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How Advance Care Planning Neglects Black Americans

— Researchers are rethinking living wills and other ACP documents to ensure seriously ill patients get the care they want.

By Carina Storrs

When Kevin E. Taylor became a pastor 22 years ago, he never expected how often he’d have to help families make gut-wrenching decisions for a loved one who was very ill or about to die. The families in his predominantly Black church in New Jersey often didn’t have any written instructions, or conversations to recall, to help them know if their relative wanted — or didn’t want — certain types of medical treatment.

So Taylor started encouraging church members to ask their elders questions, such as if they would want to be kept on life support if they became sick and were unable to make decisions for themselves.

“Each time you have the conversation, you destigmatize it,” said Taylor, now the senior pastor at Unity Fellowship Church NewArk, a Christian church with about 120 regular members.

Taylor is part of an initiative led by Compassion & Choices, a nonprofit advocacy group that attempts to encourage more Black Americans to consider and document their medical wishes for the end of their lives.

End-of-life planning — also known as advance care planning, or ACP — usually requires a person to fill out legal documents that indicate the care they would want if they became unable to speak for themselves because of injury or illness. There are options to specify whether they would want life-sustaining care, even if it were unlikely to cure or improve their condition, or comfort care to manage pain, even if it hastened death. Medical groups have widely endorsed ACP, and public awareness campaigns have promoted the practice.

Yet research has found that many Americans — particularly Black Americans — have not bought into the promise of ACP. Advocates say such plans are especially important for Black Americans, who are more likely to experience racial discrimination and lower quality care throughout the health care system. Advance care planning, they say, could help patients understand their options and document their wishes, as well as reduce anxiety for family members.

However, the practice has also come under scrutiny in recent years as studies reveal that it might not actually help patients get the kind of care that they want at the end of life. It’s unclear whether those results are due to a failure of ACP itself, or due to research methods: Comparing the care that individuals said they want in the future with the care they actually received while dying is exceedingly difficult. And many studies that show the shortcomings of ACP look at predominantly White patients.

Still, researchers maintain that encouraging discussions about end-of-life care is important, while also acknowledging that ACP either needs improvement or an overhaul. “We should be looking for, OK, what else can we do other than advance care planning?” said Karen Bullock, a professor of social work at Boston College, who researches decision making and acceptance around ACP in Black communities. “Or can we do something different with advance care planning?”

Advanced care planning was first proposed in the U.S. in 1967 when the now-defunct Euthanasia Society of America advocated for the idea of a living will — a document that would allow a person to indicate that they wouldn’t want to be kept alive artificially if there were no reasonable chance of recovery. By 1985, most states had adopted living will laws that established standardized documents for patients, as well as protections for physicians who complied with patients’ wishes.

Over the last four decades, ACP has expanded to include a range of legal documents, called advance directives, for detailing one’s wishes for end-of-life care. In addition to do-not-resuscitate, or DNR, orders, patients can list treatments they would want and under which scenarios, as well as appoint a surrogate to make health care decisions for them. Health care facilities that receive Medicare or Medicaid reimbursement are required to ask patients about advance directives and provide relevant information. And in most states, doctors can record a patient’s end-of-life wishes in a form called a physician order for life-sustaining treatment. These documents require that patients talk with their physician about their wishes, which are then added to the patient chart, unlike advance directives, which usually consist of the patient filling out forms themselves without discussing them directly with their doctor.

Many people simply aren’t aware of ACP, or don’t fully understand it. And for Black individuals, that knowledge may be especially hard to come by.

But as far as who makes those plans, studies have shown a racial disparity: In a 2016 study of more than 2,000 adults, all of whom were over the age of 50, 44 percent of White participants had completed an advance directive compared with 24 percent of Black participants. Meanwhile, a 2021 analysis of nearly 10,000 older adults from a national survey on aging found that Black Americans were 57 percent less likely than White Americans to have a health care surrogate.

Many people simply aren’t aware of ACP, or don’t fully understand it. And for Black individuals, that knowledge may be especially hard to come by: Several studies have found that clinicians tend to avoid discussions with Black and other non-White patients about the care they want at the end of life because they feel uncomfortable broaching these conversations or unsure whether patients want to have them.

Other research has found Black Americans may be more hesitant to fill out documents because of a mistrust of the health care system — rooted in a long history of racist treatment. “It’s a direct, in my opinion, outcome from segregated health care systems,” said Bullock. “When we forced integration, integration didn’t mean equitable care.”

Religion can also be a major barrier to ACP. A large proportion of Black Americans are religious, and some say they are hesitant to engage in ACP because of the belief that God, rather than clinicians, will decide their fate. That’s one reason why programs like Compassion and Choices have looked to churches to make ACP more accessible. Numerous studies support the effectiveness of sharing health messages in church — from smoking cessation to heart health. “Black people tend to trust their faith leaders, and so if the church is saying this is a good thing to do, then we will be willing to try it,” Bullock said.

But in 2021, an article by palliative care doctors laid bare the growing evidence that ACP may be failing to deliver on the promise to get patients the end-of-life care they want, also known as goal-concordant care. The paper summarized the findings of numerous studies investigating the effectiveness of the practice and concluded that “despite the intrinsic logic of ACP, the evidence suggests it does not have the desired effect.”

For example, while some studies identified benefits such as increasing the likelihood of a patient dying in the place they desired and avoiding unwanted resuscitation, many found the opposite. One study found that seriously ill patients who prioritized comfort care in their advance directives spent just as many days in the hospital as patients who prioritized life-extending experiences. The authors of the 2021 summary paper suggested several reasons that goal-concordant care might not occur: Patients may request treatments that are not available, clinicians may not have access to the documentation, surrogates may override patients’ requests.

A pair of older studies suggested these issues might be especially pronounced for Black patients. They found that Black patients with cancer who had signed DNR orders were more likely to be resuscitated, for example. These studies have been held up as evidence that Black Americans receive less goal-concordant care. But Holly Prigerson, a researcher at Cornell University who oversaw the studies, noted that they investigated the care of Black participants who were resuscitated against their wishes, and in those cases, clinicians did not have access to their records.

In fact, one issue facing research on advance care planning is the fact that so many studies have focused on White patients, giving little insight into whether ACP helps Black patients. For example, in two recent studies on the subject, more than 90 percent of patients were White.

“It’s a direct, in my opinion, outcome from segregated health care systems,” said Bullock. “When we forced integration, integration didn’t mean equitable care.”

Many experts, including Prigerson, agree that it’s important to devise new approaches to assess goal-concordant care, which generally relies on what patients indicated in advance directives or what they told family members months or years before dying. But patients change their minds, and relatives may not understand or accept those wishes.

“It’s a very problematic thing to assess,” said Prigerson. “It’s not impossible, but there are so many issues with it.”

As for whether ACP can manage to improve end-of-life care specifically in areas where Black patients receive worse care — such as inferior pain management — experts, such as Bullock, note that studies have not really explored that question. But addressing other racial disparities is likely more critical than expanding ACP, including correcting physicians’ false beliefs about Black patients being less sensitive to pain, improving how physicians communicate with Black patients, and strengthening social supports for patients who want to enroll in hospice.

ACP “may be part of the solution, but it is not going to be sufficient,” said Robert M. Arnold, a University of Pittsburgh professor on palliative care and medical ethics, and one of the authors of the 2021 article that questioned the benefits of ACP.

Many of the shortcomings of ACP — from the low engagement rate to the unclear benefits — have prompted researchers and clinicians to think about how to overhaul the practice.

Efforts to make the practice more accessible have spanned creating easy-to-read versions, absent any legalese, and short, simple videos. A 2023 study found that one program that incorporated these elements, called PREPARE For Your Care, helped both White and Black adults with chronic medical conditions get goal-concordant care. The study stood out because it asked patients who were still able to communicate if they were getting the medical care they wanted in-the-moment, rather than waiting until after they died to evaluate goal-concordant care.

“That to me is incredibly important,” said Rebecca Sudore, a geriatrician and researcher at the University of California, San Francisco, who was the senior author of the study and helped develop PREPARE For Your Care. Sudore and her colleagues have proposed “real-time assessment from patients and their caregivers” to more accurately measure goal-concordant care .

“Sometimes it’s awkward,” Taylor said. “But it’s now awkward and informed.”

In the last few years, clinicians have become more aware that ACP should involve ongoing conversations and shared decision making between patients, clinicians, and surrogates, rather than just legal documents, said Ramona Rhodes, a geriatrician affiliated with the University of Arkansas for Medical Sciences.

Rhodes and her colleagues are leading a study to address whether certain types of ACP can promote engagement and improve care for Black patients. A group of older patients — half are Black and half are White — with serious illnesses at clinics across the South are receiving materials either for Respecting Choices, an ACP guide that focuses on conversations with patients and families, or Five Wishes, a short patient questionnaire and the most widely used advance directive in the U.S. The team hypothesizes that Respecting Choices will lead to greater participation among Black patients — and possibly more goal-concordant care, if it prepares patients and families to talk with clinicians about their wishes, Rhodes said.

When Taylor talks with church members about planning for end-of-life care, he said they often see the importance of it for the first time. And it usually convinces them to take action. “Sometimes it’s awkward,” he said. “But it’s now awkward and informed.”

Complete Article ↪HERE↩!

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Rosh Hashana Can Change Your Life (Even if You’re Not Jewish)

By David DeSteno

Celebrating a new year — as Jews the world over will do this week, when Rosh Hashana begins on Friday at sunset — is all about making changes. It’s a time for new beginnings, for wiping the slate clean and starting over from scratch. In that spirit, on Rosh Hashana Jews say prayers and listen to readings that celebrate the creation of the world and of human life.

But Rosh Hashana also strikes a different, seemingly discordant note. Unlike so many other New Year’s traditions, the Jewish holiday asks those who observe it to contemplate death. The liturgy includes the recitation of a poem, the Unetaneh Tokef, part of which is meant to remind Jews that their lives might not last as long as they’d hope or expect. “Who will live and who will die?” the poem asks. “Who will live out their allotted time and who will depart before their time?”

And we’re not talking about a gentle death at the end of a reasonably long life; we’re talking about misfortunes and tragedies that can cut any of our lives short. “Who shall perish by water and who by fire,” the poem continues, “Who by sword and who by wild beast / Who by famine and who by thirst / Who by earthquake and who by plague?”

This focus on death might seem misplaced, bringing gloom to the party. But as a research scientist who studies the psychological effects of spiritual practices, I believe there is a good reason for it: Contemplating death helps people make decisions about their future that bring them more happiness. This is an insight about human nature that the rites of Rosh Hashana capture especially well, but it’s one that people of any faith (or no faith at all) can benefit from.

When planning for the future, people typically focus on things that they think will make them happy. But there’s a problem: Most people don’t usually know what will truly make them happy — at least not until they are older. Across the globe, research shows, people’s happiness tends to follow a U-shaped pattern through life: Happiness starts decreasing in one’s 20s, hits its nadir around age 50 and then slowly rises through one’s 70s and 80s, until and unless significant health issues set in.

Why the turnaround at 50? That’s when people typically start to feel their mortality. Bones and joints begin to creak. Skin starts to sag. And visits to the doctor become more frequent and pressing. Death, hopefully, is still a good ways off, but it’s visible on the horizon.

You might think this morbid prospect would further decrease contentment, but it ends up having the opposite effect. Why? Because it forces us to focus on the things in life that actually bring us more happiness. Research by the Stanford psychologist Laura Carstensen has shown that as we age, we move from caring most about our careers, status and material possessions to caring most about connecting with those we love, finding meaning in life and performing service to others.

That’s a wise move. When people in the Western world want to be happier, research shows, they tend to focus on individual pursuits. But that same research confirms that this strategy doesn’t work well: Pursuing happiness through social connection and service to others is a more reliable route.

Of course, you don’t have to be old to confront death. During the SARS outbreak and the Covid pandemic, younger adults changed what they valued, research showed. When death suddenly seemed possible for anyone, even those in the prime of their lives, younger people’s opinions about how best to live suddenly began to look like those of seniors: They turned toward family and friends, finding purpose in social connection and helping others.

You don’t even need to face something as drastic as a pandemic to experience some version of these changes. Research shows that simply asking people to imagine that they have less time left, as congregants do on Rosh Hashana, is sufficient.

Rosh Hashana hardly has a monopoly on this insight. Christian thinkers such as Thomas à Kempis and St. Ignatius of Loyola urged people to contemplate death before making important choices. Stoics like Marcus Aurelius argued that meditating on mortality helped people find more joy in daily life.

But the particular brilliance of Rosh Hashana is that it combines thoughts of death with a new year’s focus on a fresh start. As work by the behavioral scientist Katy Milkman and her colleagues has shown, temporal landmarks like New Year’s Day offer an effective opportunity for a psychological reset. They allow us to separate ourselves from past failures and imperfections — a break that not only prods us to consider new directions in life but also helps us make any changes more effectively.

There is a lesson and an opportunity here for everyone. Contemplate death next Jan. 1 (or whenever you celebrate the start of a new year). Any brief moments of unease will be well worth the payoff.

Complete Article ↪HERE↩!

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Young workers finding their place in end-of-life care

— ‘I realized death can be positive.’


Mary Phelps, a grief massage therapist and Shiatsu bodyworker, gives a client a massage on Aug. 28, 2023, in Chicago. Phelps’ work focuses on getting the nervous system to calm down. Phelps is a member of the Chicago Death Doula Collective.

By JENNA SMITH

At age 19, Mary Phelps stood at her grandmother’s bedside. In mere minutes, she would watch the woman with whom she had shared a home and a life take her final breaths.

She held her grandmother’s legs, lightly massaging them as the seconds ticked by. “I just remembered her becoming so young in the face and relaxed,” Phelps said. “That’s when it came to me. Death can be calm and peaceful.”

Phelps’ perspective toward death and dying would forever be changed.

“It was just a really beautiful moment,” Phelps said of her grandmother’s passing. “So to see that, I realized death can be positive.”

Now, six years after that transformative moment, Phelps is one of Chicago’s youngest death doulas at age 25.

The role of a death doula is to educate clients on what to expect at the end of life. The little-known field is centered around easing an individual’s dying process, such as by informing the person of their burial options, serving as a point-of-contact between the person and their loved ones, and assisting in caregiving. And Chicago’s young and diverse end-of-life care workers are striving to provide comfort and representation during an inevitable period of life.

Young doulas say they aim to change the perception that death is laden with gloom.

Phelps, for example, opened the door to her North Center office sporting a messy bun atop her head and a welcoming smile. She pressed her hands together in a namaste symbol and offered a small bow.

With an elephant tattoo on her arm and beads in her hand (a gift for completing her doula training), she sat down, folded her legs in a rolling office chair and began to share her story. When the beads broke between her fingers as she spoke, she smiled and said, “must be the energy clearing.”

Phelps describes herself as “death positive.” While the expression may raise eyebrows, she uses it as a way of calling attention to the impact of her work.

“I think some people hear the word ‘death’ and they’re like, ‘What witchcraft is going on here?’ But it’s not like that,” she said. “It’s just helping us to give better care to those that are dying, because they get neglected a lot.”

Phelps channels better care through touch. She offers massages to hospice patients, fulfilling a need that she feels is underappreciated in the elderly community.

“A lot of times, they may not even be getting hugs or even gentle pats on the back,” she said. “So the way I see it … touch can help them feel more comforted and safe. It brings a calming presence. Yes, this is a scary time, but this can be a safe space.”

The fear surrounding death is something that Phelps has encountered throughout her career. However, she and her partners at the Chicago Death Doula Collective work to help communities unlearn that fear.

Phelps may be one of the youngest death doulas providing care in Chicago communities, but she is not the only one.

Sam Kopas, 34, is new to the death doula scene. While on a thrifting excursion, she spotted a flyer advertising support for elder care, with one of the options listed as “death doula.”

“I thought that’s the craziest thing I’ve ever heard,” Kopas said.

The flyer made her think about her travels through Europe with her husband. She recalled seeing the Prague Astronomical Clock that tolls every hour, reminding her that regardless of your age, death comes for us all.

“I thought that was really metal,” she said with a chuckle. With those memories coming to mind, she said she suddenly became acutely aware of the infrequency of open conversations surrounding death in America.

With her interest peaked, Kopas began to research Chicagoland death doulas to learn more about the practice. Soon, she found herself under the tutelage of Catherine Durkin Robinson, the owner of Anitya Doula Services and a death doula and educator.

Kopas became one of Robinson’s youngest students.

“I love seeing younger people. We need as many people as possible to get into this because so many different kinds of folks feel comfortable with so many different kinds of folks,” Robinson said. “I want to see more people who are trans, who are part of the LGBTQ community, getting trained to do this work.

“I think she brings a really bright perspective to the work,” Robinson said of Kopas. “Because sometimes when we’re dying, we want to be around people that have familiar language, that use similar words, sometimes that look the same and are in tune with what we’re going through.”

Robinson said that although younger workers are needed in the field, youth does not come without its challenges. She said some patients prefer an older practitioner. “Being in end-of-life work as an older woman, I’m thrilled with this process of getting wiser. That’s actually needed in this work,” Robinson said. “It’s comforting; we know a thing or two and we’ve been around the block.”

Kopas echoed these concerns, saying, “I definitely think there’s some challenge with clients because when there’s an age gap that’s so significant, where someone’s in their 70s or 80s talking to someone who’s a good deal younger than them, there’s probably even more of that intensity of, ‘What would you know that I don’t at this point?’”

Kopas navigates that resistance by acknowledging the challenge as it arises. She said that holding the client in unconditional positive regard and addressing their discomfort directly is the key.

“Just saying, ‘I hear you, this is rough,’” Kopas said. “I’m certainly not here to fix the disease or cure it, but to give you the most comfortable space in the end.”

When envisioning end-of-life care, Kopas said, a “standard kind of patient” comes to mind, someone elderly and bound to a hospital bed. But not everyone seeking end-of-life care is elderly. For young patients, doulas can adjust the care and comfort priorities.

Community health care worker Kandis Draw was forced to grapple with such adjustments as she cared for her sister battling liver failure at age 22. While burdened with grief, she discovered the distinct differences of navigating the dying process with someone in their 20s.

“When you deal with people who are in their 60s and up, some of them have the attitude, ‘Well, I’ve lived my life. I don’t have any regrets,’” she said.

She recalled one senior saying, “When you get old, stuff happens to you. There’s no way around that.”

This peaceful acceptance can starkly differ for those who are dying at a young age. According to Draw, 41, young patients can be burdened with a different sentiment. “‘This is not fair. I deserve another chance. I wasn’t parented right. I wasn’t cared for right. I didn’t have the resources. People just threw me out there,’” Draw said, recounting some of the comments she’s heard over the years.

Despite their grief, Draw said she was able to connect with these patients. “I think that you can communicate better when it’s someone that’s close to your age. You can have more of an open conversation,” she said.

Like Draw, Maureen Burns, who is 38 and a fellow collaborator with the Illinois-based HAP Foundation for hospice and palliative care, considers her work to be heavily influenced by her personal experience with grief and loss.


Mary Phelps gives a massage on Aug. 28, 2023, in Chicago.

Hospice is comfort care without curative intent; the patient no longer has curative options or has chosen not to pursue treatment. Palliative care is comfort care for people with a serious illness with or without curative intent.

Burns reflected on the death of her father in 2021. Despite working in health care, it took her a “surprisingly long time” to realize that her father was a candidate for hospice care. He struggled with chronic obstructive pulmonary disease, or COPD. While his decline in health made daily living and traveling to doctors’ appointments challenging, she did not consider that those challenges could be addressed by hospice care. “I think that informs my work now,” Draw said. “If it was that hard for me, imagine someone who hasn’t heard the word hospice. Imagine what they could be missing out on.”

For Kopas, becoming a doula was a way to bypass structures that imagine a standard patient. “I know lots of families that don’t think that hospice would be a good fit for them because they don’t fit the standard kind of patient or family that would go through it,” she said.

Kopas focuses on ensuring that everyone has the information they need. “Did you know that green burial is an option? Did you know that palliative care can start early? Did you know that you can opt into hospice and then opt out if you want?” she asked. “All of this is just stuff that I felt like, if I could be a messenger for that kind of information to people who didn’t know it, then that would be a significant improvement right there.”

For many of Chicago’s end-of-life-care workers, having conversations about a patient’s legacy and final moments have affected how they plan to move forward in their own lives.

Kopas found death doula work to be her method of leaving a lasting legacy in the world. She recently concluded that “parenting might not be for me.” This decision led her to ponder “what could I still do and bring to the world that would be valuable and helpful, and offer a perspective and nuance and ease someone’s time here.”

The answer was to be there for people when they are at their most vulnerable.

Phelps’ open and positive approach toward death isn’t limited to her work. She has begun planning for her own death and encourages other young people to consider what a good death would look like for them.

For her, a good death would take place in her home, after which she would have a water cremation and have her ashes turned into a diamond. Although many young people don’t like to discuss death, the 25-year-old said firmly that, “Dying does not have to be a scary process.”

The work of the city’s death doulas also reminds the public that advanced care planning can be pursued at any age.

“Death work isn’t an exclusively older generation (issue),” Kopas said. “It can be a regular conversation. Having these chats before anything tragic, terminal or diagnosis-related happens is a large benefit that a lot of people don’t think about.”

Chicago’s young end-of-life specialists provide varied forms of care. Draw hosts conversations with her Englewood neighbors who are navigating existential dread. Phelps massages the shoulders of an Uptown resident who has spent years bearing the burden of grief. Burns sits with Far North Side neighbors planning for a nearly unspeakable reality where they leave their children behind. Kopas spends hours studying the logistics of hospice care options so her client has the information needed for a death with dignity.

Regardless of the day-to-day appearance of their work, one message stays consistent: All of Chicago’s communities need end-of-life support.

“We need younger workers, older workers, Black workers, Hispanic — we need everybody because everybody is gonna need this type of care. It’s not just one group that dies or gets sick,” Burns said. “Everybody needs it.”

Complete Article ↪HERE↩!

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Study Finds Gap Between What Rural Residents Want for End-of-Life Care and What They Receive

— Lack of conversations among the family members, and a more difficult access to healthcare are among the reasons responsible for the discrepancy.

By Liz Carey

When it comes to end-of-life wishes, a new study has found that while most people have end-of-life wishes, only a little over a third of them actually get them fulfilled. That is even more true with rural residents, researchers said.

Lula Reese said she didn’t have to ask her mother what she wanted as she neared the end of her life – she just knew.

“She told us she didn’t want to live with any of her children,” Reese said of her mother, Lula Simms. “She didn’t want to be a burden on any of us. We never talked about what she wanted. We just knew.”

Lula Simms lived in rural Bastrop, Texas , population 10,434, all her life and turned 100 in November, 2022. For the last two years of her life, her eight children cared for her in her own home with the help of hospice.

“She was in hospice for two years,” Reese said. “One day, she was different – she had stopped eating and she wasn’t the same. We took her to the hospital, and they told us she was transitioning.”

Simms died in February 2023, just a few days after her children rushed her to the hospital. For Reese, making sure that her mother’s wishes regarding the end of her life was never something that was written down. It was just something the family knew – her mother wanted to stay in her own home as long as he could. With the help of hospice, her family was able to make sure those wishes were met.

A new study from St. David’s Foundation in Texas has found that when it comes to end-of-life care, most Texans want to die at home (76%), and to not be a burden to their family (77%). But only one in three people surveyed said their loved one’s wishes were honored. Of those who are least likely to have their end-of-life wishes followed are rural residents, the study found.

Only 37% of the survey respondents said their loved ones died at home. Close to half of them (47%) said their loved one faced challenges related to their care – from problems with insurance coverage to facing cultural or language barriers.

Andrew Levack, senior program director with St. David’s Foundation, said there are a number of reasons why ensuring a rural loved one’s wishes are met may be difficult. Key among them is that conversations about the end of life just don’t take place.

“I think a big part of it is that those conversations and that planning around how to make (end-of-life wishes) happen don’t necessarily take place,” he said in an interview with the Daily Yonder. “One of the interesting things the study found was how few conversations respondents had with their doctors around plans for end of life. I think people have an idea of what they would like, but it takes some active planning and advocacy to make that happen. In the absence of that, I think people don’t realize what their ideal scenario would be.”

Dr. Kate Tindell, medical director for Austin Palliative Care and Hospice, said most of the hospice referrals her program has come from hospitalizations. That presents a problem for rural residents who are further away from hospitals and more isolated, she said.

“The rural community I think tends to already have limited exposure to health care,” she said in an interview with the Daily Yonder. “I think (the Covid-19 pandemic) really compounded that for them. Rural communities were suffering from the closure of healthcare access. The strain on health care from Covid makes it feel like we’re seeing them have less and less access.”

Lack of access can lead to a less intimate relationship between patient and doctor who could discuss hospice with an elderly patient.

“People have really disjointed health care now,” she said. “We’ve sort of lost that sense that there is a captain of the medical ship who is aware of all the moving parts and is giving the patient that guidance. I think that really causes people to not have the kind of relationship that would allow them to have that kind of conversation (about end-of-life wishes) the way they would if they had seen the same provider every single time for 10 years.”

Sometimes, it falls to non-profit organizations to get information about making end-of-life decisions to older rural residents. Sumai Lokumbe, is one of Bastrop’s OWLs – or Old Wise Leaders. She works with the aging population in her area to make sure they get the care they need. Many people in her community are unaware of what hospice and palliative service is or have a misunderstanding about what end-of-life care entails.

“I explain to people exactly what hospice does and what it is,” she said in an interview with the Daily Yonder. “They come in to make sure you’re not in pain and make you comfortable and take some of the stress off the family members, plain and simple.”

In some instances, cultural differences create challenges to overcome. Many African Americans in her area face cultural beliefs that prevent them from having anyone but family care for loved ones as they age. Other African American community members may distrust a system that has previously not cared for them.

“In the African American community especially, there is a belief that you stay with your family,” she said. “But there’s also a lot of distrust of the system. They don’t have a lot of trust in things put in place for them by people who don’t look like them.”

For Lula Reese, hospice was a way for her family to care for her mother as she transitioned through the end of her life.

“We had heard of hospice, but we used to always think that hospice care meant that she was going to pass away in the next five or six days,” Lula Creek said. “But we learned that wasn’t the case… Hospice and helped us take care of her, like giving her baths and bringing her supplies when she ran out.”

Even without those final wishes in writing, the family was able to keep her in her home as long as possible, she said. Hospice helped them to care for their mother, as well as alleviate financial burdens they know she would have feared placing on them.

“We didn’t talk to her about hospice care, and you know, we didn’t talk to her about what she wanted to do in her last days, ” she said. “We didn’t find out about it until after we had her service. She had already written that her desire was just to live long enough to see her children be grown. Her youngest child is in their fifties, so she had everything she wished for. We never asked her if she wanted to go into a nursing home. We just knew that was not her desire.”

Complete Article ↪HERE↩!

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My three-point turn toward personalizing good death in old age

By Marcel G.M. Olde Rikkert

It was New Year’s Eve, and my wife and I were visiting my father in his long-term care apartment. He had been cautiously wandering around, waiting for a visit, when we arrived, something he’d been doing since my mom had died a year ago. He looked frail. The “surprise question” occurred to me: Would I be surprised if he passed away in the next year?

No. I wouldn’t.

After we’d spent some time together, I asked his wishes for the coming year.

“I don’t know,” he replied. “I’m 101 years old. I was married nearly 70 years and have finished my life. Marcel, I am very much afraid of dying. Will you ensure that I don’t suffer and that dying won’t take too long?”

I promised him I would try.

The second week of January, I received a call that my father had fallen and was in pain. He had no fracture, but he insisted he did not want to get up anymore. I drove the 120 km to his home, thinking about all of the possible scenarios. My first thought was to get him on his feet again, with enough analgesics to overcome his fear of falling. As a geriatricianson, I had always tried to keep my parents active and felt proud that they had enjoyed so many years together this way.

But would such encouragement fit the situation my dad was in now? He’d asked me to make sure dying didn’t take too long. Was it already time to consider death by palliative sedation? I felt uncertain. To qualify, he needed a symptom that could not otherwise be helped, and death had to be expected within two weeks.

When I arrived at his bedside, he repeated, “I don’t want to get up anymore,” and again, he asked me to help alleviate his fear of dying. I had to honour his heartbreaking request for a peaceful death. With a leaden soul, I went to the doctor on call — luckily his own physician — and asked for his assistance in ensuring a peaceful death. We discussed all options, acknowledging my father’s increasing frailty, despair and anxiety, and we agreed to start acute palliative sedation with midazolam, adding morphine according to the Dutch national protocol. I watched as the doctor prepared the equipment, feeling reassured by his calm professional acts.

My father could not understand the plan himself, but after an hour or so he woke for a few seconds and, with a frail smile, said goodbye to my sisters and me. We made a schedule for staying with him and I took the first turn. I sat next to him for two hours, and just after his second dose of morphine, he stopped breathing and passed peacefully away, just as he had wished. Sadness and relief turned to warm gratitude in my heart. Life had given us a sensitive and wise physician who enabled us to overcome what my dad and I had feared most.

***

In December of the same year, my 86-year-old father-in-law asked me to come to Antwerp and talk to him about the options for assisted dying. He had metastatic prostate cancer and had not recovered over six weeks of hospital care. He was bedridden with a toe infection and painful pressure sores. My reflex, again, was to involve geriatricians and try to get him on his feet. However, my father-in-law, an engineer by profession, had decided it was time to turn off his engine after losing hope for sufficient recovery. My wife and I explained to him what medical assistance in dying and palliative sedation could look like, as both are allowed under certain conditions in Belgium.

Without hesitation, he chose medical assistance in dying. He was very satisfied with his life, having experienced war, liberation, marriage, births, retirement and nice family holidays. In line with his story of life, he did not want to deteriorate further and end his life in pain and misery. We kept silent while he wrote his last will, then thanked us for everything and suggested we should now watch the Belgium versus Morocco World Cup soccer match.

When the game ended, saying goodbye was hard. We looked into his eyes, still bright, and shook his hands, still strong. We knew it was the last time. But his calm smile wordlessly assured me it was time to turn off my own geriatrician’s inclination to pursue mobility and functional improvement. Death was made possible within a week, and after ensuring that all requirements were met and speaking to each family member, his oncologist carried out the procedure carefully in the presence of his children.

***

Just two weeks later, our Spanish water dog, Ticho, made me reflect again on what’s needed most at the end of a long life. For 16 years, Ticho had been my much-loved companion and daily running mate. I had begun to dream he might become the world’s oldest water dog. However, his sad eyes now showed me that his life’s end was close, also evidenced by having nearly all possible geriatric syndromes: slow gait, repeated falls, sarcopenia, cataract, dementia, intermittent incontinence and heart failure.

Still, he came with me on short walks until, one day, he became short of breath, started whimpering and did not want me to leave him alone. Patting calmed him a bit, but I realized we needed to help him die peacefully instead of trying to mobilize him again. Though not comparable to the last days of my dad and father-in-law, there were echoes.

Our three adult kids rightly arranged a family meeting, as Ticho was their sweet teddy bear. We agreed to consult a veterinarian and ask for help with a good farewell. Next morning, the vet agreed with assisting dying. She said Ticho was the oldest dog she had seen so far, and she reassured us that it was the best decision we could make. Again, I felt very thankful for this professional and compassionate help. Ticho died peacefully after sleep induction and, together, my son and I buried him in our garden.

***

Strangely, although death in old age is as natural as birth is for babies, pediatricians seem much more involved in deliveries than geriatricians are in dying. These three encounters with death in my life made me feel I had fallen short so far as a doctor, having undervalued assisting dying at old age. How to guide people to a better end of life was largely left out of my training as a geriatrician. Like pediatricians, geriatricians prefer to embrace life. In geriatric practice and research, we tend to reach for the holy grail of recovery by improving functional performance and autonomy to enhance well-being for frail older people, rather than focusing on facilitating their well-being over their last days. In this tradition, I practised hospital-based comprehensive geriatric assessment and integrated care management, as this had proven effective in giving older people a better chance of discharge to their own homes.

In my research, I had steered a straight line toward longevity and improving autonomy, in accordance with the dominant culture in society and medicine. I had excluded older people with short life expectancies from our intervention trials and did not adapt outcomes to this stage of life. Even for our recently updated Dutch handbook on geriatrics, we did not describe death or dying in any detail. I served many older people in their last days and hours, but did so with limited experience, few professional guidelines and little legal leeway.

Now, having been helped so compassionately with the deaths of three beings close to me, I realize how rewarding it can be to switch clinical gears from recovery-directed management to dying well, and to do so just in time. Older people can show and tell us when they arrive at this turning point and are ready for ending life. I hope other physicians will realize, as I have, how important it is to allow death into a conversation, even a care plan, and to be adequately trained to do so. Perhaps we also need our own turning points as physicians to get ready for the delicate responsibility of compassionate and professional assistance in personalizing good death in old age.

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End-Of-Life Workers Are Sharing The Major Things We Get Wrong About Death

Palliative and hospice care physicians, nurses and social workers discuss the biggest misunderstandings they see.

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The one big thing that people have in common is that we all will die, and we likely will experience the death of someone we love, too.

And yet despite this shared future, death can be hard to talk about, because it’s not an experience that anyone can report back from to say how it went. When you or a loved one starts approaching death, the existential stakes can go from theoretical to personal, sometimes feeling emotionally, physically and spiritually fraught.

That’s why it can help to hear the insights of people who see death all the time, because understanding it now can help us better process grief about others and feel more at ease when thinking about our own mortality.

I had conversations with palliative and hospice care physicians, nurses and social workers that comforted me, surprised me and challenged my own assumptions about death. Maybe they will for you, too.

Here are some of the biggest misunderstandings they shared with me about death and what the reality actually is:

The physical process of dying doesn’t look like it does in the movies.

This was a repeated theme among the experts I spoke with. Pop culture may have you thinking that death happens quietly and quickly, with eyes closing and arms crossed, but dying from natural causes often looks different in real life.

“My own dad said to the nurse, ‘I’m about ready to hang it up,’ and then he died minutes later. But that type of death is very uncommon,” said Penny Smith, a hospice quality manager and registered nurse in Washington state.

In her decadeslong career, Smith said she’s only come across a few instances in which people died quickly.

“It’s usually more of a process where they go into that unresponsive state, and there’s all kinds of things going on with their body. Their color’s changing, their breathing is changing and then they finally slip away,” she said.

Smith started posting TikTok videos about working in hospice care during the COVID-19 pandemic shutdown of 2020 and has since amassed around 640,000 followers on the platform. She uses skits and sound effects to educate people on what it’s like to be in the room with someone who is dying, covering topics like deathbed visions to the sounds that dying people make.

Common responses to her TikToks are comments of relief, acceptance and commiseration at seeing someone describe an experience that resembles how their own loved ones died.

“I, as a hospice nurse, have been with so many families where they were really disturbed by what they were seeing, or scared. And I would say: ‘That’s normal. We see that all the time.’ The relief is palpable,’” Smith said.

In one TikTok, Smith explains that when a person’s body is “shutting down,” it’s normal if they do not want water. A top comment on the video reads: “Thank you for this. My mom stopped drinking when we knew she was going to pass and I still felt like I should have tried to have her drink water more.”

Among all the physical processes of dying, Smith said the biggest misunderstanding she sees is when family members worry that their loved ones are dying of starvation because they’ve stopped wanting to eat.

“These are people who are already dying. They don’t need the food,” Smith said. “And when the family starts to try to force them or coerce them into eating just by, ‘Come on, just have a bite just to eat something,’ it just sets up so much stress between the family and the person.”

Similarly, families often worry that the use of morphine and other opiates will hasten the death of loved ones, according to Frances Eichholz-Heller, a senior social worker for the palliative care consult service at NewYork-Presbyterian/Columbia University Irving Medical Center.

“Some people will say to me, ‘Well, we had an uncle who was in the hospital dying, and then as soon as they put the morphine on, he died really quickly,’” Eichholz-Heller said. “I have to explain to them: ‘Well, he probably died really quickly because he was dying. He wasn’t dying because of the morphine, but they put him on the morphine to help.’”

Families can live with a lot of regret over what they should have done.

If you are seeking to support a loved one who is dying, be mindful of how your own fear and discomfort could impact what a dying person shares with you, said Dr. Aditi Sethi, a North Carolina-based hospice physician and end-of-life doula.

According to Sethi, some dying people try to talk about their experience with loved ones but the families dismiss it because of their own discomfort, using language like “You’re not dying, don’t worry about it.”

“So many times, loved ones have the most regret,” Sethi said. “They’re so terrified of losing their loved one that they can’t be fully present to their loved one at the time when they need them the most, really — to hold their hand and to really honor what they’re going through, and have a space to share what they’re experiencing in this epic journey they’re about to embark on.”

But if you had a strained relationship with the person before they were dying, don’t feel like you have to force a connection that is not authentic, either. “Your relationship with the dying person is personal, and if you didn’t have a good relationship, you are not obligated to go and be with that person,” Smith said.

It’s also important to provide space for people to be themselves when they are grieving, said Ladybird Morgan, a California-based registered nurse, palliative care consultant for the company Mettle Health, and co-founder of the Humane Prison Hospice Project nonprofit.

“I really ultimately believe that what happens is what needs to happen. And I see a lot of suffering for families that get left behind when they feel like they should have done something different,” Morgan said. “You grieve the way you’re going to grieve. You let go the way you’re going to let go. I tend to want to be careful about saying, ‘You should do X, Y and Z.’”

Not everyone wants silence or a somber mood when they are dying.

Health care providers and family members can make assumptions about what a dying person would find comfortable, without considering what that person truly enjoys. Some people may desire silence, but others may welcome raucous celebrations.

Smith recalled worrying about a football game party happening in the room of a dying woman until one of the patient’s adult sons reassured Smith that this was her passion.

″[The son] said: ‘Oh, my gosh, she was the queen of football parties every Sunday [with] everybody in the neighborhood. Yes, she loves this,’” Smith said. “I was new in my hospice career and making assumptions about what I thought a dying person would want. I thought they would want a quiet, dark room, and that’s not necessarily the truth.”

Not enough people plan or talk about how they want to die.

Most Americans say that given the choice, they would prefer to die at home, but about 1 in 5 deaths in the U.S. occur after admission to an intensive care unit. In the book “Extreme Measures: Finding a Better Path to the End of Life,” Dr. Jessica Zitter details what she calls the “end-of-life conveyor belt” — a type of care in which dying ICU patients receive painful treatments to be kept at alive at all costs.

“Unfortunately, by the time someone is on the conveyor belt, it’s often too late to talk to them about what they want. And then everybody is trying to play catch-up. And it’s hard to get it right when the chips are down and there’s so much emotion,” said Zitter, who specializes in palliative medicine and critical care.

“So my recommendation is to talk about these issues early on in life, maybe starting when you become an adult. Start to think about your mortality, and visualize how you would want things to go for you when you get into that stage of life, the end stage. Communicate honestly.”

“The people that I notice that have the least amount of distress are the ones … [who] have lived really fully, and that they can say to themselves, ‘I was here.’”
– Ladybird Morgan, a palliative care consultant at Mettle Health.

Filling out forms for so-called advance care planning goes a long way. But “it’s as important that you, number one, identify a person you trust — or two or three [people] — that can honor your wishes,” Sethi said, “and have the conversations ahead of time, before you’re in the state where you can’t communicate your needs and wishes.”

Some hospice workers recommended Five Wishes, an advance care planning program, as one way to get clarity on how you want things to go.

Morgan recommended playing a card game called GoWish with a friend, a partner or someone else you hope will follow your end-of-life wishes. “[The cards] have different statements on them about possibilities of what you might want or not want,” she said. “And you make stacks of the ones that you like, the ones that you know you don’t care about, and the ones that you’re not sure about.”

Someone playing the game may find it difficult to choose which cards represent their values, which is why Morgan suggests having two people play together, so that it can be a conversation starter.

Keep in mind that there is no one right way to die, and preferences may differ.

“There are people who feel that every moment of life is precious and that they value the length of life over the quality of life,” Eichholz-Heller said. “So they are willing to endure a certain amount of suffering to be able to be kept alive. Then there are other people who value quality of life over length of life. And they would rather focus on comfort, even if it means that they won’t live as long.”

There are still a lot of negative associations with hospice care, even though it can be helpful.

There’s a difference between palliative care and hospice. Palliative care workers help to make patients comfortable at any stage of their life if they’re suffering; hospice is a medical service specifically for people with a short-term life expectancy. While anyone living with a serious illness can seek palliative care, Medicare will help cover hospice care costs for people in the U.S. if their health care provider certifies that they are terminally ill and have six months or less to live.

Some people wrongfully assume that going into hospice automatically shortens the life of a patient. Smith said she has been called a murderer for working in hospice care, adding that the worst myth about hospice workers is that they kill their patients.

“People think that when you go on hospice, it’s a death sentence and that death is imminent,” Smith said. She cited former President Jimmy Carter, who entered hospice care in February and is still alive today, as one prominent example of how that is not always the case.

In fact, research shows that seeking palliative care at an early point can improve quality of life. Published in 2010, one study on advanced lung cancer patients found that offering early palliative care on an outpatient or ambulatory basis led to fewer clinically significant depressive symptoms and a longer median survival.

“When patients are suffering, they use so much of their energy just to fight the suffering that if we can make them comfortable, they sort of stabilize,” Eichholz-Heller said. “And a lot of times, it really helps them to live longer.”

Hospices can differ in their approach to care and the additional services they offer. There are resources that can help you figure out the right questions to ask to select the best hospice for you or a loved one.

We can’t control death.

There can also be a misunderstanding about the medical community’s ability to defeat death — even from health care workers themselves.

“The biggest misunderstanding that I see [among] patients, families and even health professionals around the issue of death is that we think we can control it,” said Dr. Solomon Liao, a UCI Health physician in California who specializes in palliative medicine and geriatric pain management.

“We believe that with all of our machines, technology and medications, we can determine when or even if that happens. Instead of accepting death as a natural endpoint of this life, we get depressed and even angry when it happens. We avoid planning for it or even talking about death, and then are shocked when it happens.”

The reality is that we can’t control death ― and we’ll all experience it at some point. “The people that I notice that have the least amount of distress are the ones — not so much that they’ve controlled every element, but that they have lived really fully, and that they can say to themselves, ‘I was here,’” Morgan said. “And people around them can honor that and acknowledge that like, ‘Yeah, we saw you, we felt you.’ … And that was so important for them, allowed a deep relaxing into what was coming next.”

At the same time, it’s OK not to be ready.

Morgan said many conversations around death and dying have focused on making sure someone is ready and not as much on cases in which a person loves life until the last minute and is not ready to go.

“It’s OK to miss life,” she said. She recalled talking to a client about how he knew everyone else was going to be all right after he died, and how that was heartbreaking for him.

In our conversations, hospice and palliative care providers suggested that it’s helpful to keep an open mind about death — leaving space for it to be “both and,” as Morgan told me.

Death can be devastatingly sad, but it doesn’t only have to be a somber occasion, as Smith’s TikTok skits show. Dying may be painful due to a terminal illness, but it’s not inherently so, Sethi said.

“It can be positive and hard,” Morgan said. “It can be, ‘It was exactly what needed to happen, and they had a beautiful death’ and ‘Wow, was that hard to see them go because I would’ve loved to have had them around for 10 more years.’”

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What Are Suicidal Thoughts, and How Do I Cope With Them?

— Suicidal thoughts can feel scary and isolating, but you don’t have to cope with them alone. Here’s how to get the help you need.

Feeling hopeless, trapped, or lonely, or having a mental health condition like depression, are all potential risk factors for suicidal thoughts.

by Shelby House, BSN-RN

Suicidal thoughts — also called suicidal ideation — include wishes, thoughts, and preoccupations with death and suicide, according to StatPearls.

Suicidal thoughts can fluctuate in intensity and duration. They tend to follow a “waxing and waning” pattern, where they’re more intense at certain times and level out — or possibly subside altogether — during others, the authors of the report noted. Sometimes they’re fleeting, passive wishes to simply cease to exist, and sometimes they’re persistent and overwhelming thoughts of harming oneself.

“When such thoughts first occur, they often feel intrusive and frightening,” says Amy Mezulis, PhD, a licensed clinical psychologist and co-founder and chief clinical officer at Joon Care, a mental health care platform for teens and young adults. “For some individuals who struggle with depression or suicidal thoughts for a long time, they can start to feel almost normal,” she says.

The types of suicidal thoughts one experiences can vary from person to person and are considered either passive or active in nature, per the aforementioned report.

Passive Suicidal Thoughts

Passive suicidal thoughts are when someone loses the motivation to live, but they do not have a plan in place to end their life, according to Salt Lake Behavioral Health in Salt Lake City, Utah. “These can be thoughts such as wondering what it would be like to be dead or to not wake up in the morning,” says Dr. Mezulis.

Even though someone with passive suicidal thoughts doesn’t have a plan in place to end their life, these thoughts could eventually progress into active suicidal thoughts and lead to a suicide attempt, per the aforementioned StatPearls report. Passive suicidal thoughts should be taken very seriously.

Active Suicidal Thoughts

Suicidal thoughts are considered active when someone loses the will to live and has a plan in place to end their life, per Salt Lake Behavioral Health.

“Active suicidal thoughts refer to thoughts that focus on methods and plans for dying by suicide,” says Mezulis. “These can be thoughts such as considering different suicide means or making a mental plan for dying by suicide.”

Causes and Risk Factors for Suicidal Thoughts

“Suicide is complex and there is never a single cause,” says Jill Harkavy-Friedman, PhD, the senior vice president of research for the American Foundation for Suicide Prevention. “There are many potential contributors that may combine to create or increase risk.”

Factors that could raise your risk for suicidal thoughts, per Mayo Clinic, include:

  • Feeling hopeless, worthless, lonely, or socially isolated
  • Experiencing a stressful life event, such as the loss of a loved one or financial problems
  • Having a mental health condition like depression
  • Having a substance use disorder
  • Having a chronic disease, chronic pain, or terminal illness
  • Having a history of physical or sexual abuse
  • Family history of suicide
  • Having a family history of mental health conditions
  • Being lesbian, gay, bisexual, or transgender without a supportive family or living in hostile surroundings
  • Having prior suicide attempts

Signs and Symptoms of Suicidal Thoughts

The warning signs that someone may be having suicidal thoughts, per Mayo Clinic, include:

  • Talking about suicide and openly wishing to die or be dead
  • Obtaining the means to end one’s life, such as stockpiling pills or purchasing a gun
  • Withdrawing socially and expressing a strong desire to be alone
  • Having mood swings, such as feeling emotionally high one day but down and discouraged the next day
  • Fixating on death, dying, or violence
  • Feeling hopeless or trapped in a situation
  • Increased drug or alcohol use
  • Changing their usual routine, including sleeping and eating habits
  • Experiencing severe anxiety or personality changes
  • Engaging in risky behavior, such as reckless driving or substance use
  • Giving away personal belongings, drafting a will, or getting their affairs in order when there’s seemingly no logical reason for doing so
  • Saying goodbye to friends and family as if they will never be seen again

How Suicidal Thoughts Affect Your Health and Well-Being

Suicidal thoughts can take a serious toll on your emotional and physical well-being, in addition to heightening your risk of dying by suicide or injuring yourself in a suicide attempt, according to the CDC.

The human brain can only process so much information at a time, says Mezulis. So when a person is experiencing constant suicidal thoughts, much of their cognitive and emotional energy is consumed by them, she says.

“That can be exhausting, both psychologically and physically,” Mazulis explains. “Persistent suicidal thoughts can impact mood and health, contributing to a cycle of negative mood and suicidal thoughts that can be difficult to interrupt.”

The most serious consequences of suicidal thoughts are attempted suicide or death by suicide. People who survive a suicide attempt can be left with serious physical damage to their bodies that can be debilitating or even permanent, according to Cross Creek Hospital in Austin, Texas. The effects can include:

  • Scars
  • Broken bones
  • Hemorrhage, or heavy bleeding
  • Organ failure
  • Brain damage
  • Paralysis
  • Coma

Prevention of Suicidal Thoughts

Suicidal thoughts are often part of a larger issue, such as an underlying mental health condition like depression, substance use disorders, or schizophrenia, according to research. “Treating these underlying mood conditions [or other mental health conditions] can help prevent and reduce suicidal thoughts,” says Mazulis.

But not all people who experience suicidal thoughts have a mental health condition — stressful life events such as relationship problems, the death of a loved one, or eviction can lead to suicidal thoughts, too, according to the National Alliance on Mental Illness. Similarly, addressing those contributing factors (through strategies like talking to a mental health professional about those stressors and finding ways to manage the resulting feelings of distress, for instance) can help lessen suicidal thoughts, too.

Other factors that can protect against suicide and suicidal thoughts, per the CDC, include:

  • Having access to high-quality, consistent healthcare for mental and physical health conditions
  • Developing effective coping and problem-solving skills
  • Focusing on your reasons for living, such as family, friends, or pets
  • Having or developing meaningful connections with others
  • Having a strong sense of cultural identity
  • Getting support from friends and family

How to Cope With Suicidal Thoughts

Suicidal thoughts should always be taken very seriously. Don’t wait to get help for yourself or a loved one who’s considering suicide.

“If you feel like life is not worth living, notice changes in your thoughts and behaviors that make it hard to keep going, or you feel depressed or hopeless, it is important to trust your gut and take action,” says Dr. Harkavy-Friedman.

If you feel like you or a loved one are in imminent danger of suicide, call 911 for emergency help. For immediate crisis assistance from a trained counselor, you can reach the free, 24/7 988 Suicide and Crisis Lifeline by calling or texting 988, or the free, 24/7 Crisis Text Line by texting HOME to 741741.

If you feel you’re not in immediate danger, you should schedule an appointment to see your doctor or therapist to talk about what you’re going through, according to Mayo Clinic. They can help you determine the severity of your suicidal thoughts and come up with a treatment plan to manage them.

Treatment options for people experiencing suicidal thoughts, per Mayo Clinic, may include:

  • Psychotherapy Also called “talk therapy,” psychotherapy involves working with a licensed therapist to explore the root causes of your suicidal thoughts and learn skills to help you manage your emotions.
  • Medications These could include antidepressants, antipsychotics, or anti-anxiety medication if you have a mental health condition. Managing the symptoms of a condition can in turn lessen suicidal thoughts.
  • Addiction Treatment If you have a substance use disorder, getting treatment for it can reduce suicidal thoughts. This could include detox, addiction treatment programs, or self-help group meetings.

Along with professional treatment, practicing self-care can help you feel better and can reduce thoughts of suicide over time, says Harkavy-Friedman. Some self-care strategies that can help are getting regular sleep, exercising, eating a nutritious diet, spending time with friends and family, and making time for things that bring you joy, she says.

You could also reach out to family members, friends, or members of a faith community, for instance, when you feel like you need support. Having a strong support system can help lower your risk for suicide, according to Mayo Clinic.

In addition, it could help to reach out to one of the suicide hotlines described above, even if you don’t feel like you’re in immediate danger. A trained crisis counselor can offer free and confidential emotional support and connect you to resources that could help.

Resources We Love

American Foundation for Suicide Prevention (AFSP)

The AFSP is committed to raising awareness about mental health and suicide, and funding research related to suicide and suicide prevention. They offer specific resources for anyone who is experiencing thoughts of suicide, has survived suicide attempts, has lost a loved one to suicide, or is worried about someone else with suicidal thoughts.

988 Suicide and Crisis Lifeline

The 988 Suicide and Crisis Lifeline provides 24/7, free, and confidential support for people in distress, suicide prevention and mental health crisis resources, and best practices for health professionals in the United States. Dial 988 to speak with a trained crisis counselor who can help you if you or a loved one is experiencing thoughts of suicide. They also have a chat tool for those who are deaf or hard of hearing or who may otherwise prefer a chat option.

National Institute of Mental Health (NIMH)

The NIMH is the lead government agency for research on mental health conditions. It provides a “Suicide Prevention” resource for people experiencing thoughts of suicide or for their loved ones.

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