Una entrevista con Victor Armstrong sobre la prevención del suicidio

When you speak about suicide and share suicide awareness and prevention messages, what are the throughlines you most want people to understand? 

I believe that when people reach a point of suicidal thinking, they have lost hope and social connection. In my messages, I try to infuse those two things. 

I want people to find hope within themselves. I think a problem is that we often try to encourage people to look outside themselves for hope.

So, I encourage people to look within themselves, and I try to remind people: You are enough. You matter. There’s hope within you, and you have to be willing sometimes to reach down to find that hope.

Along with that, there’s also the need for social connection, because we are social beings.

For people who are struggling mentally or emotionally, I encourage them to reach out to other people to connect.

What does hope look like on someone’s worst day?

On a person’s worst day, hope is being able to see yourself on the other side of your pain.

Maybe you don’t know how you’re going to get through this right now. You might feel like you don’t know which direction to go in.

But hope is seeing past it enough to recognize and believe that you can be here tomorrow and the next day. You can make the choice to believe that life can and will get better.

I think that’s about as much as we can ask for when a person is having their worst day.

Sometimes it’s challenging for folks outside of the pain to really understand how a person can get to that point of questioning whether they want to be here or not—especially if they haven’t experienced anything like that. When you couple that with other aspects of people’s lived experiences that maybe you don’t understand—whether that’s sexual orientation or gender identity or a traumatic experience—it’s often difficult for a person outside of the situation to really comprehend the pain that someone is going through.

But you don’t have to understand a person’s pain to acknowledge that their pain is real and to engage with them in a way that helps to ease their pain.

Know that you have the power to intervene and to help someone who may be struggling.

What are the most effective things we can all be doing to reduce suicidality?

The first thing that I tell people is that human kindness is suicide prevention. 

The fact is people who are experiencing suicidal thoughts have oftentimes lost hope and a feeling of connection. You don’t know when a kind word or a smile might be something that someone needs to hear or see, just to help them feel connected back to humanity.

So, that’s one of the things I try to emphasize: Treating people with decency and respect can be a deterrent to suicide.

Beyond that, we know that there are certain risk factors and protective factors. Some people may have trauma in their history. They may be experiencing sudden loss or going through a life-changing situation. People may have chemical imbalances that are impacting their mental state. These things can sometimes put people at higher risk for suicide.

But there is no one cause for suicide. Suicide is very dynamic.

Things that are consistently effective in combating suicide come back to connection—allowing someone the space to be able to open up and talk about what they’re feeling.

If a person seems to be struggling, take that person aside, talk with them in private, and listen. Give them a safe space to talk about what they’re feeling.

It’s not for you to challenge what they’re saying or feeling or to try to fix them. Do not judge them.

Then, always try to point the person to hope. Try to connect them with help and support.

Being able to open up and talk about what they’re feeling can often help a person process things for themselves and get to a place where they begin to feel safer.

That’s very helpful—family members, friends, and other loved ones are often unsure what to do to support someone who’s struggling or seems at risk. Is there any other advice you want to give them? Also, what are things they should be doing for self-care?

If you have a family member or a loved one who is struggling mentally or emotionally, ask them how you can be a support to them and then listen. A lot of people who struggle with mental health challenges, including people who struggle with suicidality, have probably gotten a lot of advice from people already about what they should do.

But they probably haven’t had a lot of family members or friends simply ask them, “How can I be of support to you?” That’s the first thing I advise people to do. To me, that’s extremely important.

Then, for family members and caregivers, who’s there just for you? Who can listen to your challenges and thoughts and help you through difficult times?

One of the things that I do for my own self-care is get up early and exercise every day. Find what works for you—something that helps you take care of yourself mentally, physically, spiritually, and emotionally—and be unapologetically selfish about it.

As a caregiver or as a mental health professional, it’s also helpful to take a few minutes during the day for mental health and mindfulness breaks—go outside and just take some time to get quiet and reflect. If there are things that just seem to be lingering and difficult to get past, try to break those things down.

Do not be afraid to reach out for help if you need it. Never suffer in silence. Part of your self-care should be finding someone you can talk to.

It’s okay to talk to a therapist if you’re struggling. Most therapists I know have therapists. It can be a really valuable part of self-care.

What does recovery from suicidal thinking actually look like?

One reality is that you cannot necessarily take a person from suicidal thinking to not suicidal thinking from one conversation or encounter. It can take weeks, months, or even years for a person to move completely away from having suicidal thoughts.

But you can save a life in one conversation. Again, it’s about how you make a connection with that person in the moment in order for them to get past that moment of crisis.

Recovery from suicidal thinking can look different for different people. I know people who have—in their recovery—taken their pain and turned it into a mission to save lives and help other people. I know other folks for whom recovery has just meant really finding gratitude for being here.

I want to be clear: We’re not necessarily always talking about recovery from suicidal thinking. Suicidal thinking may continue to be there with you, but you can reach a point with treatment and therapy where you’re not moved by those thoughts.

I have a good friend who knows that he will have suicidal thoughts. It’s a part of who he is. But part of his recovery has been knowing people in his life who he can talk to when he feels like he is struggling.

So, recovery can look different for different people, but it really means that you’re in a place where your suicidal thoughts and feelings no longer control your life.

You acknowledge that the suicidal thinking is something that could recur, but as part of your recovery you have figured out what your triggers are. You understand what you need to do when you are having those thoughts and feelings. You know how to reach out for help. You have the resources you need in place. 

The most important thing is that you have made a determination and taken the steps to be here. I think that’s the biggest part of recovery: knowing that whatever happens, you intend to be here.

That’s powerful—thank you, Vic. How does work in suicide prevention relate to strengthening our array of mental health services more broadly and reducing stigma, both for the overall population and in specific communities?

That’s an important question, because I really see suicide prevention as upstream work. When you go further upstream, you’re trying to reach people where they live, work, play, and worship. You’re trying to give them access to mental health resources in those spaces.

In suicide prevention work, if it’s done correctly, you are trying to reach a person before they reach the point of suicidality. In my work, what that looks like is going into communities and building relationships. By understanding the stigma that exists in communities, we then can create resources and build programs that can combat it.

When we go into different communities, stigma looks different.

I grew up in Plymouth, a small town in rural, northeast North Carolina. The population of my hometown is about 3,300 people. I also was the son of a pastor. Growing up, I had three messages coming at me about how suicide impacted me and my community.

The message from my Black community was suicide is a white problem. You know, we don’t deal with suicide. We’re resilient people. We’re strong. Suicide is not something we need to worry about or talk about.

My faith-based community told me that if you are experiencing suicidal thinking, anxiety, or depression, you just need more faith. You need to pray more. You need a closer walk with Jesus, but you don’t need therapy.

When I’m doing presentations, I joke sometimes that when I was growing up we used to sing a song in church called “Jesus on the Mainline, Tell Him What You Want.” We didn’t sing “Therapist on the Hotline, Tell Him What You Want.”

Then, also, being a part of a rural community, there was this mentality that you are supposed to be strong people, so pull yourself up. We don’t give in to mental health challenges.

So, all three of those things were telling me that if I was feeling anxiety, depression, or suicidal thinking, I was doing something wrong.

For me, part of how we combat suicide is to understand the thinking that is in the ground in many communities. Let’s really engage with communities and try to understand how people actually think about mental health and suicide.

Stigma is just a narrative that a community forms about whatever the situation is. Oftentimes stigma is designed to label or to do harm. So, narratives have formed around mental health and suicide in the Black community, the Asian community, and the Hispanic community.

An example of engaging with communities about mental health is the program Soul Shop for Black Churches, which is about suicide prevention, mental health well-being, and making churches places of connection and hope. Research shows that people in the Black community are more likely to go to a faith leader than they are a psychiatrist or psychologist. That’s part of what’s woven into some of the stigma in the Black community—that we don’t go to institutions, psychiatrists, or psychologists.

But the faith leader has always been a part of our culture. So, part of the way that we address mental health and suicide is by engaging with the faith community, taking the evidence-based resources that we have and finding ways to embed them in the places and resources that the community is familiar with.

If we can do that, we can address stigma at its core. Part of the reason stigma about mental healthcare exists is because it was allowed to form in a vacuum. In my hometown growing up, I never met a psychiatrist or psychologist, but we had a church on every corner. Faith was woven into our lifestyle, our history, and our traditions. So, that’s where we went when we were experiencing challenges. The problem is that the church—the faith-based organization—wasn’t equipped to deal with people’s beliefs about mental health and suicide. 

So, we have to think differently in working with communities and adjust and adapt what suicide prevention looks like in communities in ways that are culturally relevant. It needs to be relatable to the lived experience of the community. People need to see themselves in the resources we are offering for suicide prevention and mental health.

Most importantly, we need resources that people are willing to utilize. If I give you resources that you’re not willing to utilize, I haven’t given you access to what you need.

If we have cultures within our society and our communities that are being left behind, we’re not really doing what we’re supposed to be doing.

What are some of the biggest needs for equity in suicide prevention work right now?

One of the fastest rising demographics in suicidality is among young Black males. We are seeing increases in the AAPI (Asian American and Pacific Islander) community. We are seeing increases in our Indigenous community.

We also are seeing an increase in suicidality among older Black women, which is something we are trying to learn more about.

We have always had a one-size-fits-all approach to suicide prevention. We haven’t made it easy for people to see themselves in the work. While we are seeing an increase in suicide rates in Black and Brown communities, we now are also starting to see more startups in Black and Brown communities to address suicide.

We want to make sure these resources are evidence-based and effective. We don’t want resources that are shrouded in stigma. We want to make sure that the resources that people are getting are genuinely going to be helpful to them.

One thing to remember is organizations are vying for the same dollars. So, it behooves us to think about how we are going to partner in communities.

When I began to do suicide-prevention work for the AAPI community, I found somebody who was already doing work on the ground—who already had built some momentum and credibility—and then came alongside her and said, “You guide me and then let me support you in this work.”

That’s the way we have to approach communities. Let’s find what may already be working and build relationships.

In mental health, we are very transactional. I give you a diagnosis, and you can get a certain level of services. If I provide this service to you, I can draw down my funding.

But a lot of our communities are more relational than transactional. They value relationship. If we’re not willing to go in and build the relationships, it’s going to be very difficult to reach people.

Also, a lot of these communities, including Black and Brown communities, have had negative interactions with systems and institutions. To build trust and begin to address their mental health needs and challenges, we have to be willing to acknowledge that, in many ways, we have been failing them. 

When I was growing up in my community and forming this narrative about how mental health and suicide were not supposed to be problems for us, there were no organizations saying, “No, this really is about you, too. We care about you.”

What else can help turn that around, Vic, and make our approach to mental health more equitable?

Core to health equity work is a recognition that the system is inherently inequitable. If we don’t start from that framework, we’re not going to get it right. So, the first thing that has to change is our mentality. We have to acknowledge that the system isn’t currently built to support marginalized communities.

With every policy decision that we make and every resource that we create, we’re either going to be leaning into equity—and making sure that health equity is at the forefront of everything we do—or we’re going to be perpetuating inequity.

We also have to keep getting better at embracing, utilizing, and incorporating lived experience in our work. People who have lived it and experienced it—they’re the people who can guide us in better serving their communities. Health equity work has to be willing to accept the intersectionality that people bring to the table and incorporate it into what we do.

We often think about equity just in terms of race and ethnicity, but health equity means so much more than that. It really is about making sure that every individual person has the ability to be their healthiest self—to live their best life—regardless of race, ethnicity, geography, identity, and lived experience.

So, we have to broaden our definitions and our ambition. For example, in my health equity work at the American Foundation for Suicide Prevention, I also focus on industries and vocational communities that disproportionately impact mental wellness. We have a whole line of work that we do with the construction industry (a program called Hard Hat Courage), because they have disproportionately high rates of suicide. The same is true for veteranos. We have to make sure our rural communities have access to the same resources that urban communities have. We have to make sure that people in LGBTQ communities are supported.

One of the core things for me—and maybe it’s more of a value for me—is that we have to get past this mentality that we would rather have someone suffer and not get what they need than have someone else get something they don’t deserve. That’s really hurting us in addressing equity. When I hear it, it sounds un-American and anti-Christian, so I’m not sure where this mentality comes from.

But a lot of organizations that were addressing issues in health equity are in a different place now. It ebbs and flows, and it really has become more of a taboo subject today.

We have to be consistent with health equity work for people to trust us.

One of the things that I encourage organizations to do is be intentional about health equity—be visibly intentional about it. Say to the communities you serve—whether it’s the LGBTQ community, the Indigenous community, the AAPI community—that we see you, we hear you, and you matter to us.

We need to elevate equity in suicide prevention and mental health work, and they need to see it. Until that happens, we are going to continue to lose people, because they’re not going to see us as being inclusive.

If they don’t see us as being inclusive, then they’re not going to utilize our resources. They have to know we’re here not just to help other communities. They have to know we are here for them.

Speaking as a person of color, I think one of the things that has been harmful in mental health and other areas is inconsistency. It’s that start and stop. When I go into communities, a lot of what I hear is, “You’ll be here today, but you’ll be gone tomorrow.” So that consistency of showing up and meaning it is very important.

People who are hurting make the decision about who is safe to talk to and who is safe to trust.

If you could debunk one myth or misunderstanding about suicide, what would it be?

The one myth I would want to debunk is that if you ask someone if they’re experiencing suicidal thinking, you’re going to make them suicidal.

A person is either suicidal or they’re not. You don’t make someone suicidal by asking if they’re thinking about suicide. By asking them, though, you might give them space to talk about what they’re feeling and help the person feel supported and connected.

So, don’t be afraid to ask the question, even if that means a person might get upset about you asking. I would much rather they be upset with me than they end up losing their life.

What are we doing well in suicide prevention in North Carolina and nationally? What’s working and what can we do better?

One of the biggest advancements in suicide prevention, in mental health generally, and in addiction has been 988. That’s been huge. North Carolina has done a good job promoting 988, but there’s still work to be done on how we socialize communities to what 988 is and how to utilize it. 

I think we are doing a better job both nationally and in North Carolina of at least acknowledging that mental health and suicide are real and important and encouraging people to talk about them. More and more, people are being encouraged to open up. That’s very positive.

I think we have to do a better job of blending evidence-based and community-based. I am a proponent of evidence-based practices, but we also have to acknowledge that there are very few evidence-based practices that are based on evidence for people who look like me.

So, for people in the Black community or the Hispanic community, for two examples, we have to do a better job of understanding how we can take those evidence-based practices and combine them with community-based practices, so that we can create something that has more cultural relevance. 

I also think we have to redefine the workforce. We can’t produce psychiatrists quickly enough. And the way that we currently define our mental health workforce and our crisis workforce doesn’t necessarily mirror what happens in a lot of communities.

In a lot of our communities, the person they go to first—who becomes their first responder—isn’t going to be a crisis counselor. They’re going to go to a faith leader, a coach, or a community center.

So, we have to think differently about what the workforce looks like and what the crisis continuum looks like, because people in these communities often enter the crisis continuum at a different place, not at the hospital or the emergency department or by calling 988. Their crisis first responder might be their grandmother.

Historically, we’ve created a system and invited people to find their way to the system. But we haven’t done a very good job of crafting a system that speaks directly to the needs of these non-majority communities that we’re trying to serve. There are a lot of communities that are doing some amazing things and addressing needs. We need to do a better job of learning from them.

Thank you, Vic. Is there anything else you want to share?

On a personal note, I have two teenage boys, 14 years old and 12 years old. I want their experience with their mental health to be very different from mine.

I want them to know that it’s okay to not be okay. I want them to know that if they are struggling or hurting, they can talk to me about it, and it’s going to be okay. I want them to know that it’s okay to cry, to be sad, and to feel vulnerable. It makes you no less of a man.

I think a lot of damage has been done to men and the mental health of men by placing false expectations on them. 

The other thing is that I am a person who lives with attention-deficit/hyperactivity disorder, or ADHD. I was diagnosed as an adult. As a child, I hardwired a lot of things into my brain to help me deal with my ADHD and find ways to navigate it. I’ve had to undo some of those things as an adult. 

I don’t want to see young people, especially young people of color, feel like you have to adjust to the mainstream because you feel like there’s something wrong with you, like you have to change yourself to fit in.

I want young people to know that it’s okay to be different. It’s okay to think differently. It’s okay to be neurodivergent. Because when you learn to feel negatively about yourself—when you’re taught to feel that way—that can spiral and turn into mental health challenges.

There are a lot of people right now who feel like their identity has been challenged or is being erased. I try to tell people that everyone matters, and I will intentionally call out specific communities—the LGBTQ community, the Asian American community, or the Black community—to say to them specifically: You matter.

No matter what anyone says, you matter. It’s important to let people—and especially young folks—know that they are fine and they are important, just as they are. Let’s acknowledge and respect the person in front of us and make sure we connect that person with hope.