A San Francisco psychiatrist and mental health consultant has written a comprehensive resource and educational guide on suicide risk, the concept for which was inspired in part by the youth suicide clusters in Palo Alto.
"Suicide Risk in the Bay Area: A Guide for Families, Physicians, Therapists & Other Professionals," released Wednesday, Oct. 14, lists more than 300 local and national mental health resources that are interwoven with educational information about how to talk about suicide, statistics, narratives and explanations of the various elements of the mental health continuum, from hospitalization to outpatient programs.
Author Eli Merritt, who completed his psychiatry residency at Stanford University and lost his mother to suicide, sees the book as more than a resource and care navigation guide, but as a "public health initiative," he said in an interview. Woven throughout the book is a recurring call to action: "talk about it."
"Good listening, empathy, love and connections stand together as a powerful gateway to suicide prevention," Merritt writes. "It's not the only pathway we have to save lives, certainly ... But it is infinitely the most important and the most overlooked."
The book was born of a mix of professional and personal experiences, including his mother's death by suicide, a young-adult patient who died by suicide in 2008 and the recent youth suicide clusters in Palo Alto, Merritt said.
Before moving to San Francisco, Merritt operated a private practice in Palo Alto and also taught at the Stanford Department of Psychiatry.
Patients and others affected by suicide have told Merritt that the thing that has made the "greatest difference" in their lives was friends and family simply broaching the subject with them, he said in an interview. The book offers step-by-step instructions on how to talk about suicide risk, which begins with "ask," and progresses to "listen," "validate" and "keep listening."
Part of the fear around talking about suicide risk, Merritt writes, "stems from the mistaken belief that talking about it risks planting ideas or opening doors to dangers."
"We have to recognize that there are obstacles to talking about it in a complex way that's even a little paradoxical," he told the Weekly. "It's by talking about it in a courageous way that we actually work through the same fear."
In the book, Merritt urges teenagers, adults, friends, family members, teachers and mental health professionals alike to move beyond this misperception, and also the idea, particularly among parents and health professionals, "that you are supposed to respond to a problem suicide risk with a solution."
"Listen. Empathize. Validate. These constitute a matchless triad," Merritt writes. "Don't be strong. Don't instruct. Don't fix anything, especially feelings."
The book includes several references to the Palo Alto area, both local resources and anecdotes. Kara, Adolescent Counseling Services and Project Safety Net are among the myriad of organizations listed. Merritt also includes pieces of a guest opinion piece published in the Palo Alto Weekly in March that went viral, "Keep Calm and Parent On" by Palo Alto parent and psychiatrist Adam Strassberg,
The introduction also includes a story about a Palo Alto father who called Merritt for advice on how to best support his 16-year-old daughter who had recently been hospitalized for suicidal ideation.
In 2014, Merritt founded his own consulting practice, Merritt Mental Health, to help families like this one navigate the mental health system, which he describes in the book as a "fragmented 'non-system' of potholes and pitfalls that adds stress to the lives of those seeking care long before it helps them."
The book offers at least a beginning road map for others to navigate that system, with chapters on mobile crisis services, emergency departments, hospital inpatient units, crisis stabilization units, clinics, dialectical behavioral therapy and bereavement resources, among others.
Merritt sees the book as "a beginning of a movement, not as the end of a research project," the introduction reads. He envisions future versions replicated throughout the country "Suicide Risk in New York City," for example, and plans to also expand and update the Bay Area edition.