In all matters involving health and legal issues in ministry, the civil laws of your state and the policies of your working diocese take priority in any crisis or controversy. Know the law.
Last Wednesday on this stream I alluded to a particular personality disorder in which the risk of suicide is considerably high. I do not want to leave the impression that risk of suicide is limited to some particular disorder or population, but it remains a distinct possibility across the board in all populations. If you are a church minister for some years, you will come in contact with the trauma and tragedy of suicide. Most times this will involve the survivors, but on occasion you may be confronted with an individual in your family or your ministry who freely speaks of the desire to die, or more specifically, elaborates a plan to do so.
It is my personal opinion that we will never reach a point where we can “save everyone” from suicidal attempts, any more than we will successfully identify every potential killer or mass annihilator. In the present debate over guns and mass murders, the argument for greater mental health intervention and screening, while certainly defendable on paper, places too much credit upon the mental health community to identify high risk individuals and what their future behaviors might be. This is not to say that years of collective practice by health care personnel have not yielded an algorithm of likely clues of suicidal thinking or intent; but rather, the two major problems remain that likelihood is not the same as certainty, and the practitioner, and certainly the non-professional, generally does not have access to an individual’s history, previous attempts, current medications, etc.
The questions on all of our minds, of course, is what should I do in the presence of suicidal suspicion, and equally importantly, what does civil law require me to do in possession of such information? This is very complicated on a lot of levels. Civil responsibilities of church workers are a complex issue of law, as we have seen in such matters as child abuse over the past twenty years or so. The issue of suicidal potential receives less attention, though it is my impression that societal concern about suicide is spiking, particularly when it involves family annihilation or harm to others. Twice in recent times professional airline pilots have committed suicide by taking down loaded commercial planes.
In my experience in church work I have heard some priests (outside of confession) and particularly lay youth ministers make the rather grandiose claim that “you can say anything,” the clear implication being that the lay minister enjoys some sort of airtight confidential status by virtue of working for the church, or that any information revealed in church ministry stays in the group, so to speak. Let’s carry that out to its logical conclusion. A parish conducts a weekend overnight retreat, and a group of teens and a church leader sit around a camp fire and talk. In the seemingly safe environment of the setting, one of the minors admits to the group that he or she has thought about killing themselves, has in fact made some previous attempts, and adds that he or she had come on retreat with the plan of killing themselves during the event, except that a beautiful song played that afternoon had caused a change of heart. My guess is that regular readers of the Café have already sniffed out the acute danger. If a teenager has planned to take his own life on a retreat, then the odds are that he has also brought the means to do so—likely a weapon or a large quantity of illicitly obtained medication.
There is a lot of research done on “psychiatrists’ fantasies,” and the leading fantasy is that the provider can cure the patient, period. My guess is that this is a powerful ministerial fantasy, too, particularly as the “treatments” invoked in church life are spiritual or infallible, thus granting infallible status to the minister. An inexperienced or hubris-bound minister who is leading the group described above may jump to his feet and lead the group in a rousing chorus of “Now Thank We All Our God,” proud that his group facilitation and compassionate listening has saved another soul on the brink.
As the colorful ESPN college football guru Lee Corso would say, “Not so fast, my friend.” The unfortunate young suicidal person at the campfire is unglued and at serious risk despite appearances. The proper response is to keep the individual in one’s presence until the parents can be notified and the appropriate hospital/psychiatric facility is determined and safe transportation arranged for. Or, 9-1-1 can be called immediately if the individual becomes belligerent or hostile. There is a certain shock effect in making that kind of call, as if the caller is sending a friend to a Boris Karloff Bedlam Sanitarium, but the actual hospitalization experience is generally tame and restful, often less than 72-hours if involuntary. The patient, in the better facilities, gets diagnostic attention and a treatment plan for follow-up service is drawn up.
What would happen if the intervention ended with the hymn by the campfire? We can’t say for sure. But the percentages are high that trouble may be lurking soon: the individual has previous attempts in his history, he has probably left previous treatment against advice, his mood is as fragile as a soap bubble, and he has actively planned the event with means and forethought. Reading the clues is a critical skill; it is not the same as diagnosis, which can only be undertaken legally by a health care professional, but rather it is more along the lines of first aid and getting help as soon as possible.
Given that ministries and schools are ramping into gear for the fall, issues surrounding suicide and other mental health issues seem like an excellent area for continuing institutional education. Such training involves multiple components. The first is an introduction to the kinds of issues one is likely to face in ministry—depression, narcissism, suicidal tendency and legitimate threat, etc., as well as the appropriate and at times legally required intervention. This takes us into legal matters, where diocesan attorneys can explain precisely what must be done in crises, the chain of command, the limits to confidentiality, the sharing of medical information, etc. It is ironic that there is no stigma attached to a peanut allergy and schools go to great pains to protect students from exposure. By contrast, what about the student who returns from a hospitalization after a legitimate suicide attempt. Do his teachers need to know this? Matters of this sort would make for an interesting in-service day—or week.