myself. I’m not that fragile.
Des: Yeah, it’s hard. When you start to feel [sick again]…’cause it happens. You don’t have an option. You start to feel a little shaky and then it’s like, "Oh, I’m doing this thing where I’m trying to help people." It’s a strange feeling, [realizing that you're not healthy]. You have to pull back.
Sandra: Well, sometimes I do pull back entirely. I will go offline if I feel I’m in a rough place and I need a little self-care. I will just avoid it because I don’t want it. I don’t want to be triggered and I also don’t want to upset somebody else by saying the wrong thing... Unsuicide is a place—I’m a pretty pessimistic person and pretty cynical and negative, but none of that is on that account. I'm careful to maintain a level of optimism and hope.
Des: Talk more about the mental healthcare in Canada. I don’t know anything about it, so…
Sandra: Well, it’s government funded, so it’s free healthcare, which means, theoretically, that it’s more accessible. And in a way it is. You do have to pay for psychotherapy, though, private psychotherapists. There’s kind of a dual system. Psychiatrists and hospitals and family doctors are all covered by the system, but if you want to see a private psychotherapist, they’re not licensed in the same way, so they’re not covered by the system and it can be kind of costly to do private therapy, over a hundred dollars an hour. There are also social workers who are sometimes trained to do therapy, so you can get in through social services agencies, and I’ve had that before. There’s also a third kind of level, which is the nonprofit charities who will offer some services like peer support groups, recreational programs, that kind of thing.
Des: You mentioned a lack of beds, which is...
Sandra: A lack of system capacity is a big problem.
Des: What about the professionals themselves? Do you feel like they’re equipped?
Sandra: Some are, some aren’t. They’re really variable about their competence. I’m lucky I have—I finally ended up with an excellent psychiatrist, and she is fantastic. She’s there for me in a crisis. I can call her, page her in the middle of the night if I need to, email her, whereas other doctors don’t let you have that kind of access. I’ve been really lucky with her, but I’ve also had doctors who misdiagnosed me or didn’t take me seriously or didn’t understand the problem.
It’s a battle sometimes to get people to understand where you’re at, especially when you’re high functioning like I am. You know, because I can still tie my shoes and heat up a can of soup, I’m not considered deserving of the best care. It’s a challenge.
Des: But then there’s that duality where you have people who are really, really paralyzed by it. The stigma is intense and people kind of want to give up on it.
Sandra: Yeah, stigma’s another issue though. I know, for some people, it’s a real barrier for getting care, but for me it never has been. It’s always been the lack of access and not [being] sick enough.
Des: If I want to die, that doesn’t make me sick enough?
Sandra: Theoretically, it does. I mean, we have a mental health act in Canada. That’s a legal thing, similar to being committed here in America. They call it "certification" in Canada. You can be certified if your mental condition is deteriorating and there’s an imminent risk of death or harm. That's supposed to get you into the hospital immediately.
But the last experience I had when I was having suicidal thoughts was not that long ago. It was about two years ago, and my psychiatrist did certify me at that time and sent me to the emergency room. And I couldn’t leave the emergency room because I was certified, right? I had a security guard attending me at all times and I was not allowed to leave. But they also didn’t have beds, so I spent 27 hours in the emergency room until they finally said, “Well, it’s gonna be at least five days before a bed’s open, so go home.”
That’s a very common story. I don’t want to make it sound like the Canadian system is all bad because there are good things about it, especially that you don’t have to pay to access care. I know, for many people that I’ve talked to in America, that’s a huge barrier.
Des: Absolutely. It’s terrible. It’s really difficult here, very difficult.
Sandra: Yeah, so there are good things and bad things, but there are cutbacks, government cutbacks all the time. In Vancouver, my local health authority just cut half a million dollars from their budget and are cutting services again, and it’s just constant struggle to have adequate services. Partly that is due to stigma in the government level. They don’t consider it a priority. Mental health is not the same priority as physical health, so it’s not funded.
Des: Is suicide still an option for you?
Sandra: I have a mantra: death is not an option. I had to come up with that and tell myself over and over and over. My mind [was] telling me, 'Kill yourself. Die, die, die.' I had to fight that thought with, 'Death is not an option, death is not an option,' just repeating it over and over.
So, no, to me, suicide is not an option. Having that mantra forces me to look for other solutions, no matter what my problem is. If it’s not a solvable problem, like if it’s not something tangible that triggered it, if it’s just illness... making myself sleep, just quieting the thoughts so I can get a break from them is how I deal with it.
If you’re feeling suicidal, please talk to somebody. You can reach the National Suicide Prevention Lifeline at 1-800-273-8255. If you're not in the U.S., click here for a link to crisis centers around the world.