Episode #88

Guest: Dr. Kristin Tugman

“Breaking down 7 Myths about Student-Athlete Suicide”

[00:00:00]Stef Strack: Welcome to a special episode during our suicide prevention month series of the voice and sport podcast, featuring Dr. Kristin Tugman because we are gonna be talking about suicide prevention. We wanna share a trigger warning. If you or someone in your life is struggling with suicide, you can call the 988.

National suicide lifeline and reach out to a mental health resource or counselor doctor or any expert on the vis platform. Please know that you are not alone recognizing that it is suicide prevention month. We are incredibly grateful to have Dr. Kristen Tugman join us in busting seven common myths about suicide.

Kristen Tugman is currently the vice president of health and productivity, analytics, and consulting practice at prude. She recently started a nonprofit organization in Maine called community action for mental health. She has our bachelor's degree in sociology from the university of Florida, a master's of science in rehab counseling from Georgia state and a PhD in industrial and organizational psychology from Capella university.

Kristen has a passion for bringing awareness to mental health, and we're so excited to have her on the podcast today.

Welcome to the voice and support podcast. Kristin, we're so excited to have you here with us today. Your background is absolutely incredible. And you just started your own non-profit that focuses on mental health and suicide prevention.

So we have a lot to talk about today. But let's begin with really your sport journey because we know that you also played tennis and soccer in high school. We would love to just start with your own experience that you had with mental health in sports at a very young age.

[00:01:38]Kristin Tugman: Oh, wow. Yeah. When I think about my own sport journey, tennis was definitely my sport. Soccer, I would say it was sort of almost an addiction. I couldn't give it up. And so I. Definitely played both along the way. I focused that was certainly more tennis. But when I think about mental health in sport, then, you know, I think we've come a long way because we did not talk about mental health.

As it related to sports, you know, I'm generation X we, really talked more about mental toughness. No pain, no gain.

you know, and it was, it was all about drive and motivation, nothing about mental wellbeing.

[00:02:14]Kristin Tugman: So I'm glad that we've turned the conversation. I think a lot of it was, my generation kind of thinking through how we went through.

Our own mental health and mental wellbeing journeys, and we didn't talk about it. And so we've tried to give our kids, I think, permission to have that conversation. I remember when I was in school, it wasn't like it didn't exist. We just didn't talk about it. We whispered about. I can think of a friend who clearly had major depressions.

She had some self-harm tendencies and we as a friend group really just tried to support her. And we worried about telling her parents I had a friend who had an eating disorder and nothing happened for treatment for her until she collapsed. And I had a friend who had substance use disorder and nothing really happened until she got expelled from high school.

And so, I think we've come a long way, but we do have a long way.

[00:03:05]Stef Strack: Absolutely. And I'm so proud that we've moved forward as a society to speak more about the mental side of who we are as humans, because it's not just about the physical component, it's both. And I think we're both aligned that we're trying to keep them on the same field, the same playing field.

And we want our young daughters to realize. Both are equally important and you have a young daughter yourself. Who's a division one runner and also of his creator I might add.

And so as a mother, and somebody who's spending a lot of time in this space, what do you wish that you could whisper to your younger self today about the importance of mental.

[00:03:42]Kristin Tugman: Yeah, I think we put so much pressure on ourselves and, we think about mental health. I think, when I was younger, I thought about. Almost mental illness, which is a term that we've moved away from. We talk about mental health conditions. And I thought I had this picture of what it would look like, and I didn't necessarily think about maintaining my own mental wellbeing.

And as I thought about my life journey, In my mind, very linear and that can set us up for disappointment and ultimately anxiety and depression when things don't go exactly in that linear path that we picture. I think what I would say to my younger self is. Life is not linear and really the beauty in our accomplishments and our relationships come from the zigzags and the left turns.

And that's where we learned the most and that's where we get to where we're supposed to be. So I think that's what I would, whisper.

[00:04:35]Stef Strack: I love that. Well, I hope all these young girls today, listening to this episode and in our community here, that same message. Because it is so important to be talking about mental health and wellness in a way that is part of who we are. Not in a. Connotation, but just the name change, like you said, mental illness.

No, it's not. Let's, pivot that thinking and that narrative and that really is all about what our episodes about today is. We're going to go through and kind of talk about the myths and the misconceptions around suicide that influence how people view those struggles.

And I think it's going to be really important. So I'm excited to shatter these with you today and give the girls in our community, the resources to help themselves. So let's start with the first myth. I Would love to hear kind of your response to each myth. So I'll say the myth and then you can walk us through a different way to think about this.

Okay. Myth, number one, you shouldn't talk about suicide because it will lead to suicidal ideations in others.

[00:05:36]Kristin Tugman: Yeah, that one frustrates me almost, I would say the most. Because it, is in fact the most dangerous and I'll be very Frank in saying that if we don't talk about suicide, more people will. That's the most important message there's a lot of stigma attached to suicide, a lot of shame attached to suicidal ideation.

And if we don't give folks the permission to talk about it, those feelings will only continue to escalate. So we've gotta be willing to ask the question. We've gotta be willing to give people permission to talk about it. That is absolutely false. By talking about suicide and asking someone, if they're having suicidal thoughts, we will not perpetuate their thoughts and we will not put suicidal thoughts into others.

[00:06:19]Stef Strack: And where do you think that has stemmed from this myth that if you talk about it, it's going to happen.

[00:06:25]Kristin Tugman: I think it's fear. Suicide is very scary. How many times have you probably in your life, I know many times in mind seen an obituary. That's very vague where, somebody died unexpectedly and we all suspect that person may have died by suicide, but we don't talk about it.

We don't try to understand what happened. We don't try to support the survivors in the way that they need to be supported. And so we've perpetuated that stigma to the point where people are afraid to talk about it. I also think it comes from a small phenomenon that we're folks talk about cluster suicides, and we worry that, especially in a high school setting or middle school setting if one person dies by suicide, that others will follow, but there's ways to talk about it in a way that's healthy in a way that Projects, the right messaging around that this person was suffering greatly and they felt like there was no other option than to take their own life.

And you are not alone. We've just got to make sure that we educate folks about what to say, how to talk about it after the fact. And we've frankly, we've got to talk about it or more people that.

[00:07:32]Stef Strack: Absolutely. Well, thank you for, sharing that. And also just being so direct. I think this is why we're doing this episode, right? So

myth number two, Suicide only affects those with existing mental health conditions.

[00:07:47]Kristin Tugman: Yeah. So there's a couple of conflicting statistics actually that you'll see out there. One from the centers for disease control, that talks about 54% of all people who died by suicide have no known mental health diagnosis. And then you'll see from organizations like the American foundation for suicide prevention national Alliance for the mentally ill, I believe that 90% of folks who die by suicide have mental health diagnosis.

So, those statistics are confusing. The 54% is Based on statistics that are a little more superficial. So when somebody's death is designated as a suicide, there can be a quick sort of look at records, a quick question to family members. At the time of death, it says, does this person have an existing mental health?

It's nowhere near in depth as the 90% figure, because it's just a quick check of the records. And so that statistics suggest 54% of folks don't have a known mental health diagnosis that can show up in a medical record. The 90% is actually as a result of a psychological autopsy, which is a little bit more in depth after the fact of an individual being deemed having died by suicide.

And it's actually interviews with family members. It's really an in-depth interview with any treating providers. And so while, the individual might have a medical record that says that there was a mental health diagnosis based on that more in-depth investigation, it's highly likely there was in fact, a mental health diagnosis.

So when you think about suicide and having a mental health diagnosis, it's ultimately folks that feel a sense of unbearable pain. It is likely that there is a mental health condition that is resulting in that sense of unbearable pain. It doesn't mean that we can all see it.

It's not going to be necessarily overt and every case. And that's why we wonder if, things like the suicide happened out of the blue. It's highly likely that most folks who died by suicide do have a mental health condition. It just doesn't mean that we can readily.

[00:09:46]Stef Strack: So that really leads me into myth. Number three, which is only sad and lonely people commit suicide.

[00:09:55]Kristin Tugman: Yeah, again, it's not necessarily overt that you can see it, written all over somebody you know, folks doing a good job of, having their external selves and internal selves, I think, especially in sport, where. Many times athletes are expected to be tough and have a tough exterior or they don't want to necessarily show that they might be struggling because they don't want to disappoint their teammates or they don't want to disappoint their coach, or they don't want to be sidelined.

So it becomes really scary that stigma around it. But the other piece I would highlight is, there's a lot of research right now on loneliness. And so when you say sad, lonely people, when you think about lonely people, right? You think about folks who don't have a network, they don't have parents, they can count on, they don't have a team that they can count on.

And really, what we're finding around loneliness is that it's not about the people that are around you. It's about feeling like no one understands. Michael Phelps actually talks about loneliness for his mental health condition. That that's really the precursor for him, that he starts to feel like nobody understands my burden and that is the warning sign to him that he's headed down the path of, having depressive symptoms again.

So I think that loneliness piece is really important.

[00:11:11]Stef Strack: Well, and that just brings, to the forefront, why it's so important if building community, right. And this is a big thing of what we're doing at voice and sport is creating a safe space for young women to come and talk to other people, talk to experts, but just not feel alone. And I think that's really, really critical. So myth number four. Once someone has suicidal thoughts, They will always be suicidal.

[00:11:36]Kristin Tugman: Yeah, that's definitely not true. Treatment works. We are really the linchpin and the scary part of this mental health crisis that we're all facing is that we don't have proper access to care. 12% of therapists right now are accepting new patients. on top of that suicidality for a lot of therapists is it's scary to think that you could lose a patient to suicide.

And so there's therapists that specialize in crisis intervention, there's therapists that specialize in suicidality and self-harm. And so if you think about 12% of therapists are accepting new patients as a whole, it is hard to get to that specialty. But people that go through. Get better.

And 80% of folks with major depression who get proper care get better. And so there is hope. I think we think about it almost deviously that this notion of suicidal ideation or self harm, or we're actually now shifting a little bit in our language to call it sort of suicidal intensity.

Where are you today from feeling like you either want to die or you want to engage in self harm. What's the intensity of that emotion so that we can really get at it and put together things like a crisis response plan, but in general therapy, sometimes that doesn't happen and, folks can get really frustrated.

And, a lot of times drop out of care. But if we get proper care things, get.

[00:12:57]Stef Strack: so if you are somebody who's listening to this right now and are having suicidal thoughts, what is the best first step to do?

[00:13:07]Kristin Tugman: Absolutely seek care. As much as we talk about. Access to care is tough. Use your resources. We think about women in sport, you, do have a community talk to your, trusted resources, talk to your coach, talk to your trainer talk to your parents. Whoever it is that, you trust enough to share what's going on. That's really the first step is to talk to somebody about what's happening so that we can get you the help that you need at the time that you.

[00:13:37]Stef Strack: What kind of goes back to the first myth. Right. And don't be afraid to talk about it because it's not going to lead to. Others having suicidal thoughts. And I think that it's only going to lead to hopefully a path in which you get to a better place. So that's really critical. Thank you.

So myth number five. Once someone decides to take their life, they will always find a way to do it regardless of what other people in their life do to help.

[00:14:07]Kristin Tugman: Certainly not true. So when we think about Access to lethal means is important. And I think we do sort of have this connotation that when somebody makes the decision to die by suicide, that they will die by suicide but in reality, when we talk to suicide survivors, They did not want to die by suicide.

They didn't want to die at all. They just believed that was their only option. And so I think it's really important to understand suicide. The way my brain works is I would really like to understand the problem and sort of the inner workings of it. And so when we. Now look at the research suicide is sort of made up of three components.

The latest research suggests that it's really this sense of an overwhelming sense of burden that my family, my friends, my loved ones would be better off without me. It's feeling like I don't belong. And then, we all have this innate sense and fear of pain and. And it's about overcoming that. And so there's this we call it fearlessness.

That's why folks that have been trauma victims. That's why veterans actually have more an ability to get over this innate fear of pain and death, and that leads to fearlessness. And so ultimately that's sort of the combination that leads to a suicide attempt.

The point is most people think that that's their only option. And again, access to lethal means is important. I'll just tell you a quick study that was done in Washington DC, about two bridges where the suicide rate was pretty high for both of these bridges. And they were across town from.

So they were sort of different funding, right? So one had the funding to put up guardrails to prevent folks from being able to jump off of that bridge. The other one did not the one with the guard rails. The suicide rate at that particular bridge went down. Now, keep in mind, this other bridge was just across town, but the suicide rate on that bridge and.

So that means that one folks pick a lethal means they tend to stick with it. And that's why it's so important to ask the question, are you feeling like you wanna hurt yourself or that you want to die by suicide? And do you have a plan? We talk a lot about gun control and making sure that, folks have a safety plan related to any access to.

So again we can intervene and, and it's never hopeless.

[00:16:36]Stef Strack: What about Ms. Where we've heard people say in comments, suicide is selfish.

[00:16:45]Kristin Tugman: Oh, that's like the one that. Most infuriating to me. So if there's one myth that you can take away today, don't ever tell somebody that they're selfish for thinking about taking their own life. I talked about those three components and it's, really an individual who feels like they have no other option and that everyone else around them would legitimately be better off.

It's not selfish. In any respect of the act. It's almost selfless. Where, folks think they're doing their loved ones have favorites. It makes it extraordinarily sad, but it's not selfish.

[00:17:19]Stef Strack: And then our last myth is myth. Number seven. Suicide happens out of the blue.

[00:17:25]Kristin Tugman: Generally there are signs. And that's not to say that folks missed it and they made a mistake. And when somebody dies by suicide, there was something that somebody should have done or should have said. But that's why we have to talk about.

We have to be able to ask the question. We have to be able to open the dialogue and have open communication. Generally, there are signs folks become withdrawn. They become irritable. \ they're not themselves, but our brains are very sophisticated and we have very sophisticated coping mechanisms.

I'll give you a quick example. I had a close friend this year who passed away not by suicide by. Of cancer, but I was able to go visit her before she died. And my own coping mechanism was that my brain would not register that this was the last time I was going to see her.

And so we had a very lovely visit, but I found myself sort of in denial and almost feeling like I wasn't necessarily there. I give that example because think about, if you've got a close friend, a loved one, your child who, has signs of being withdrawn or irritable, or even giving things away and talking about like there's no future.

It's hard for someone's brain to really allow themselves to decide that yes, this person, as at risk for dying by suicide, which again is why it's so important to have the open lines of communication and feel like it's something that we can easily talk about just as we would ask about a physical.

[00:18:52]Stef Strack: Well, now that we've shattered a lot of these myths I really want to talk about how do we help all of our amazing young women here at voice in sport? You know, talk to their friends, have conversations, navigate hard conversations of maybe somebody coming to them. Let's help them figure out how to have those conversations because we just broke the myth at the beginning here that it is important to talk about it. I think because we're still uncomfortable as a society to talk about suicide. Don't know how, so I want to talk first about navigating the conversations with somebody within your community or your team you feel like is at risk. And maybe it's because you've noticed some of the signs that you just called out. How can you have a conversation that will help that young.

[00:19:40]Kristin Tugman: Absolutely. So don't be afraid to have the conversation ask the question I've known. That you've been a little bit withdrawn. is there something I can help you with? Are you okay? We spend a lot of time worried about again, physical illness and I don't know if you've heard of Kevin Heinz, he's a suicide survivor.

And I think his story and his message is so powerful. He was 19 years old. Felt like his only option was to die by suicide. But when he got on the bus the golden gate bridge, which is eventually where his suicide attempt was where he jumped off the golden gate bridge, he had a pact with him.

And he said, if anyone shows me any signs of compassion, I won't do it. And so he's on the bus and he's crying the whole way. And nobody says anything and he goes to get off the bus and the bus driver calls him back, but really sort of trying to get them to get off the bus so we can move on to his next stop.

And he's on the golden gate bridge and somebody comes up to him and he said that he thinks to himself, this is it. This person's going to ask me if I'm okay. And the person asks if he would take her. And he jumped off the golden gate bridge. And what he realized in that moment was the only thing he couldn't change about his life was the fact that he had just jumped off the golden gate bridge and made a mistake.

But his message going forward has been, we do not treat physical illness and concern as we would treat mental wellbeing. Right. If we in public and we see somebody crying, we tend to take away. If we see somebody on the field or getting ready to go into the game and it's clear that their knee is bothering them or they have a back injury, we're going to say, Hey, should you really be going in?

Or are you doing okay? And we've got to get ourselves to a place where we recognize that it's okay to say, Hey, I've noticed you seem upset. Are you okay? Is there anything that I can do? And we've got to work diligently to do that while at the same time, it is scary. Suicide again is scary.

Talking about mental health is scary. It's uncomfortable to be around somebody who's upset. But we've gotta be able to also think about. Making that leap to mental wellbeing and physical health being equal, but we've also gotta be mindful of our own self care and make sure that as we commit to asking the questions, we've also got to make sure that we have something set up for ourselves and we recognize, I always say self-awareness is at least 50% of the.

How are you feeling about having just talked to this person or what's your anxiety level about having to go in and have this conversation with this individual? Who do you need to debrief with after who are your trusted resources? Is it your coach? Is it your trainer? Is it a counselor that, you know is it a family member?

Really, we all have to think about who's. You know, we're all at risk in the end. And so we want to make sure that we know who to go to and we can manage our own self care ongoing while we support others.

[00:22:29]Stef Strack: Well, I think you really nailed the, the next question that I wanted to ask, which was about making sure you take care of yourself too. Right. But I want to go a little deeper, on the conversation again. I think starting it with a question. Sounds like one key piece of advice here about something that you noticed.

And then, is there anything else that you don't want to say? Is there things you want to stay away from seeing? Sometimes it's also not about just saying the right thing, but it's about not saying something that you feel like will be actually worse for the person.

[00:22:59]Kristin Tugman: Right. Things like tomorrow will be a better day. Look at all the things that you have going for you. Everything's gonna be okay. It's really making sure that we're validating what's happening for that individual and taking them seriously. And not just pointing out to them, all the things they should be grateful for because, if they could do that, they already would have, and, they would be doing okay.

So you know, I think a lot of times what happens is we do want to point out to folks, Hey, you know, your parents are so great or you're so talented or your grades are so good. And that actually will invalidate somebody's feelings.

[00:23:36]Stef Strack: So, how do you validate somebody's feelings then? What's the language use.

[00:23:42]Kristin Tugman: It's really more about listening, you don't have to solve it. make sure that the person feels heard again, I've noticed you've been withdrawn lately, or you haven't wanted to go out like you used to you know, what's going on.

I actually always say if you're thinking it and it's appropriate, it's okay to say a lot of times folks don't want to talk. You might sit in front of somebody. I would say, I'm a therapist I'm really comfortable in silence. But you know, if we don't have that training, it can be really uncomfortable.

And just to say, it's really hard to talk about, so just know you're not alone. And when you're ready to talk about it on. And sometimes that can make all the difference. It doesn't have to be this life-changing conversation. a lot of times it's just really about letting people know that they're not alone.

And that they have support

[00:24:28]Stef Strack: so having responses, like I hear what you're saying, or it sounds like you're really having a difficult time with this is a way in which to show the empathy and that you're listening.

And we talk a lot about this when we train our mentors at voice and sport, you're there to

listen and support them and make them feel like they're not alone. So it's great to kind of hear, similar advice here, because I think as humans, especially as like teammates, we want to be there to help the other person. And often that. I feel like I have to come up with a solution. I have to figure it out and fix it myself. Right. And I just don't want any girl out there thinking that that is their role when they're having these conversations.

[00:25:11]Kristin Tugman: Absolutely. And it's highly likely that the person doesn't necessarily want you to say. I've learned that with my own daughter we have conversations and, she's has a problem with something you really kind of want to take a step back and say, okay, are you looking for a solve or are you just looking to vent?

A lot of times people just need to be heard and they need to have their feelings validated. And that goes a long.

[00:25:33]Stef Strack: Well, let's go a little bit deeper into girls because unfortunately suicide attempts in young girls specifically ages 12 through 17, started to rise in may of 2020 from February to March of 2021 visits to the ER, due to suicide attempts, rose and girls about 50.6% as compared to that time of 2019. Boys that only increased by 3.7%. So what, what do you think is driving this large increase? For young girls and what do we need to know?

[00:26:05]Kristin Tugman: Yeah. I think we have to think about, you know, we go back to the fundamentals around, this unbearable pain where young girls feel like this is the only answer. And so, ultimately we've got to get ourselves to a culture That intervene sooner. I think a lot of times we do wait. Talking about mental health is uncomfortable. Talking about suicide is uncomfortable. 12% of therapists are accepting new patients. And so if we continue to wait for folks to need therapy and to be in crisis we're never gonna have enough therapists. It's gonna take time, but it does come down to creating A culture that talks about mental health and mental wellbeing from the time that we're young.

And one of my favorite quotes actually is from Desmond Tutu. And it actually helps me wrap my head around how we can solve for this crisis, which is we have to stop being satisfied with pulling them out of the river. In fact, we have to go upstream and try to figure out why they're falling in, in the first year.

And so it's about that foundation of equality between physical health and mental health. You've got to start these conversations young and then create the infrastructure necessary to have the next level of support. So we talked a lot about peer support, so it is education normalizing mental.

Creating opportunity for peer support and then maybe less folks get to this place where they need therapy. And we have enough therapists to meet the need and there will always need crisis intervention, but again, it comes down to education and making sure that folks understand that it's okay to raise their hand.

Over time, if you think about young girls in general, there's been certainly added pressure. You think about social media you know, I think about their generation as being sort of brand managers. I know I would not have been able

handle it.

I've frequently told the story of when Kate, when she was young, she was still so having to sit in the back seat and I was watching her take selfies in the rear view mirror, and I said, wow, how many selfies are you going to take? And she said, mom, until I get the right one.

And then she launched into all of the rules of social media around how many likes she had to have in order to keep the post up, how often you can post a selfie, what time she needed to post that selfie in order to get the maximum likes. And I know for myself, I would have been in my bedroom in the corner, probably rocking if I had to manage all of that for myself, for my.

And so the demands on, young women are much different in that generation. It's the social media, it's the need for perfectionism to Excel in both academia and whatever extracurricular. And obviously we're talking about sport. So it starts very, very young, this whole notion that there's this perfectionist expectation around how they're going to achieve.

And it gets back to life is not linear. But we teach them that perhaps it is, and we've got to continue to achieve. And if you don't achieve in that linear fashion it's a failure. I think we've got to shift that discussion and talk about the pressures that they're under.

Ultimately when they get to the, division one NCAA and they've had that singular goal to get to that place, the pressure is just immense.

[00:29:17]Stef Strack: I want to dive a little deeper into that pressure for girls, because I mean, the stats don't lie and I'm a mom of a young son and a young daughter, and I'm sitting here thinking, gosh, what is it that is causing so many more young girls to attempt suicide. And as a mom, as a friend, as a teammate coach, what do we need to do to really make sure that this doesn't continue to rise for young girls? And I totally agree with you that social media and the impact of pressure is placed on young women, but why

is it that the young women are having a harder time?

I mean, they're so young, we're talking to you about, you know, this starting around 11 and 12 years old. And so

Can we do as a society or even in our small world, as a mom and a dad, to make sure that for our own young daughters, that, it's more equal, for the boys and the girls in this scenario.

[00:30:11]Kristin Tugman: Yeah. I mean, I think we've got to have the conversations. I do think it starts with coaches too, to your point, it starts at 11 or 12 even younger you know, seven or eight, they're trying out for the travel soccer team and they may or may not make it And that can shift their sense of self and sense of failure and sense of success immediately.

I sound like a broken record, but we have to talk about mental wellbeing just as we would talk about physical health. I think we have to do it in our homes. Parents, a lot of times don't know what to say or how to bring it up.

If your child isn't communicative, sometimes it's easier just to let the kid go upstairs and know that they're doing their homework and they're they're doing sort of what they're supposed to be doing without taking.

Added step to have the hard conversation. I think about the difference between girls and boys and girls, a lot of times are more conscientious. So, if you're in a family where you've got a boy who's kind of rambunctious getting in a little bit of trouble that seems to be more acceptable.

And you've got a girl who's in their room being quiet, doing what you perceive they're supposed to be doing. Maybe they're not, getting the intervention at the time that they need it. So we've had to just think about it differently and educate parents on how to have these conversations young.

[00:31:26]Stef Strack: Let's talk about that. Like how young is too young to have a conversation with your young daughter how do you even approach that? How do you approach your daughter?

[00:31:37]Kristin Tugman: Yeah, absolutely. I mean, I think you think about really young ages starting them, the mental wellbeing conversation, young you know, in kindergarten

[00:31:47]Stef Strack: And how does that look? What does that look like? And sound like.

[00:31:50]Kristin Tugman: You're never too young to start to think about, your feelings. How are you feeling today, or were you embarrassed by that?

You seem sad. Tell me more about that too. When a kid is crying, our immediate instinct, right. Is to just get them to stop crying and not necessarily deal with what it was that was happening, that surrounded that emotion.

So if we can make sure that from a very early age, in my view that we normalize emotion and talk about. Where it's coming from and how to manage it effectively. We're going to be in a much better place. Talking about suicide, it is scary. But we're seeing it happen at much younger ages.

We saw it double from between the ages of five and 11 during the previous 10 years. And that was suicide attempts between five years old and 11 years. So it's never too early to talk about the finality of death to talk about the emotions and talk about what's happening for a child so that they feel like they have a safe space.

That's really the key is to make sure that all of us as humans from the time we're old enough to comprehend that we have a safe space to be who we.

[00:33:09]Stef Strack: So, this happened to me because, we're creating this series on suicide prevention to talk about it, to have more conversations, right. And my kids overheard me say suicide, and they didn't know what that was.

And they asked me, mom, well, what suicide? You know, what, what is the best response? And these are we're talking young kids, right? So six, six to nine years old.

[00:33:32]Kristin Tugman: Kids find out. I'm not a child psychiatry or a psychologist but from what I know in the research I've done and the experts that I've talked to suicide is when someone feels so sad that they feel like they want to die and , they take their own life.

I actually was on a webinar with an expert Not too long ago, who talked about a very similar situation, where there was a family member who died by suicide. And the kids were very young and they hadn't really talked about what had happened. And finally, the kids said, Hey mom, I know what happened to let's just say uncle Joe.

And she said, oh, do you? And he said, yeah, he killed himself. And she said, Yes, that's accurate. And he said, that's very sad. And she said, yes, it was very sad. And he just wanted her to be honest, and then they could have a conversation. So kids find out and the best guidance is to just be honest and talk to them about the reality and let them know they're not alone.

And if they ever have feelings where they feel so sad or they feel sad at all that you're there to help.

[00:34:38]Stef Strack: Well, where do the athletes, particularly the student athletes in college fit into this demographic and all these facts, because over the last year, there have been unfortunate lately. Several people who have died by suicide in the student athlete community and. I'm just curious to know if there has been a shift in these statistics. And then what is it that we can do to make sure that there are better and more resources for student athletes in college?

[00:35:06]Kristin Tugman: Yeah I wonder if some of it's reporting because there is certainly a spotlight now on mental health and I think that's absolutely a good thing. I think the pandemic and I mentioned the statistics back in 2018 and have allowed us to sort of shift our mindset. And folks are taking mental health more seriously and we're moving away from the stigma.

I don't think that the statistics necessarily have drastically gone up as of late. But as we think about college athletes and all the pressure that they're under it does put them at risk in terms of.

Not feeling like I get to say that I'm not okay. We've talked about, it's got to start with coaches early on and saying that it's, it's okay to talk about the pressure it's okay. To say that you need something and too often it's suck it up. No pain, no gain.

So there's this culture of not talking about mental health that we've got to shift that culture. And then, I always worry about the singular goal. Athletes, especially at the division one level are very driven and from a very young age, right? There's a very small percentage of middle school athletes and high school athletes that actually get to the division one level.

And so it takes a significant amount of motivation and discipline and hard work to get there. And so once they get there that level of pressure. I mean, I've experienced with my own daughter. It's almost indescribable that singular goal. Now I'm here. Do I deserve to be here? What does it look like?

I think about how she tells me all the time, you know, I'm going to treatment and I always sort of wished that was mental health, because I think she needs that, they all need that equally. So why wouldn't we just have a mental health. Provider on staff just as she goes to see the trainer.

Who's wonderful. I wouldn't at the same time you have the athlete talking to a counselor, even if they don't think they have a diagnosable condition. Just how are you? Talk to me about the pressure. What do you need? How can we help you cope? How can we be more proactive? I've done some, some reading on what prevents division one athletes from getting therapy and it's.

And that's unfortunate because we really should be working into their training regimen, mental health counseling proactively, because they all could benefit from it. We could all benefit from it, but in particular, if we want to make a difference at the division one level integrate mental health into their daily act.

[00:37:28]Stef Strack: Well , it's funny. Cause that is really why we started the platform, right. Is because we looked at everybody's experience for these young girls, whether it was in the youth programs or to club team or at the collegiate level. And there was like one. Person or maybe two, if they're lucky three, but mostly one sports psychologist for their entire department.

And that's when we rallied the best women we could possibly to become this experts and help these young women, because there shouldn't just be one. And it needs to be accessible. That's why you can come to small group sessions, you can access a one-on-one and you can find somebody who you connect with because I'm sure you've seen it time and time again too.

It's like, if you don't connect with that one person, that one time, if you're already scared to go, and then you don't really like that one experience, then

people give them. And we don't want that. I love what you said, like make it part of the day and I wish it would be more integrated. So what can coaches do to make sure that they're having , conversations and raising awareness on their teams around mental health and suicide?

[00:38:41]Kristin Tugman: Again, I think they have to talk about it equally as they talk about physical health, as they talk about training, they've gotta be able to check in and feel comfortable enough, checking in about mental wellbeing.

What are you doing to take care of yourself? What are you doing in your free time? That isn't just academics and sport? We've got to make sure that athletes have other. And I think it's normalizing mental health and being sure that athletes understand that they're not going to be penalized, that they're not going to be thought of as weak that they're not going to be thought of as a liability to the team that your mental wellbeing is just as important to your performance

as your physical health is. We all know that if somebody from a mental health perspective is suffering, they're not their best on the field or the course or the track. And so while, division one sports it's, I know it's tough coaches are expected to perform just like athletes are expected to perform.

And I think as a result of that dichotomy in terms of. Coaches being expected to win. A lot of times the mental health of the athlete gets lost and the person in the athlete gets lost. And so we've got a battle that because ultimately the team is going to be much better for it.

If the team is mentally held.

[00:39:56]Stef Strack: A lot of what we talk about at vis is like using your voice, right? So if the coaches are not going to talk about it, how can the young girls on the team inspire their coaches and aspire the administrators to make it more part of the conversation?

[00:40:10]Kristin Tugman: Yeah. I mean, this generation inspires me. They do talk about their mental health. They talk about mental wellbeing. They talk about their therapists. I actually was able to sit in on a group session with some athletes and one of the coaches was asking about how did you get through COVID?

And she said, my.

[00:40:25]Kristin Tugman: So, I think we should be inspired by this generation and continue to allow them to talk about their mental health. And as parents even encourage them, talk to your coach about it. As, we check in with our kids, each week, talk to me about your mental wellbeing.

I think they're probably ahead of us. I realized at least my generation generation X we're a little more standoffish about talking about our mental health. And so we've got to help them embrace who they are and who we've allowed them to become. And really encourage those conversations.

[00:40:56]Stef Strack: I love that. Well, I mean, so much knowledge that you've shared with us today, Dr. Tugman I think the work that you're doing as well as your new nonprofit, that you're launching is just really important work. So as we close up the conversation, I would really love just to hear from you about what are the most important resources for young girls out there to know about if they are struggling with suicidal thoughts.

[00:41:21]Kristin Tugman: I mean, I absolutely believe always have the suicide lifeline on speed dial so that's something to make sure that folks are educated on and they feel comfortable using a lot of times, I think from our crisis intervention perspective folks might be nervous about calling a crisis line.

You don't have to be completely at a place where you want to take your life in order to call a crisis hotline. Those folks are there to support you to let you know that you're not alone, but I'm a huge fan of. Developing you're 18. I think what's most important is for all of us to recognize that were at risk.

And so when you think about suicide and the fact that folks get there because of unbearable pain, none of us are immune to experiencing unbearable. And so we should all know where our resources are. Who's our ATM. Who do we trust? Who are we going to call when we are feeling most vulnerable? Is it, our parents?

Is it our best friend? Is it our coach? Is it a counselor? And then who are we going to call? If that one person isn't available. So make sure you know who you trust and develop that ATM and know you can count on that 18.

[00:42:29]Stef Strack: I'd love that. Thank you so much, Dr. Tuckman. I really appreciate you joining the voice and sport podcast and helping us break all those myths and misconceptions. And I think we're really excited to see the great work you continue to do.

[00:42:46]Kristin Tugman: Great. Thank you for having me. I really appreciate the opportunity.

[00:42:51]Stef Strack: this week's episode was produced and edited by vis creator. Kate Tugman a cross country and track runner at UCLA, and yes, she has the same last name as our amazing guest today. She's the daughter of Dr. Kristen Tugman after busing, these myths with Kristen Tugman and addressing how we can have better conversations about mental health.

We hope that you understand more about suicide and realize that you are never. If someone you love is struggling with mental health and experiencing suicidal ideation. Please call the suicide hotline at nine, eight, eight, or reach out to your supporting system or somebody at voice in sport. To help get you connected with a professional.

If you wanna follow along with Kristin's professional journey, you can follow her on Twitter at Dr. Tugman PhD. We also recommend that you check out some of our previous episodes that also address mental health, such as episode number 87, titled mental health and suicide prevention for athletes with vis expert Dr. Kimberly O'Brien. Dr. Kimberly O'Brien is also hosting a free session at the end of the month on the voice and sport platform. And we would encourage you to sign. Please subscribe to the voice and sport podcast. Give us a rating and review on apple podcast. And of course, use that share button on voice and sport.com and send it to a friend that you think might enjoy the conversation.

Head to the feed on voice and sport filter by mind or by story, and spend some time diving into the incredible free resources and experts we have here at vis on our session page, you can find incredible opportunities to meet with professional athletes or sign up for a session with the vis. See you next week on the voice and sport podcast.