Bay Area psychiatrist pens comprehensive guide on suicide risk | News | Palo Alto Online |


Bay Area psychiatrist pens comprehensive guide on suicide risk

New book comes with a call to action: 'talk about it'

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.

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Like this comment
Posted by Misha
a resident of Midtown
on Oct 15, 2015 at 1:35 pm

Where can we find this book? Is it in the local bookstores?

3 people like this
Posted by Old Palo Altan
a resident of Gunn High School
on Oct 15, 2015 at 2:41 pm

It's available on Amazon Prime for $14.95. Just ordered it.

1 person likes this
Posted by Eli Merritt
a resident of another community
on Oct 15, 2015 at 2:49 pm

I look forward to your comments on the book.

7 people like this
Posted by Don
a resident of Palo Alto Orchards
on Oct 15, 2015 at 4:21 pm

When I was suicidal I reached out and the authorities took me to a so called hospital where their main concern was what kind of insurance I had. They stashed me in a room with a stranger even after I informed them of my ptsd condition. I believe they treat folks badly on purpose so they learn not to ask for "help" again.Suicides are increasing; sadly; but in a heartless world that seems logical.A study put out recently stated that people who are in er rooms or psych wards have a greater risk of self harm and suicide than before!I do wish teenage suicides could be stopped; but; how?

2 people like this
Posted by Word
a resident of Palo Alto High School
on Oct 15, 2015 at 7:37 pm

"Listen. Emphasize. Validate. These constitute a matchless triad."

Was that supposed to be "Empathize"?

1 person likes this
Posted by Sarah1000
a resident of Los Altos
on Oct 15, 2015 at 9:26 pm

Thanks Dr. Merritt. I preordered your book a couple of weeks ago and have received a notice that it should arrive by Monday. We commute to San Francisco for my 18 yr old son's mental health services so I'm looking forward to learning more about available services.

6 people like this
Posted by Heart
a resident of Another Palo Alto neighborhood
on Oct 15, 2015 at 10:34 pm

This sounds like a really helpful guide.

I hope someone will buy a copy for the PTAC, because they absolutely shut down any soul searching or connection parents were trying to establish on parent lists with each other after suicides last year. The parent lists didn't even have children on the lists. PTAC reasoning was that the experts made them do it. Much later, an expert wrote some about how important talking is, but the damage was done. After tragedy hits, one of the side effects is mobilization in affected communities -- but timing is everything -- it was almost like someone benefited from putting a stop to it. Sadly, the kids lost for it.

I hope there is no cause to ever have to go through that again, though.

6 people like this
Posted by Susan Usman
a resident of Triple El
on Oct 16, 2015 at 6:11 pm


PTA sponsored secondary school Parent Network Groups PNGs were created for pushing grade specific information out to parents and to build community by organizing face to face meetings as our children naturally start the process of independence. They were never meant for discussions especially political or emotional conversations. When we were suffering during the suicide cluster last fall, 100s of people were commenting, making it impossible for the moderators to keep up with the posts and remove any that weren’t appropriate. These on-line conversations were becoming increasingly unhealthy and unproductive. I made the decision that they needed to go on “information push out only” status so we could still post resources and meeting dates and times. I had the full support of our local mental health experts at the HEARD Alliance. I recently attended a workshop given by Dr Madelyn Gould, a national expert on suicide contagion and media coverage. In today’s world, everyone’s electronic posts are considered media coverage. She too agreed that conversations or posts on several 100 person email groups is not a healthy way to express our grief, fear and anger. Please see the Weekly on-line article about Dr Gould’s workshop. Web Link
The Gunn PTA and Gunn Administration did a fantastic job of organizing face-to-face parent gatherings both during the day and at night with mental health professionals in attendance for support and resources. Both high school PTAs offered in person suicide prevention trainings. PTA Council is all about child advocacy and parent education and connection– especially face-to-face connections that build community – even during the toughest of times and having hardest of conversations.

2 people like this
Posted by Heart
a resident of Another Palo Alto neighborhood
on Oct 17, 2015 at 10:41 am

I appreciate your intentions, and I don't know about other schools, but our parent list (not Gunn) was shut down after a handful of posts. It's true not all were helpful, but cutting off the soul searching and parents coming together online had an overall negative and chilling effect. Some parents from countries with oppressive governments felt especially bad for it. Our school had no such in-person community gatherings. Even though we knew one of the students, there was no support at our school, only antagonism as if any talking about it through existing student networks was tantamount to pushing someone over the edge. It made it seem like talking about it was bad. These articles paint a different picture.

Perhaps the parent lists were not created to be a place where families soul searched about another cluster of student suicides, but why would anyone expect such a thing or have such a list? Desperate tomes call for desoerate measures. The existing means families had of reaching out to each other should have been left alone except in perhaps the case you mentioned.

("Advocacy" usually entails more than just the easy or noncontroversial. Advocacy usually entails having to push for the right thing when all other forces are against. That is not something I would ever describe PTA or PTAC locally as engaging in in all my years here. I've seen far more true advocacy among parents trying to get PTA out of inertia. With PTA locally, the actions usually havent measured up to the talk, though I think individually it's full of good people.)

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