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Episode #87

Suicide Prevention

with Kimberly O'Brien

06 Sep, 2022

In a special series for September, National Suicide Prevention Month, VIS Expert, Dr Kimberly O’Brien discusses suicide prevention for student-athletes. She shares important resources and ways that we can speak about suicide.

Voice In Sport
Episode 87. Kimberly O'Brien
00:00 | 00:00

Transcript

Episode #87

Guest: Dr. Kimberly O'Brien

“Episode 87. Mental Health & Suicide Prevention for Athletes with VIS Expert, Dr. Kimberly O'Brien”

[00:00:00]Stef: Welcome to a special episode during our suicide prevention month series of the Voice in Sport podcast, featuring Dr. Kimberly O'Brien because we are going to be talking about Kimberly's line of work and about suicide prevention, we want to share trigger warning. If you or someone in your life is struggling with suicide, you can call the 988 national suicide lifeline and reach out to mental health resources, like a counselor, doctor, or a VIS expert on the Voice in Sport platform.

Please know that you are not alone recognizing that it is suicide prevention month, we are incredibly grateful to have VIS expert, Kimberly O'Brien join us here and bring more visibility to the resources for anyone that might be struggling. Kimberly O'Brien is currently a clinical social worker in the sports medicine division and female athlete program at Boston's Children's Hospital.

She is also a research scientist and assistant professor of psychiatry at Harvard Medical School In college, Kimberly played ice hockey at Harvard university. She went on to obtain her Master's in Social Work and PhD at Boston College. She continued on to complete a post-doctoral fellowship at Brown University, where her research focuses on the development and intervention for suicidal adolescence. We are so excited to have Kim on our podcast today here at Voice in Sport.

Welcome Kim.

[00:01:20]Kimberly: Thanks so much for having me.

[00:01:21]Stef: Well, I'm excited to have you because you're a dedicated VIS expert. You've been part of our community for a few years. You've done some incredible work as part of the Voice in Sport platform, but you're also an athlete yourself.

So I wanna start way back just in your, your experience as a young athlete in sport, you played ice hockey, field hockey, lacrosse in high school, and then went on to play ice hockey at Harvard, where you were one of the captains of the team and won the national championship in 1999. So what was the experience like for you growing up as a young athlete and specifically with mental health?

I just wanna know if that was something that you thought of and that you worked on at a very young age, cuz clearly that became your course of study, but was that something that was part of your sport life early on.

[00:02:07]Kimberly: Well, it's interesting you say that because when I was growing up in middle school, high school, there was really no attention paid to mental health at all. It was not something that we talked about. So I'm 44. So, if you look back, you know, 30 years ago, I mean, this was not something that we talked about at all.

But I was somebody who from a very young age, you know, when I was in kindergarten, my teacher told my mom that she felt like something was wrong. Like something was going on. I looked sad, you know, so take her to a psychologist, which in my family, this was not something we were comfortable or familiar with, but you know, did start seeing a psychologist for depression since age five.

So, but even, even with that, it was still not something that was talked about at all in sports, in school, throughout my life. So I think it was it certainly now looking back, it's absolutely a part of why I do what I do because I was an athlete with mental health issues who struggled with depression, anxiety but at the time it was just something that I felt like was something I had to hide and, and, you know, not show on the surface, cuz if you saw me on the surface, you'd think, oh, what a well adjusted person, you know, she's got friends, she's an athlete. She you know, she does well in school. And, so on the surface I looked like this person has it all together.

But underneath I felt like I was drowning and I, I really struggled for a very long time. I struggled at Harvard with my mental health, but again, I had a lot of protective factors, a lot of supports like I had my team was like my best friends. They still are. And my family's super supportive, very loving and, and I had friends outside of that. Those things like buoyed me a little bit. Like I, I was always able to stay above water. I was very fortunate in that way, but I mean, I definitely struggled with a deep, dark depression for the majority of my life.

And it really came out a lot in hockey in a lot of different ways. And I think that's why I have come back to working with athletes now, you know, over, over really the past few years, I really just dug back into this and, and have decided this is where I wanna probably spend the rest of my career with athlete mental health.

But before that I'd worked more with suicidal teens, teens with substance use, things like that to really kind of make sure I had all the skills and knowledge I needed to be able to do the work I could with athletes. So now that I'm doing it, I feel like everything's kind of come full circle and it feels like I'm doing what I was really meant to do.

[00:04:41]Stef: Wow. I mean, just living the experience yourself and at such a young age, and then coming through, you know, division one hockey and then on to like studying all of the incredible things that we're gonna talk about today that puts you in a really powerful position to help so many young athletes, which is why we're so excited to talk to you today.

I wanna kind of go back to that like five year old version of yourself. I mean, you might not remember, but what, what was it that your, your teacher saw as signs and what have you then learned since, I guess, as signs of depression or for things for people to watch out for to see if maybe maybe they should seek help.

[00:05:19]Kimberly: Yeah, we, we actually wrote a book recently, me and Ann Moss Rogers. It's called Emotionally Naked. It's a teacher's guide to suicide prevention. And I talk in my story, I talk a little bit about that five year old me and what the teacher noticed was that I would just kind look out the window. Like I was not fully present. I could do ABCs one, two threes, but I was fine there. It was more just, I never felt fully present with the other kids. It wasn't connecting and, and it seemed like something was off. So, you know, that's what they noticed.

And I, I talked about in the book of like, this is really one of the only teachers who noticed in my entire life that this was happening for me, which I think is really interesting because you know, I did have a lot of years after that where I was really struggling, but it wasn't picked up on and I don't blame anyone for that, but I think it was a part of the culture back then of not being taught that it's important to look at what some potential warning signs could be, what some risk factors could be you know, for suicidality and kids and adolescents. And I certainly displayed a lot of them back then, but we just weren't educated at the time, our teachers on, on how to pick up on it or, and not even that, but we didn't have the resources of what to do, how to deal with it.

I think we had one counselor for about a thousand kids or something like that from kindergarten all the way to 12th grade. So things have certainly come a long way with that respect.

[00:06:40]Stef: Yeah. Well, it's interesting that you say that, cuz my first gut is like, wow, things have not gone that have not changed that much because you go to these colleges and there's like one or two sports psychologists and you know, there's just not enough for like so many athletes. So in a lot of ways I feel like we're still yet, haven't moved fast enough in this space.

And I wanna go to that culture part, which I do think has shifted, like you said, so for the, from the cultural perspective, like you, you weren't really able to talk about it much back then. I feel like it wasn't as accepted within even like your sports team talking about anxiety or depression. Have you seen that shift change?

And if so, like what are those positive shifts within the culture around talking about the importance of mental health.

[00:07:23]Kimberly: Yeah, I really have seen it change. And like you said earlier, not enough, but that's, you know, we're, we're working towards it. We're still pushing for it. But what I have seen change is I, I think just this idea, I think it started actually with this idea that mental health impacts performance.

Okay. So I think that's where it kind of came in where people were like, oh, if you're feeling good mentally, you're gonna perform well. And so now though, it's even gone beyond that, where it's like there's more to the whole athlete than performance. Like we need to treat the whole athlete as a human being. So now I think there's even some attention towards that.

But I think sports psychology kind of got hooked in through the performance piece, but I think what we're seeing now is, you know, to make team culture really strong to have you know, success athletically and with respect to just general wellbeing, you need to feel good mentally and you need to have the skills that you need to help pull yourself out of a hard time and, and get the support you need to help you get out of a hard time.

So I think that I have seen that change, but I, I, you know, there's definitely more that I, I feel like needs to be done. I love to see the day when as part of every coaching staff you had you know, mental health coach along with it, because I just think it's such a big piece of, you know, especially for like these division I athletes, where this is where they're spending the majority of their time they need some support.

[00:08:46]Stef: Absolutely. Well, if you were to like whisper back something to your, like, you know, 13, 14 year old self regarding mental health and sports, what would you tell her?

[00:08:56]Kimberly: Hmm. I don't think my 13 or 14 year old self would listen to me. I don't think , that's the thing too, as I think that when you're at that age, you know, that that young teenager, you really are not at that stage in development yet where you're really thinking on the outside. So what I would, I would just tell her is just keep going.

There are good things out there. Like you will, you will find your attention to the good things. There are bad things. There are good things you'll get there. It's about the same sort of hard work you put into all the other things you do. You need to also put that into figuring out ways to help yourself cope when you don't feel so good. I think that's what I would say to her.

[00:09:39]Stef: I love that. Well, what, one of your, you know, professions in your background is being a clinical social worker. You got your master's in clinical social work, and you are also part of the female athlete program at Boston's Childrens.

You know, how did you, I guess in particular want, why did you wanna focus on social work for your masters? And, and is that the moment that you then sort of started thinking about athletics and like kind of going in that direction? Give us a little bit of history about like, why, why that area.

[00:10:08]Kimberly: I graduated from Harvard in 2000, so played you know, hockey there that was just my love, my life all through college. I'm sure a lot of young college athletes can relate when you really love something so much and put everything into it. But what ended up happening was because I didn't put so much time into thinking about my career.

I came out and, you know, then starts the quarter life crisis where you're like, what am I doing with my life? I'm not an athlete anymore. What am I doing? Because back then they didn't have any pro hockey for women. It wasn't a thing you could do. And frankly, I probably wasn't good enough any way to make it into the pros at that time.

So I would've had to find something else anyway, but I started out, I, I was an economics major. Like it couldn't be farther from what I do right now. And I tried going into business and I'll never forget just on the literally the T ride home from my first day crying the entire time I hate this, what am I doing?

And then I just cried every day on the way home. And then when my, my roommate at the time, who was my college co captain college teammate was like, Kimball, what are you doing? What are you doing with yourself? Like, just figure this out. And she was just like yelling at me and I'm then I, it kind of jostled me, like, what am I doing?

Like, I don't wanna do this. And so then I kind of figured out, okay, I tried different things. I tried teaching coaching the next year at a, at a prep school, loved the coaching. Didn't love the teaching. So figured, okay. Then maybe I'll go into, into coaching. Did college coaching for a year after that loved the relationships with the girls and, and that, and the, the love of hockey, didn't like how it felt like a business. So then I ended up deciding, okay, I wanna do something where I'm helping people. That was ultimately what I felt I needed to do something that is relationship based, and that is helping people like achieve goals. They want for themselves in their lives.

And so that's why I decided, okay, I need to go into the mental health field, like psychology, social work. And then the reason I chose social work over psychology was I knew it was a shorter amount of schooling and I'd already been out for a few years and I was feeling, feeling ready. And I knew you could go right from getting that two years of schooling right out to practice. And that's what I wanted to do. So I ended up, I ended up going that route and I also at the time it wasn't as big of a deal as it is to be now, as I've gone through social work school and, really kind of lived in the profession, but this commitment to social justice is so important to me, and so that's why I'm really glad that I'm a social worker.

[00:12:23]Stef: And so what is it like for those of, of everyone out there that might not know what it entails to get a master's degree in social work? Like at the end of the day, when you pull back, what are those skills you felt like you really came out of there with, and even after you started practicing for a few years.

[00:12:38]Kimberly: I think, you know, it, it's not a rocket science degree. It's just not, it's about learning how to really empathically connect with another person and then learning how to think outside the box of how to help somebody. And I feel like that's like, fortunately what I'm good at doing. And so it really like, it was kind of a natural fit for me in, in terms is that it really doesn't feel like a super hard job for me.

It feels like, and that's because I love it so much. And it's so everything I do, I feel like has meaning behind it. And that to me is important to me, in a job is to find that whatever that is for, for all different people, you know whether it's coaching or you know, being a dietician or whatever it is you do, it's like, if this is something you could like do all day long, like this is probably a good clue that this is the type of profession for you. And that's, that's how I felt about doing this kind of work. The other thing too, is social work that I like is that you can bounce between things. I bounced between teaching and research and clinical and before I started with the female athlete program a few years ago, I was doing mostly research, developing interventions for suicidal kids with and without substance use problems and doing, you know, that whole thing publishing and all of that, still doing some of that, but I, I really missed the clinical piece. And so it was ready for me to go back and with social work, you can do that. You can bounce around, which is really nice for me.

[00:14:04]Stef: Well back in 2013, you completed a post-doctoral fellowship at Brown researching about the interventions for suicidal adolescents. Like you're talking about with co-occurring substance abuse disorders from your research and the book that you've written, what did you learn? That would be particularly insightful for the young athletes here at VIS that are listening today.

[00:14:24]Kimberly: Wow. That's a, that's a tough question. I, so I ended up going to get my postdoc at Brown because, I did my dissertation while I was working at Boston Children's. I was working in the emergency department and now he is doing psychological evaluations of emergency psychological evaluations of kids who would come in and have some sort of mental health concern. And that's why they would present to the ER. So I, I would do those and, and through that clinical work which is what always drives my research questions. I saw that there were about two thirds of the kids I saw in the ER had some suicidal thoughts or maybe they'd made an attempt. And so a lot of them had made an attempt, so what I wanted to look at in my dissertation was there's a real difference between the attempts that were not lethal, meaning that even if they tried to kill themselves, they couldn't die from it. Like for instance, if you over, you know, you'd take an overdose on like five Advil or something, but for some kids, they have extreme intent at that time that they, they want to die and it is an attempt.

But so, so there could be really like non-lethal attempts all the way to extremely lethal where you use other methods that are more likely to lead to death. So I wanted to look at what are the things that differentiate these two categories, these two types of kids who try to kill themselves, and what I ended up finding was that the only thing that differentiated them was the presence of a substance use disorder. So that made me say, huh, well then I've gotta figure out how to treat kids with substance use disorders if I wanna prevent suicide. So that's why I ended up going to get my postdoc.

And I ended up hounding this, professor there who really did a lot of work in substance use and teen suicide, and I just kept saying, do you any postdocs open any postdocs open? And, and then he tells me later, and he's one of my mentors to this day. I literally just saw him earlier today. He tells me to this day, the reason he hired me was because I was a Harvard hockey player. So I say that because it's like, don't underestimate, you female athletes, the importance of the fact that you play a sport. Because part of it was me being so, you know, on top of it and trying to get, get that position.

So that's one like practical thing I learned from that whole experience, but what I learned through the postdoc was all about how to do research and how to do intervention research. So it's doing intervention research is, is different from just being a clinician. A lot goes into it, and so I, I took so much away from that. And I think at the end of the day, what I really learned was when you're really curious about something and when you see a problem facing the world, there is a way to try to figure out a solution to it. And one of those ways is, is through doing really methodologically sound research studies.

So we developed an intervention there. I spent my whole postdoc developing it with my mentor, a brief motivational interviewing intervention for suicidal teens who are in acute psychiatric care facilities. Because when kids go there for a suicide attempt, the suicide risk is treated as primary and the substance use isn't really touched on. So we developed an intervention that can be delivered in psychiatric hospitals that can address the substance use piece.

[00:17:39]Stef: What is the most common substance abuse that you see in young athletes today?

[00:17:45]Kimberly: That's a great question. I've seen this cycle a lot since I started working clinically in 2005. When it started, it was mostly alcohol. But as alcohol's coming down a touch, marijuana has gone up a ton. Since I started working clinically with athletes though, college athlete, we still in America have this strong culture of binge drinking in colleges and so we do see that a lot. And I don't think it's until the culture of college binge drinking changes that that will change with athletes. You know, a lot of them tend to use nicotine less because of knowing the potential effects on lungs. But what's, what's tricky though, is, you know, cuz kids are starting to vape in, you know, middle school and, starting with very lower levels of nicotine, but I think we are seeing a little more addiction there that's getting harder to kick as they get older. But, I think there's a wide variety of substances in college athletes. I think what I see most clinically is probably alcohol use, but there's also a lot of marijuana use too.

[00:18:49]Stef: Well, according to the CDC in 2020, suicide was among the top nine leading causes of death for people ages 10 to 64, that's a pretty wide range of age, but for age groups 10 to 14 and 25 to 35 suicide was the second leading ,cause of death behind unintentional injuries. So we know suicide can affect all ages, people of all ages, but according to the CDC, suicide rates vary by race, ethnicity, and age and other factors such as where someone lives.

So given your experience with the subject matter and with athletics, are there certain groups of people that are more likely to become suicidal and what characteristics or life experiences can maybe put people at greater risk to becoming suicidal?

[00:19:40]Kimberly: Wow. Great question. Not something I can answer in a short podcast, but I'm gonna give you some, some little tidbits. One little thing too, is if you break that number down more too on the CDC where it's the second leading cause of death for ages 15 to 24. If you break it down by age you, you see that ages for ages 14 to 15, it's the leading cause of death.

So it's, again like you can, you, you can go into the whiskers system and, and run those numbers yourself. But it's, it's really important to note that. And, and to be aware of that, in terms of demographic differences there are some differences racial and ethnic differences. We see that native American and Pacific Islanders are at higher risk than all other ethnicities in terms of risk for suicide.

We see that females are more frequently attempt suicide than males, but males more frequently die by suicide than females. Part of the reason for that is the means that males use to try to kill themselves tend to have a greater likelihood of death.

But so what we're seeing lately, though, is an increase in female suicide rates. The males are holding pretty steady coming up a touch, but the female rates are really coming up high. And, you know, there's a lot of questioning as to why this is, but it really seems to be again, being explained that they are adopting more lethal means now.

So that's why their suicide rate is increasing. The other thing you wanna look at though, too, when you're looking at all the epi data is you need to look at intersectionality, so like overlapping groups and their different risks. So for instance, the Trevor project has a whole study out of LGBTQ plus youth and asks a bunch of questions related to suicide. And when you look at just that subset, right, just that group you find that biracial black and Latinx groups were actually higher than white in that subset of the minority group of LGBTQ.

So if you look at these overlapping minority statuses is on top of each other. That's really where a lot of the risks lie. Okay, which makes a lot of sense if you think about it in a social context. So you wanna really be clear about what data you are looking at and what rates, you know, you're comparing them to.

So the other thing too, that is important to know is you need to look at what is increasing. Like I said earlier, the, the rate of female suicide deaths is increasing. Same thing is happening with young black males. It's increasing at a really high rate. So we just, we, we need to be very careful and look at that too.

[00:22:23]Stef: So before we go into kind of the athletic side of these data of these numbers, can we just briefly speak about the 14 to 15 year olds and that being the leading cause of death and the fact that females are on the rise? Like, can you, do you know why for either of these groups, why it is such a, you know, alarming issue.

[00:22:46]Kimberly: I think for females and it's not just, I think evidence is showing that what's happening is females are using more lethal means because it used to be that ingestion was the, and poisoning was the most common for a lot of females, but that number's coming down and then you have other higher other methods of higher lethality that are kind of popping up and utilized more frequently.

And so if you're gonna use that method, then the likelihood of death following that method is, is higher. And so your're gonna, your rates are gonna be higher. It doesn't mean that things have changed for you know, different subsets of the society in, in, in some ways, although they have, but that doesn't mean that that's why people are dying by suicide.

It might be explaining more why they are suicidal, but not necessarily why they're dying by suicide. So I think that's, that's a, the biggest piece of it right now. And especially as we think about the huge issue of gun control that we have in our country right now this isn't just a violence problem this is a suicide problem that we're talking about here, too.

[00:23:45]Stef: Well, and so what, and what is going on with the 14 to 15 year olds? Why is it that suicide is the leading cause of death for, for this particular group? I mean, obviously a lot is changing in that time, right? Your, your bodies are changing. There's so much going on. Your hormones are changing.

[00:24:00]Kimberly: Yes exactly. And I think part of it too, like part of it is that this is like for them, the, the, the percentage, you know, the death rate and what it's attributed to for that age range, there's fewer accidental deaths, you know, that the, those ha happen more like what the little, little ones and then like motor vehicle accidents are typically like once they start driving.

Right. And so but what's happening with this group? So it's part of it's that is just where we, where that group lies there. Like, you know, it's not like it's rare to get cancers and all these other things at that age. But why suicide's a problem in the teenage years is there's a lot of times we think that kids, teenagers are just little adults, but they're not. And the reason for this is that they haven't yet developed, not until age 16 have you developed the part of your brain fully that has the capacity for abstract thought. So what we understand and know about suicide and why people die by suicide it's because the emotional pain and distress they're in puts them in such a place of despair that they don't think there's any other way out aside from dying.

And this is especially true for a teen who doesn't have the capacity for abstract thought to look beyond it and to see what other solutions there are. So this is partly explained by brain development in this way.

[00:25:21]Stef: And so what do we do as parents during this particular age group, you know especially if parents of athletes, what do we do in that age group? You know, like to prevent suicide and to also just keep an eye out for any activity that might be warning signs.

[00:25:38]Kimberly: Well, that's a great question. I think it's important though, that suicide prevention doesn't start in that age group and it starts right when you have your baby. You start teaching kids how to self soothe. You start teaching your child, how to take care of themselves when they're struggling and what to do.

You know, just like you put a bandaid on a boo boo for them, you help them when they're struggling and upset about something. And what happens when your kids get, you know, you know, around 10, 11, 12, when the, the hormones start going and they start like having these real emotions that they're, that are confusing to them, they need to talk about what these emotions are, what what's happening, what are you feeling? And, and so that they can learn to identify what it is they're feeling, and then learn to identify different coping strategies and things they can do to help themselves. It's kids who feel like suicide is the only option when they hit this distress, this despair that's, who's at risk here, but if we can really focus on talking with kids about this feelings of hopelessness, despair, suicide, suicidal thoughts as a parent, as a, as a coach, as a whoever, be able to talk with kids about what that feels like and what can be done to help them. And they don't have to do it alone. You know, there are people who can help them to get out of the space that they're in to help get them some additional support to get them out of feeling so horribly.

[00:27:04]Stef: So, what advice do you have for parents to have suicide prevention conversations with their daughters in particular?

[00:27:11]Kimberly: It's really important that parents are open, direct and honest with their kids when talking about suicide. So I always encourage parents to not be afraid to use the word suicide, because you want your kid to know that you're okay talking about it. So if they're ever thinking about it, you will go to them.

They will go to you. A lot of parents think, well, if. Talk about suicide, aren't I putting the idea in their head, and this is a huge myth that we need to debunk because it, it doesn't, there's so much research out there that shows time after time, like replicated studies, showing that if you talk about suicide with somebody that does not give them the idea to do it.

So what's really important as a parent, when you're, when you're asking your child about how they're feeling. And, and if, if you're concerned that they may be at risk for suicide, I usually start, like, if it's with my own kids, I'll say what I, what I may do. Like I would ask them, okay. So how are you? Like what's going on? You seem sad. How are you feeling or something? And if they're able to sometimes like fine, you know, like do the typical preteen thing. But if they're able to engage and talk about it. I wanna ask them like are you feeling like, you know, life's not worth living or like that you, you wanna die, you know?

So you start kind of like, you could start leading into it like that. And then if they say yes to that, or, or, you know, start, you know, endorsing some of those emotions or thoughts, then you can say, have you been thinking about killing yourself? So you wanna really name it, you know, and don't say just hurting yourself because non-suicidal self injury is a whole separate issue when people self-harm cutting is a very common method that a ,lot of teens use, but not to kill themselves, but to cope with suicidal thoughts.

So you wanna really understand your child and what, what is they're experiencing? So, you know, and if the kid does tell you that they're thinking of killing themselves, you you wanna ask them to tell you more about it. You wanna thank them for telling you, and you wanna ask all the details about it that you can, and as nonjudgmental and empathic ways, as you can, even though you're probably terrified as a parent sitting there hearing your kid talk about this, but just know that by you being okay, hearing what they have to say, they're more likely to come back to you again in the future.

And you don't have to make the decisions as a parent for what to do with your kid if you don't know. You can call a professional, you can call a crisis line. You can call the pediatrician, you call a trusted adult, who you think can help you. And that's, that's what I would recommend to the parents out there.

[00:29:40]Stef: I mean, just hearing you say these things. I just, like, I, I think for me as a parent, to a daughter and a son, I just like, I don't, I would struggle to say those things out loud, you know? And so I think what you're saying, and, and knowing your experience in this area, it's comforting to know that it's okay to have those conversations and you're not going to cause them to do something.

Which is definitely a fear I had without understanding you know, really the research behind this. So thank you for bringing that up. And, you know, I, I think it's a big part of why we're building Voice in Sport is so that you can have a place to have conversations and have an open dialogue, so I wanna pivot a little back to now, since we talked about kind of the macro conversation of the demographics, wanna really focus on athletes, you know, over the last year alone, several suicides with women, college athletes have been, you know, pretty tragic and, and all over social media. And I'm just wondering, is it, is it that there, the world is just more global and social and, you know, we are just more aware of the things that are happening. And those that are dying by suicide, or is there an increase in this particular subset of the demographic that we really need to be concerned about?

[00:30:54]Kimberly: I don't think we know for sure, to be honest, my college roommate killed herself actually, too. And she was an athlete. And I, I just know having been through that in my college years, I do know that this was happening a lot then too, but it wasn't being talked about, but now it's being talked about, and now parents are more willing to say this was a suicide because they don't want other kids to go through it.

So I think that's part of it, Stef, but I also, I don't think, I think what's happening in the media right now a little bit is people are pinpointing like the NCAA or the teams or things like that for reasons for deaths of, of these athletes. But I think this is when it's important to dispel another myth, which is, you know, there's no single cause for suicide, you know, suicide really it occurs when stressors and health issues converge, and then they create this experience of hopelessness and despair. And so it's, it's never just one thing, you know, this, this was coming out a, about 10 years ago when it was like bullying was the thing. It was like bullying causes suicide. No, it doesn't. No, it doesn't, it's a risk factor, but it doesn't cause it, it's not why people kill themselves. So I, I think that's a big thing when we look at female athletes right now and what everyone's experiencing is that we need to take a step back and think. What's gonna be helpful here now, is it helpful to figure out what, what this is or is it helpful? Like what is going on here or is it helpful to put evidence based resources that we know work in place for these athletes to help them? I mean, I'm a treatment person, I'm an interventionist. So that's what I think. But there are researchers who feel the other, but that's just my opinion is, okay, look, this is a problem. And now look, people are bringing it and it's not just suicide deaths. It's also look at like Simone Biles and Naomi Osaka. Like all these people who are coming out, talking about like, I'm going through a hard time. I need to put my mental health is my priority. Yeah, you do good for you and let's do it and let's do it across the board.

So, and that's, you know, you know, that's what Voice in Sport is doing too, is giving, giving, you know, a place for this and showing its importance and talking about, especially doing a podcast like this, like you're showing suicide is an important thing for female athletes to be aware about, to have knowledge about and to know what to do.

[00:33:06]Elizabeth: Thank you for listening to the Voice in Sport podcast. My name is Elizabeth Martin, a soccer player at Emory University and producer of this week's episode. If you enjoy hearing from Kimberly O'Brien and would like to get the chance to talk to experts like her, go to voiceinsport.com/join to sign up for a free membership and gain access to exclusive episodes, mentorship sessions, and other weekly content.

Don't forget to follow us on Instagram, Twitter, and TikTok @voiceinsport. Additionally, if you were someone in your life who struggling with suicide, Please dial 988 for the national suicide hotline. Or you can reach out to a counselor or doctor also on the VIS platform. We have a network of incredible counselors and experts.

Please know that you are not alone. Now let's get back to the episode.

[00:33:49]Stef: Absolutely. So what are those resources and tools that you think really need to be put in place across the sports industry? And I know it's not just for female athletes, but because we're really trying to help the, this demographic in particular at Voice in Sport, what do you think are those tools and resources that like should be put in place at the schools, in, at a national level and what do these young women need to know that they have access to?

[00:34:16]Kimberly: I think again, just opinions here. I think that each team needs its own mental health coach. Some of it can be done. Some of it can help with performance. Some of it can help with just general mental wellbeing. I, I do that now with the Harvard hockey team, I do, that's my role with them. And I think it's really, it's an important position that they've, you know, carved out that gives it what it does too is it shows athletes like this is important in your, as your development, as like holistic development as an athlete. Like you need to work on this, you know, this is, it's not, you know, just working on your sprints or whatever the other thing you're doing for your, for your sport. You've gotta work on your, your mental health or else you're not gonna be able to play. You're not gonna feel well enough to play. You know, it's just, it's the same as taking care of your physical self. So I think until we're treating it as the same by funding it in the same way, we're gonna see the lags.

We're gonna see the, the you know, these discrepancies, these issues. So I think it's, it's putting money there, I think is, you know, gonna make a big difference. You know, funding positions for this, and we're seeing more and more of it, which is great. But it's still not enough. We still need to do more work.

[00:35:28]Stef: Well, figuring out how to navigate conversations about suicide. Can be really tricky, you know, I'm, I have a mental health platform and I still struggle with it at times to talk about suicide. And I think that's one of the things we wanna really debunk in this conversation with you, Kim.

And I wanna help the young women out there today that might know of somebody on their team right now that is suicidal. And they're not sure how to support them, how to have a conversation with a teammate that you know, is either showing clear signs or who is actually attempted a suicide. So what, what advice do you have for, for women athletes out there that, that do have teammates and they, they wanna have conversations, which is what we're talking about here today that is important to do that, but without triggering something else for that person and protecting your own mental health.

[00:36:22]Kimberly: You know, I think a lot of thoughts about this, but I think one thing that can be done too, is that it can be that's important to be done is that it comes from the top down where the coaches are like, listen, you guys need to check in on each other and how you're doing emotionally. It's like, almost like a team expectation.

That's key, you know, it has to be something part of the culture of the whole team. Okay. But if your team doesn't have that culture, that's okay. You can still help. You can help by just simply having a conversation with them and just being like, Hey, I've noticed you seem more and then you can maybe note what the warning sign is that you're seeing, is there, are they with, you know, are they more like withdrawn? Do they seem to feel like in emotional pain, a lot of the time, are they sleeping too much or too little? Are they being a little more irritable or aggressive? Are they seeing more fatigued?

You know, those are using more alcohol or drugs. You know, those are just some examples of some warning signs that you may see. If you're noticing it, you can just say, Hey, I'm worried about you as a teammate. I'm noticing this, am I, is, is this just me? Or am I catching up on, am I like seeing something here that might be affecting you?

Like I'm your teammate, I'm here for you. I'm here to help you. And you know, you say it in your own words, however, it fits your own way you talk, you know, it doesn't, you don't, it's nothing scripted, be yourself when you're talking to somebody. But the key is then after you bring it up, that you listen and you really engage in active listening where you're trying to, the way I teach clinicians, how to actively listen is, and, and you know, this, I teach this to to not just clinicians, but I teach it, you know, to other people I work with. But if you can go and when you're with somebody almost like, see the soul that's in front of you, like you just kind of what you're doing is you're trying to, to be able to reach the soul that's in front of you talking with you.

And if you can do that with somebody and learn how to really do that effectively, that listening is the biggest gift you can give anybody. And I really believe that. And if you can learn to do that with your teammates and really be present in their pain and be able to sit with it and hear it and think of how to help and usually a trusted adult needs to become involved, then you're doing such a good thing for somebody. So yeah, I, I just, I can't say enough about the importance of active listening and just being empathic in all of your interactions with your teammates when you're gonna be talking to them about this stuff.

[00:38:51]Stef: Well, it go of goes back to like what you learned in your master's program, right? Empathy. And just how, how important that is to also to be a great listener, but what are maybe some of the things to maybe watch out for? Like what to not say maybe is there, are there any things to like, maybe not say when

[00:39:08]Kimberly: Yeah, there's a lot. we talk about this in our book. Things like if someone says, "oh, I just don't. I feel sad." And like, if someone says back to that, like "why you have such a good life" or "you have so much to be happy about", you know, that's obviously the worst.

I think we've all maybe experienced someone saying that to us before. Maybe not. Maybe it's just, you, me who's experienced that, but it's saying things like that is really just not helpful. You wanna think when, before you respond also just take a second before you respond to somebody to think like, how's this gonna land?

You know, don't, if you're worried about the emotional state of the person you're, you're sitting with. So other things not to say you know, I think sometimes when people mention to people like to a friend, like, you know, I've been having some suicidal thoughts lately or something. I think sometimes people freak out when they immediately hear that.

But what I urge you is don't .Listen first, because if you freak out and you say, "oh, we need to like, like that's bad. You can't think that. And we need to talk to this person" or whatever. If you get that your anxiety comes out in that. They're gonna shut down and you know what that's gonna do too. They're gonna feel like they can't open up to people.

Like if they can't open up to their close teammate, oh, then who can I open up to? So, you know, I think it just avoid any sort of judgemental comment or highly anxious response I think is, is important.

[00:40:32]Stef: One of the things we talk about in the training, when you become a Voice in Sport mentor, these are the athletes on the platform is, is really being careful to, to help them understand that mentoring is not there to provide a solution. Like we're not there to give you the answer. So in a, in a situation like this, where you're actually, you're there to listen and provide empathy again like natural tendencies of, of people who wanna help other people are to like provide solutions for them. So what is your feedback regarding that? Because that's a tendency. I think a lot of people who do care for other people then tend to lead to like, well, here's a solution.

[00:41:12]Kimberly: Yeah, I think that's hand in hand with like just not being judgemental in your response and because if, think about it, if a person had a solution to feeling suicidal, they'd probably figure it out and find it. So they probably don't have the right solution. And I it's important too, that you don't have the solution for the person you're sitting across from the person you're sitting across from has the solution for themselves.

So you wanna help them to figure out what that is because I tell that when all the therapists I teach about how to do therapy one of the first things I say is what you have to understand in this therapeutic relationship is that you mean nothing and they look like I'm just some crazy person, but you don't, it's not, you, you're not doing anything to them. You are simply giving them a safe space for them to figure out what they need to do for themselves. And I think it's the same thing in a friendship in a lot of ways, or as a teammate

[00:42:04]Stef: I think that, thank you for saying that. I think that's so important for the girls to know, because I think as, as friends and as teammates, you, you put a lot on your shoulders, right? Your, your own shoulders, and then it can affect your mental health. And so I do, I just think like, you know, if there's any advice you have for, for those girls that who do tend to carry other people's . Stuff around, how do

[00:42:23]Kimberly: That happens a lot. Yeah. I work with a lot of athletes and, and that's what they bring to me in therapy is they're worry about their friends. And so this is a big thing that comes up because there are, you know, so many, because there are a lot of caring, female athletes around there who are worried about their teammates.

And I think if you find that it's preoccupying your mind and there's something in your gut saying, something's not right here. I I'm worried about this person. That's usually a clue saying we need to get a trusted adult in involved. Because these are things that older adolescents, young adults can't do on their own.

It's it's not anyone an adult should do on their own it's to help a, a suicidal person. It takes a team to help somebody out of this dark deep despair. So it's hard because you never wanna break the trust of somebody. And I think a lot of times teammates are afraid, like, well, she told me this in confidence, like I, what am I supposed to do?

And I think that can be really, really difficult. Again, why there should be resources on teams to help athletes when they're worried about their teammates because they can help talk them through possible what to do in this case, because I do think every case is different. I don't think I could come here and say, if this happens, you should do this.

I think every, every case is different and might have a different approach. But I think the one thing that goes across is that it usually, if you're, we're up worrying about this a lot, a trusted adult, you should bring in to give you some guidance.

[00:43:46]Stef: So I, I wanna go back to something you said, which was like to, which I agree with, which is like check in on yourself, but check in on each other. And I remember specifically helping a, a young group who was dealing with a teammate suicide and, and they were, they were being asked to check in with each other and sort of felt like, oh, well then that means it was my fault for not checking in enough with, so and person on my team.

What would you say to, to girls about that? Because it's obviously like pretty devastating. If somebody on your team has died by suicide. And so what, again, there's like this really tough feeling of like, I could have done something more. What do you say to young women who, who might be going through that right now?

[00:44:31]Kimberly: There's a really fine line between this idea that I embrace and that most researchers and clinicians embrace, which is that every suicide is preventable, this idea, right. There's a fine line between that. And then the fact that suicide still happens. And if it does happen, it's nobody's fault. Like really, I really am a big believer in that, that, that it is never anyone's fault when someone dies by suicide.

And after a teammate's suicide, that's the time to drop any sort of self blame that's happening or any of that, any guilt and come together as a team and support each other because that sort of a thinking style like feeling that guilt, which is so natural and it happens all the time, ends up over time, not, not helping people get beyond the grief.

So it's part of, part of the grieving process is, is letting go of that guilt and you know, that, those feelings about what happened to their teammate, but that this is why it's tricky, this, this work, because what could work really well for one person like these check-ins could really affect another one in a different way.

Like, feel like, oh, I let this person down. So I think again, if you op, if you keep yourself open and empathic and, and really just kind of hear everyone out, you know, as, as a team and there's just good teammate rules anyway regardless of suicide prevention it, it's just, it's a, a good way to, to live your life as a human being, to just be open, be kind, be empathic, you know realize that like, you know, you may not always know the right thing to do in a certain situation and you may do something that affects someone negatively, but you can still get through it together as teammates

[00:46:22]Stef: Well, let's talk about some of those since it's suicide prevention month here in September, let's talk about some of the strategies that you use with people who are struggling with suicide. What are those strategies, those prevention strategies that just on an individual level, we can start incorporating into our, you know, weekly, monthly, daily habits.

[00:46:40]Kimberly: Yeah. So there's. I mean, there's actually, there's so many different things you can do to help your mental health in general. And I think what's, what's tricky about suicide is different suicidal individuals need different things to help them.

There's not just one thing that works. Like for instance, with depression, we know that the best practice is cognitive behavioral therapy and and sometimes medications along with that can be helpful too. Like we know that that's kind of the gold standard and, and, and we know that. Suicide's different because suicide. Isn't about, you know, always somebody who's depressed and feeling suicidal, suicidal suicide can happen with people who are having extreme anxiety, people who are having significant substance use, people who are having psychotic symptoms. There's so many different things that can cause suicide. So it makes it harder to treat and harder to know, you know, what to do.

What I typically work with people on is figuring out what the drivers are for the suicidal thoughts and then figuring out, okay, what can we do to help you with those things? You know, what kind of skills are needed for some people, if, if it's driven by things like panic attacks or things like that maybe it's focusing more on deep breathing and you know, and mindfulness activities and things like that to keep the overall stress level down. And that sort of thing. Now, granted, things like that isn't a simple fix to prevent suicide, I wanna be clear. But when you are talking about, you know, what are little habits you can incorporate into your day, that will help over time . For those sorts of things. If, if it's a person who is acutely suicidal, the only evidence based practice we have for acute suicidality is the creation of a safety plan with that individual. So a safety plan is basically a where you come up with a list of warning signs that a suicidal crisis is coming along for yourself, like what you notice in yourself or some of the triggers, things like that.

Then you want a list of supports and people who you can contact when you feel this way, as well as some internal coping strategies you can use to help yourself in that situation. And it's always good too, in a safety plan to note how to make your environment safe for yourself, like getting rid of, you know, like mean safety, like getting rid of lethal means things like that out of your home.

And also identifying reasons for living. So that's there, if you look up Stanley and Brown's safety plan, you'll find a template and that's the gold standard of what you wanna use. And anyone can do it again. It's not rocket science. This is something that, that anyone can do with somebody to help them.

Yes, it's usually done with a clinician and that's, that's probably the best way to do it, but if you wanna make one for yourself, go for it, just print it up online and make it for yourself. There's absolutely something you can, you can easily do. But that's, that's really, if for acute suicidality, it's, it's really safety planning and, and, and I also wanna just push the, the importance of therapy because really every person in society should have a therapist, just like every person in society has a PCP, it's really the same thing. You need to take care of yourself. And so whether or not it's someone you check in with monthly, just to say, you know, like at this point, fortunately, that's where I'm at. I feel pretty good, but I'm still checking in, just, you know, doing what I call my tune up, my monthly tune up, you know, make sure I'm doing okay. Or maybe it's maybe you're going through something and maybe you need to do weekly work to get you through it. And whatever it is, this is just like, it's just really medical care, mental health care one, and the same, we need to take care of ourselves.

[00:50:13]Stef: All right. I appreciate that you talking about that because you've been very intentional in how you've set up your own practice to include licensed therapists, to include sports psychologists, and really like having both is really important, right? Not always are, are you maybe just dealing with a sports specific anxiety or sport specific issue you might actually be needing to go a bit deeper. And so can you just talk a little bit about, like, how do you, what's your philosophy on serving athletes holistically? Because I think that is so important. It's why at VIS, we have sports psychologists, nutritionist, we have a little bit of everything.

[00:50:49]Kimberly: Totally. It is so important. So I started a group private practice back in October of 2020 called Unlimited Resilience. And well, I started it because it was right after COVID and there were so many athletes who were so much distress because they couldn't be playing their sport and they were just having such a hard time.

So that's really how it started of like that we needed clinicians who understood the importance of athletics to know what, you know, what a loss it felt like for them not to have it. And then it ended up just, you know, getting into this enormous thing where now we have like 20 clinicians and you know, hundreds of athletes who are, you know, just coming to take care of their mental health.

And it's it's been a great experience. And I think the way we treat the, the athlete holistically is, you know, first kind of like working with the athlete to identify like, what are the, what are the things they wanna work on? What are the things that are causing a problem for them in their lives, and then helping them to create goals for themselves of what they want to achieve.

And once they've done that for some of our athletes that involves goals where they need a nutritionist or where they need you know, an endocrinologist or they need a physical therapist, I don't know there's so many things. So we wanna ID it's really go, you wanna meet the athlete where they're at in terms of what are their goals, what do they want for themselves?

What I always ask my athletes in my first session is what do you want to be better as a result of our work together? And then once they identify what those things are, then it becomes pretty easy to figure out, okay, well, we need someone to help you with this, we need this, you know, so it's kind of like you're doing the work together, but you're doing it as a team. And that's so hand in hand with just athletics in general is just working on a team to achieve a goal. And that's essentially what we're doing in our practice.

[00:52:27]Stef: I love that so much. And I think it's so incredible. I think like, it's just like everything we talk about in sports. Like there's not just one component that makes you great. It there's multiple things. And the same thing goes for your support system. So you wanna surround yourself by people who inspire you, but also who can help you.

And those areas might show up in the form of a therapist, a sports psychologist, a nutritionist, like you said, so many different things. But asking for help is, is so important. So, you know, what advice do you have for young girls out there that might feel like they can't ask for help or they feel like somebody's gonna judge them if they do ask for help?

[00:53:00]Kimberly: Well, if you, if you feel like someone's gonna judge you, there are a lot of anonymous help lines out there. So 9, 8, 8 is now the new suicide lifeline so instead of 9, 1, 1, you could dial 988 if you're in a mental health emergency, which is amazing that we have this now there's also like crisis text line, and then the Trevor project has an amazing one if you identify as LGBTQ where you can just chat someone, you can text them, you can call them, you can call somebody to talk. So if you are worried out being judged, you may wanna start that route and just see how it feels, feel it out. You may hate it and you'll be like, Ooh, I don't, I don't know if I like this.

You also may find that if that's not working for you, that doesn't mean therapy's not gonna work for you. Okay. That just means that didn't work. So let's try something else. So you can reach out to, you may wanna reach out to, if you're not comfortable yet looking to find a therapist, you may wanna reach out to a trusted adult and just let them know, like see if they have any ideas of what you can do to help.

Now, this is all really hard and I am the first to say that I didn't do this as a kid, you know, so I get it why people aren't doing it. But I think the fact that I didn't do it really held me back from my potential as not just an athlete, because my anxiety and depression really hindered my athletics in college and in high school. But it really hindered me as a person. I didn't really come into my own for a while and I think I could have done more, achieved, more, been a happier person if I had really took the risk and reached out for help sooner. And if I didn't like the first help I got keep looking, cuz there's good people out there.

I see a lot of people who have tried like three different therapists before and I was like the last shot and they're like, oh, I actually can talk to you. You know? Or, and, and I'm sure people say, you know, say that about a lot of people is that sometimes it just takes finding the right fit and it's out there for you.

[00:54:50]Stef: That's right. I love that so much. Okay. Well, as we bring this to kind of a, a wrap, I wanna hit on myths one more time, because today you already mentioned two of them. I think that's so important to talk about myths or misconceptions about suicide among athletes. So what are some other ones that you wanna shatter?

One we already talked about was like, there is no single cause of suicide. The second one we talked about today, is it's okay to talk about suicide and suicide prevention. Are there any other myths or misconceptions you wanna shatter?

[00:55:21]Kimberly: I guess the last one I'd say is that things will never get better. And this is a myth or MIS misconception among maybe suicidal athletes rather than just all athletes. Because I think I can relate to that having been a suicidal athlete, myself, feeling like things will never get better in my life.

Like, I, I will always feel this way. There's no, you know, no coming back from this. And I think what I learned in my journey is that when you're in that state of mind, you are not able to think clearly because it's the depression or the anxiety or whatever it is that's not letting you be yourself underneath it all there is the true you that can be happy with who you are and where you are in the world and your experiences. And so I would encourage all those young athletes to keep pushing through, keep being resilient, keep trying to find just a little light, a little willingness to live, sit through the feelings as long as you can and hope that there's gonna be light at the end of the tunnel, because if I hadn't done it, I wouldn't be here. And I feel really grateful for what I have at this point, but there was a time when I did not. So I guess that's the last misconception I would I would try to talk about for all of our female athletes out there listening, who might be able to.

[00:56:41]Stef: Thank you so much. I mean, it's just been incredible to hear all of your experience that, that you have been bringing to the sports industry, and I'm so excited to continue to just see you help so many athletes. So thank you for everything that you've done, and everybody should check out your book. It's incredible. You can also check out everything that she has going on at Unlimited Resilience. And of course at Voice in Sport, Kim is a Voice in Sport expert, so really excited to kind of continue to see what you do and all the amazing work you'll do in this space, Kim. Thanks for taking the time today. We're gonna end on just one question that we're gonna have across our entire series in the month of September, which is what is one of the most important elements of suicide prevention that girls should know about?

[00:57:25]Kimberly: Young girl athletes. You need to know that you're the future of this. You are the future of suicide prevention and you can work together to change the culture around suicide and mental health. A lot of you're already doing it and you're doing an amazing job and us old people like me who are looking down at you are saying, yes, finally, here we go. Here are some young kids who are gonna come change the world. So being proactive about your mental health and wellness and prioritizing it, that is suicide prevention. So keep doing it.

[00:57:52]Stef: Love it. Thank you so much, Kim. And thank you for joining us on the Voice in Sport podcast.

[00:57:56]Kimberly: Thanks for having me Stef.

[00:57:58]Stef: This week's episode was produced and edited by VIS creator, Elizabeth Martin, soccer player at Emory University. Kim's research clinical work and personal experience reminded us just how important it is to be empathetic and have access to mental health resources in our journeys as young women athletes.

Kim shares with us the warning signs you may recognize in teammate or friend and how to navigate conversations about suicide. We need to continue to have these conversations to reduce the loneliness and fear associated with finding resources or counselors that prevent suicide.

Kim emphasizes the importance of creating team dynamics that reinforce the importance of mental health so that each woman athlete can work towards the best version of herself. We take away from this episode that there is not one cause for suicide and that it is essential that we do talk about suicide in order to help the people around us acquire the resources necessary for their health and recovery.

Additionally, we wanna continue to remind everyone listening that you are not alone. If you or someone in your life is struggling with suicide, you can dial 988 for the national suicide hotline or you can reach out to a counselor or doctor.

We are so thankful for Kim for sharing her story and expertise with us today, and excited to see all the incredible research she will have in the future. Please check out Kim's sessions on the Voice in Sports session page. We also recommend that you check out some of our previous episodes with other VIS guests that speak about how they work on improving their mental health, such as episode number 76 with skier Hailey Swirbul and episode number 79 with professional diver, Molly Carlson.

Head to the feed on Voice in Sport and filter by "MIND", check out the stories and the incredible free resources we have with our experts here at VIS, check out the session page and filter by professional athlete or by sport psychologists and sign up for one of the free or paid sessions with our VIS experts or league.

See you next week on the Voice in Sport podcast.

In a special series for September, National Suicide Prevention Month, VIS Expert, Dr Kimberly O’Brien discusses suicide prevention for student-athletes. She shares important resources and ways that we can speak about suicide.