Like most people starting out in mental health, Ursula Whiteside, Ph.D., wanted to make a difference in the lives of the people she served. Looking back, she says, her younger self had no idea how hard it would be to do so. The biggest challenges: institutional obstacles and bias. She ran into roadblocks at each turn, from colleagues to institutional review boards whose decision making, she says, was driven by fear. “People working in the mental health space are often scared that they will be found liable for a person’s suicide. It paralyzes them, and so they end up not moving forward during a time when inaction isn’t an option.”
Today, Dr. Whiteside is on the clinical faculty at the University of Washington and a key disruptor in the field of suicide prevention. She founded NowMattersNow.org in 2012, a website that makes brief, effective crisis interventions accessible to all who have internet access. The interventions on the site are based on select Dialectical Behavior Therapy (DBT) skills, complemented by videos that range between 1 and 10 minutes in length. Dr. Whiteside handpicked and adapted the skills for the site alongside Marsha Linehan, Ph.D., ABPP, a therapist and researcher at the University of Washington who developed DBT in the ‘80s. In addition to interventions like opposite action, paced breathing, and mindfulness, Dr. Whiteside includes resources people can download, such as a safety plan and guide, steps to reduce suicidal thoughts, what to do when experiencing a crisis, and a diary card where people can track their moods, thoughts, and behaviors alongside the DBT skills they are learning. Dr. Whiteside also provides free guided online training that teaches healthcare providers, first responders, and peers how to deliver micro-intervention in less than five minutes to a person in crisis. She says she launched the site to give clinicians immediate access to “easy suicide prevention tools that can save lives.” “Working in this field, you quickly realize that the person you’re helping may never receive support outside the moment you have with them right now.” It’s a powerful opportunity that quickly becomes a missed one if not used. She also wanted brief interventions to be available to peers, people in crisis or trying to keep one at bay, “or really for anyone who wants to learn how to help themselves and others.”
The site also includes caring contacts, a low-cost, sustainable intervention that has a robust and positive impact on people experiencing suicidal thinking. How it developed has an interesting backstory that Jason Cherkis from HuffPost reported on in 2018. During World War II, a young soldier named Jerome Motto was deployed to Bastogne, Belgium. He received regular letters from family and Marilyn Ryan, a woman he’d gone out with a handful of times while in military training in Arkansas. Letters from his family left him feeling stressed and guilty, but he grew attached to those from Ryan. She was consistent, writing to him whether he wrote back or not. Her language was not effusive but instead spoke of the happenings of everyday life.
Knowing how Ryan’s letters helped him through the war, in the late ‘60s, Dr. Motto examined whether they could be a suicide prevention intervention. With a grant from the National Institute of Mental Health, he followed patients discharged from inpatient hospitalization who were at high risk of suicide. The participants were randomly separated into two groups: one received a series of letters, and the other did not. A critical component is that while the letters were consistent, they did not demand anything of the recipient. For example, while Dr. Motto’s team included a self-addressed envelope, they did not include a stamp because that could be construed as pressure. Participants could feel they had to respond; otherwise, they were wasting the researchers’ postage. The study’s outcome was groundbreaking: in the first two years after discharge, the suicide rate of those who received Dr. Motto’s letters was half that of those who didn’t.
Years later, in 2003, Dr. Motto told Tad Friend, a staff writer at The New Yorker, that when in crisis, people hope for someone to care. He spoke of a patient who jumped off the Golden Gate Bridge in the ‘70s. The man had written a note that said, “I’m going to walk to the bridge. If one person smiles at me on the way, I will not jump.” By then, Dr. Motto knew the potency of connection. He told Friend, “That was it. It’s so needless, the number of people who are lost.” Kevin Hines recently shared a similar sentiment with CBS News correspondent Lee Cowan. He told Cowan that the loneliness he was experiencing the day he jumped off the Golden Gate Bridge was intolerable, but he was unable to ask for help. “I could not reach out. I needed someone to reach in.”
Dr. Whiteside, who uses caring contacts in her private practice, says that she’s taken the model Jerome Motto set forward with his letters and infused it with technology. She sends texts to her clients, and on NowMattersNow.org, people can download a caring message card. On the front, it says, “Have you had suicidal thoughts? Problems that felt unsolvable? We’ve been there too.” On the back is space for someone to write a message. For those unsure what to say, Dr. Whiteside provides videos where people share the words they wished someone had told them when they were in crisis. In one video, a woman says, “… if you don’t have hope, let us hold it for you.”
Much of the content Dr. Whiteside includes feature effective ways to help a person that are simple and tangible, even if given just a brief opportunity to make a difference. Yet, early in her career, she faced resistance. She says as a young woman, colleagues felt she didn’t stay in her lane. “Like in most fields, women working in mental health have been marginalized. As a result, each generation of women has had to bend to not be too big or too small. We are constantly trying to fit ourselves into the right mold while not knowing exactly what that is. I got tired of it, and the constant struggle began to wear at my mental health.” She says at the time, it seemed her workplace didn’t value her skillset. Now looking back on it, she wonders if perhaps they didn’t understand what she was doing or what to make of her. Trying to increase people’s access to life-saving tools became an uphill battle filled with bureaucracy and cultural workplace restraints. Stepping outside of it and into entrepreneurship is what gave her the space she hadn’t been previously allowed. It wasn’t only bias that was a hindrance but also the rigidity of enforcing rules that did not benefit clients. “Many of us have gotten to where we are because we are good at following the rules, but we also have to step back and analyze the intent behind them. Otherwise, we are preventing ourselves from advancing the field.” Though useful brief-intervention tools exist, there’s been a gap in dissemination: getting tools directly to consumers. “People in crisis don’t know where to find reliable, quality resources. Inside the industry, we know how well these interventions work. We have to make it so people can easily access them.”
Photo image: Kyle Johnson