The Pharmacist's Role in Suicide Prevention

Drawing upon personal experiences and professional acumen, our guest Dawn Grittman, a steadfast advocate for mental health awareness and suicide prevention, joins Ashlee to peel back the layers of her journey intertwined with the National Alliance on Mental Illness (NAMI). As a pharmacist, Dawn’s story is a compelling narrative of transition from volunteering with NAMI to becoming a full-time crusader, keen on enlightening both healthcare providers and the general public on mental health issues. Expect an introspective look into her pioneering programs and the consequential role of candid discussions about mental health and suicide.

Navigating the labyrinth of suicide prevention, especially from a pharmacist's perspective, often encompasses a series of complexities. With an empathetic and expert approach, Dawn guides us through the nuanced process of recognizing cues and initiating life-saving conversations. Highlighting the imperative need for evidence-based resources and situational awareness, she brings to light the often overlooked role of the American Foundation for Suicide Prevention and NAMI’s Provider Program in equipping health professionals with vital knowledge about mental health conditions.

With a persistent focus on the role of pharmacists in suicide prevention, Dawn underscores the indispensable power of building patient relationships. Her passion is infectious as she emphasizes the wealth of available resources and the potential of pharmacists to provide critical help. Covering the deeply affecting personal impacts of suicide and its alarming statistics, she inspires a shift from despair to action. Dawn's poignant journey and incisive insights underscore our shared responsibility in fostering mental health awareness and suicide prevention. Her story serves as a compelling call to action to each one of us.

References:
NIMH
SAMHSA SAFE-T
QPR

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Transcript

Speaker 1: 0:00

Hi Dawn. I'm super excited to have you on Level Up. It is really an honor. I appreciate you so much. I've been following you on LinkedIn. Jen has been following you and she was just like you gotta get. You gotta get Dawn on. We gotta learn more about her. So welcome to our show. I'm excited to get to know you better.

Speaker 2: 0:16

Yes, thank you so much, ashley, and thank you to the Level Up podcast for inviting me to come talk with you guys today.

Speaker 1: 0:23

Yeah, it's exciting. So why don't you share with us a little bit about your background, about what you do as it relates to mental health awareness?

Speaker 2: 0:32

Yeah, so well. So it's been a journey. So we could spend a whole podcast or more on how I got here. But to kind of sum up where I'm at right now, I work at the National Alliance on Mental Illness and I work as a program manager and I work on programs that are related to healthcare professionals as well as the public in terms of talking about the connections between mental and physical health. So what led me there is I've had well, obviously, I went to pharmacy school. I graduated in 2006,. So that gives you kind of an idea of where I've been. But I started out in hospital pharmacy. I've done quality management, I've done quality measurements, I've done IT. I've done a lot of different things, but the mental health sphere has come a lot from personal experience. So I have had family members that have been affected by mental illness and I'm also a suicide loss survivor. So I lost my dad and a couple of my cousins to suicide, and that's been in around 10 years or so ago, and when that happened I was really lost and I knew a lot about medications and things I learned about in school in terms of our psychiatry units, but I didn't know a lot about the softer side, or the emotions, all of the things that happened and the aftershocks, if you will. And so I found NAMI and at the time I was living in Iowa. I'm born and raised in Iowa. I live in Arizona now, but I found NAMI and found this class called family to family and, as the name implies, it talks it relates to family members that have been touched by mental illness. So I ended up becoming a teacher for that class and then, as the years have gone on and this was 2013, as the years have gone on, I did lots more volunteering with NAMI. I was on their board of directors, I was president of the board for the state of Iowa, I did advocacy work, so I was at the state capitol, I was doing fundraising so lots of different activities as a volunteer. And then, within the last year, year and a half, NAMI National, so we have local affiliates, we have state organizations, and then the national level with NAMI, and the national level had an opening for working with the provider program that I mentioned, working with healthcare professionals. So when that became open, I applied for that and I had already been teaching that class in the last few years and some of that included teaching third year medical students. So since I had a lot of that background and from a volunteer standpoint, it worked out really well that I was a good fit to come in, and so now I've turned my volunteering work into my full-time job.

Speaker 1: 3:48

No, you've totally come full circle with where you were, your experiences, and then where you are today. Yeah, yeah, so on a day-to-day level, what do you do with healthcare professionals?

Speaker 2: 4:03

Right. So I do a lot of interactions with folks out in the field, as we call it. So I'm talking to people all over the country in terms of making sure we're programming doing programming for the provider program is what it's called. The other one is called Hearts and Minds, and so I'm working with because a lot of the teaching the boots on the ground happens at this state and local level. But I'm working with them to set up classes, have all the curriculum ready to go. We're updating curriculum. Those are always in process, so I work on that. That's where I bring in some of my clinical backgrounds and then I'm also still doing some of the teaching as well. So coming in as both the health professional perspective and as a family member perspective Wow. So every day is a little bit different, so that makes it really exciting. So today I'm working on we're working on a training, a piece for the Hearts and Minds program so we can have people feel comfortable teaching the curriculum, because we talk about things like diabetes and blood pressure and lung disease and the gut, brain access, a lot of different topics that a lot of people may not be as familiar with. I mean us as pharmacists are in the pharmacy world. A lot of it's second nature to us but for some of our audience we wanna make people feel comfortable with that. So that's, yeah, every day is a little different, but it's really exciting cause I get to meet people. A lot of it's virtually, but I get to meet a lot of people all across the country that have this interest in mental health and not only the connections, looking more at the whole person in terms of not siloing mental health away from the physical health, but then working with people who want healthcare professionals to know some more about what the family members and individuals are experiencing when they have a mental health crisis, or what happens after that crisis. What does recovery look like? What if there's a secondary event? How do families and individuals cope with that? So there's just a lot of different buckets to get into.

Speaker 1: 6:26

There's so many different ways that we can go with this, but there's a lot of discussion. As you're talking, I'm like, oh my gosh, you are doing God's work, you're doing amazing work and you're out there in the field with both your pharmacist head on and also your suicide prevention pharmacist hat on. So talk to us about, like a little bit about the inception of the suicide prevention pharmacist. First and foremost, the word suicide. Like can we talk about how to make that less awkward? Well, because the word itself brings I don't know if this is like a normal thing, but it brings discomfort to me and I'm a healthcare provider. And then, like, how do we train our pharmacist to remove the stigma, I guess, or the discomfort, from talking about it with their patients? What are your thoughts on that?

Speaker 2: 7:21

Right? Well, I definitely agree. So I've done presentations before where that's the first thing we talk about. You know, you put the word suicide on the screen, okay, what kind of emotions, what kind of things come up for you, right? And so a lot of times people will use the word triggering, and so that's one thing I will mention is that that's kind of there's. People are noticing that and that can be activating, if you will. So I'm trying to use the word activating more as opposed to triggering, because of some of the context around suicide. But yeah, I think that word is just. I think there's a lot of fear. So I think what has to happen is for me and I'm generalizing, of course, but when you're afraid of something, a lot of times learning more about it and getting more information can help eliminate some of that fear. Now, we can't always get rid of all the fear, right, the world's not perfect, but for me, when I was encountering this as a suicide, loss, survivor, that's really where I had to start, and so, honestly too, going to that point, this is probably something I would have never picked to get into, except that it happened in my family. I was definitely one of those. It doesn't happen to my family, it doesn't happen near me, it just happens to other people, and then it happened. So then for me that made me learn a lot more about it, and so for me, using the word suicide is, I mean, it's not a fun topic, it's not a sexy topic, but to me it's kind of become a part of my everyday language because I work so much with it and that's part of my personal experience. So I think with there's a lot of other words that we have in our language too that have a lot of power and stigma, but once you start using them more, I think that helps eliminate some of the stigma, like it becomes a common thing that people can have a conversation about. So I think that's part of it is just getting it out there and living with that discomfort and then working through it.

Speaker 1: 9:50

Yeah, because even when I was emailing you or even when we were having discussions, I was like, is it the anti-suicide pharmacist, but the suicide prevention pharmacist? So it really got me going of okay, there's like a real role for us here.

Speaker 2: 10:03

I mean you, your.

Speaker 1: 10:05

The title just itself has so much gravity that I sense from your area of expertise that there is a real need to teach community, especially community-based pharmacists or pharmacists who are working within the community or in hospitals or whatever, whatever capacity they touch patients that there's a real opportunity there.

Speaker 2: 10:31

Yeah, yeah, absolutely so. So, unfortunately, some of us come into this like kind of similar to my story. They know someone who, right, and I'm always amazed that when I share this with folks, I will have people reach out to me saying thank you for sharing. I've had this, and not everybody feels comfortable sharing that experience or that story, and that's okay. This isn't about everybody having to share every detail of their life, right? But so some people, a lot of people probably, have had that experience, or maybe they've known somebody who's made an attempt and survived. So there's a lot of different ways. People will have that first or secondhand experience, but for those who don't, I think it is as we know. Pharmacists have a lot of touch points with patients, right, we know that, compared to going to a physician's office or going to the emergency room or what have you, you will see people, and so you get to develop relationships with a lot of your patients, or hopefully, hopefully, you get time to do that with patients, and so there may be a day when you notice something's a little different or there's a comment that is made that makes you wonder. So I will say there are different screenings that are out there, and so just a couple to name off. These are things that everybody can Google is we have the NIMH, so National Institute of Mental Health. They have what's called the ASQ and I forget exactly what that stands for. I believe it's asking screening questions, or asking suicide screening questions, something like that. That's a really quick assessment people can do so. These are all clinically based SAMHSA, which is the substance abuse and mental health services administration. So another government group they have a pocket card and it's called safety. So you know government loves their acronyms, so it's SAFE-T safety. But it is something that people can carry around and it's an assessment tool. And then there's also a Columbia Suicide Severity Scale and so a lot of these are meant to be fairly quick, within seconds to minutes, so people can look at those as potential resources. Another training I think that is really great for pharmacists that I've heard pharmacy students doing as well is QPR, which stands for question, persuade and refer, I believe again, don't quote me, I know a lot of acronyms but I don't always spell them out for everybody. But what's interesting about QPR is they have lots of different kinds of trainings and they can get very specific based on profession. So I believe there's, if I remember, there's a pharmacist specific QPR training, there's a lot of different clinically based resources for pharmacists, and so, again, I think, though, it's one of those things too, that, if you hear an off comment from a patient, is and I know there's a lot of constraints, especially in the community there's a lot of metrics and there's a lot of things going on, but if you happen to hear something such as I I don't know if I'll how long I'll be around or you know, just something that catches, catches your attention, I would encourage you to explore that more, and it isn't necessarily being, you know well gosh, that that sounds terrible, but you know, just starting to think of maybe utilizing some of the tools that I just talked about and seeing if you can find out a little more, because I think a big myth is that people think that if you talk about suicide, that is going to lead people to, you know, formulate more of a plan or be more likely to do that, and the researchers and studies have found that that is not true. So people that that make some kind of statement or maybe their behavior has changed it isn't necessarily something you know like, ignoring it doesn't necessarily help keep them away from doing it, but in fact, bringing it up and having someone know that somebody is listening and wants to help can actually save a life, as opposed to, you know, ignoring it, and maybe that was, you know, not everybody has a cry for help. If you will, or is it like a cry for help, and so I think that's a really dramatic like. This is what I'm going to do and this is how I'm going to do it. It isn't always like that. It can be subtle, but those can be cues that somebody you know could really appreciate having somebody respond to that and talk to them and potentially save a life, because sometimes these things are so in the moment to with people and you know you just have to. You know again, it's not easy, it's not. You know, it's not a conversation people want to have and a lot of it comes to just trying to find out more, and maybe it, maybe it isn't related to somebody wanting to harm themselves or someone wanting to die by suicide, but in my mind I would rather run the risk of offending somebody than not taking the chance and making sure someone's okay. I agree with you.

Speaker 1: 16:31

Yeah, so many different directions again. Yeah, this is a really empowering conversation and I think, if anything, it's enlightening the audience as to. You know, use their voice and speak up. It's better to say something than absolutely nothing. So I'm curious with thoughts about you know, if there's a pharmacist working in the community and they, is it like a gut feeling that you're teaching or is it like a specific, you run the assessment? Or if they're on some type of specific medication, what you know, how would you recommend that they approach this? Because, like, for example, if you remember, I'm assuming you approach it differently than a patient?

Speaker 2: 17:11

Yeah, yeah, I would. I would think so, partly because of the type of interaction that you're having with a family member of you you know I'm assuming most people it's going to be a more intimate conversation than when you're working with with somebody in the community. So I think there are differences and that's where some of the resources that I mentioned are really helpful because they give you some ideas. Yeah, I have some phrasing that might pop up. I definitely don't want to misspeak on some of those because those are based on evidence and research. I definitely, being pharmacist, we want to go with with what we know has been studied and yeah, so I think that's what everybody out there I mean, that is how to.

Speaker 1: 17:58

Yeah, this is fascinating Okay.

Speaker 2: 18:00

Yeah, people, people study this for a living. It's called suicide ology. So there are people that they focus research, there's conferences, they're yeah, yeah, well, and and that's an interesting thing to bring up to is, when I first started looking into this, I thought, well, suicide prevention, that's pretty straightforward, right, there's there's things you do and things you can say and and that's it. But it's, it's a whole subject and there is a lot to it. And you know, ashley, you mentioned something about, you know, looking at the medication profile, for example, of your, of your patients. So it depends on who you talk to. I don't know if I'd say this is controversial or not, but one thing I would challenge people to think about is, I think a lot of times, especially when you hear about a murder, suicide, or you hear somebody dying by suicide in the news, everybody's always looking for that link to why that happened, right, and so mental illness comes up a lot.

Speaker 1: 19:08

I mean, is it 100% of the time?

Speaker 2: 19:11

Yeah, so right. Well, so we know in the pharmacy world that nothing's 100% usually right. So it's interesting, because I've read books and of course I don't remember the books or the exact studies, but mental health and mental illness isn't necessarily the explanation for everyone who dies by suicide. So I think that's really important to know. So, yes, that does happen, there are connections and links, but we can't, I think, at this point, in terms of what we know, we cannot make the assumption that every person that dies by suicide had some kind of mental health illness challenge condition, because what has happened is there are stories of individuals who have died by suicide and they're looking post-mortem and they're looking, okay, where there's signs, where there's symptoms, where there are things that would have suggested a mental illness, and they can't find them. So then that becomes well, how do you explain it? And so that's where other factors come into play, and that's the other thing too. A lot of times and I think this is just human nature we there's a cause and effect, right. We wanna think that one thing causes another and there's a nice tidy explanation we have found, and, with researchers, suicide is multifactorial. There are a lot of things that go into someone's suicidal ideation and if they make a plan and if they make that attempt, if it's completed and it's not really straightforward. So unfortunately this makes it sound even worse. But I think it's important to know that the suicidal ideation, all of that that goes with it, is a lot more complex than a lot of us would think oh for sure. I mean, yeah, so there's, you know, there's situations, it shed so much light on me.

Speaker 1: 21:17

So I agree with you. I mean, I'm here, it's just having a deeper understanding of so many. It's multifactorial.

Speaker 2: 21:26

Yes, yes, absolutely. And again, that's what a lot of researchers look at is what is. I wouldn't say there's a definite combination, but that's what they're looking at is what things are happening in a person's life, and so a lot of it can be very situational. What's happening for that person in that moment, what's going on with their relationships, their work, their life outside of work, or if they're in school, or, depending on their age, or what they're doing in life. So it can be a lot of things that can contribute. So that's again that doesn't necessarily help take away some of the fear, because in some ways it's really scary. We can't figure out all of the pieces, but if you think about things like cancer and some other disease states, we haven't necessarily figured out all the combinations to completely eradicate those things either.

Speaker 1: 22:25

So is the goal of studying suicide. Is it to eradicate suicide?

Speaker 2: 22:31

Yeah, I think I mean that would be the you know, pie in the sky ultimate goal. Yeah, however, I think you know, we know we live in an imperfect world and so we have people in the community different communities that I've looked at from suicide loss survivors that sometimes prevention can be another activating word, and the reason I say that is because people who have lost someone to suicide when they hear the word prevention, a lot of times people think that means well, we can prevent every suicide.

Speaker 1: 23:12

Right, that's what I was thinking, that I just didn't say it.

Speaker 2: 23:15

Yeah, yeah, so we. So, again, thinking about our language is very important, right? We know about person centered language and saying someone lives with diabetes instead of saying they're diabetic. You know, saying someone lives with schizophrenia and say, instead of saying they're schizophrenic, right, like the disease state isn't there in the entirety of their being. Right. So prevention. So we're heading into September, which is suicide prevention month, and so all month long that's what we'll hear about and there's a lot of great information and a lot of great resources. And, honestly, up until last year, I read an article from a suicide loss survivor and they talked about how that whole prevention message, although important, can still, you know, activate some people thinking well, I lost my loved one or my friend to suicide. This makes me feel like there's something I could have done, should have done, and that is absolutely not what we want people to feel, right.

Speaker 1: 24:22

Right, I felt that and I just didn't know if I should say it because I didn't wanna make anyone feel bad yeah yeah, yeah.

Speaker 2: 24:28

So I mean. So that's something that I've, you know, throwing the word prevention out there, I, you know, at first I didn't think a lot about it, but now I'm trying to be more nuanced about it, and so people I don't know if people are using a lot of different words, because I think when you talk about prevention, people really understand what that means. But then you know, just understanding some of the nuance with people who are survivors or even attempt survivors, you know just knowing that we certainly haven't got it figured out. I mean, if we knew how to prevent all of those that we've lost by suicide, we certainly would be making that happen.

Speaker 1: 25:13

What do you think is in the pipeline for specifically for the profession of pharmacy in regards to suicide prevention in the community?

Speaker 2: 25:23

Yeah well, so I think when I think of a pharmacy, I think of technicians, pharmacy staff, anybody who's involved in the pharmacy world. We are very big community people. Whether we work in community pharmacy or not, no matter what our practices, we're still out in the community working with different groups. So what I see pharmacies role is a lot of awareness, I would say, and having those conversations with patients, depending on on what that looks like. But there are many ways for pharmacists or pharmacy staff to get involved in the community and perhaps it's you know, one group that's a big one is the American Foundation for suicide prevention, so a lot like NAMI. They have a national organization, but they also have state and local levels and so you can get involved with them. They do out of the darkness walks, so a lot of these fundraising activities look for sponsors and so sometimes medication companies and medication related organizations will help sponsor some of these things. So these are a lot of things that are done for awareness, of course, and fundraising for organizations to help with things like research. So that's one one group in particular, and now I work for NAMI, so I'll just plug NAMI as well. So you know I I'm very biased and I will say that everything I'm talking about here is, of course, my personal opinion and I'm not speaking on behalf of NAMI but, again, local, state and national organization. We have walks, we have different states, have different fundraising. They have classes. So another way pharmacists can get involved in NAMI is if they become a member, they can take some of the classes that are offered. All of them are free of charge for members and so that's a big thing. We want people to have access to this information. But pharmacists are. A lot of other people have gone on to become program leaders, which are teachers, so they're teaching the classes. So things like hearts and minds is really great again, because we talk a lot about different chronic disease states and we talk about some anatomy and physiology and so things that pharmacists and pharmacy are very well versed in. So being a teacher and and then in the provider program, part of our program is we look at the perspectives of a person in recovery, a family member and then a health professional. So we need health professionals that can help teach that course to fellow pharmacists, physicians, nurses, anybody that's involved in health care is what the provider program is hoping to help educate and and help people understand what people are going through as part of their mental health conditions.

Speaker 1: 28:44

Well, you've really on this topic and I mean I've learned a lot, so I can only imagine what people are listening and what they're thinking, because it's gotten my will spinning as to what can I do for myself and for everyone around me, and I think there's there's so many resources out there. What's, what are some of the statistics around this suicide? If you don't mind, do you know off the top of your head?

Speaker 2: 29:11

Oh, I, I don't, actually I don't keep track of the numbers a lot. A couple numbers I do know is so I boom and again, don't quote me on it, but I believe roughly we lose about 40,000 individuals in the United States to suicide every year. I might have heard with veterans the number 22, and where that comes from is on average we lose 22 veterans a day to suicide. So a lot of you know factors there. You know you think about the experience of veterans and how some of that might play into it. So obviously very concerning, I believe, worldwide. I the last time I looked I think it's about 100,000 people a year in the world we lose to suicide. So I obviously have focused a lot on the United States, but of course this, this happens everywhere, I don't know, and so much of an interest. But sometimes the factors that play in are different depending on where people are and you know how those things happen. Obviously it can get a little, I don't know, morbid, if you will, but but people are studying this all over the world. So I think that's important because there are sometimes there are some cultural differences and factors that play into it. So I think it's important that we're not, you know, being, you know, american centric on this, because this is obviously a worldwide issue.

Speaker 1: 30:57

It's really dense in the United States. I mean, yeah, that's 100,000, roughly out of 800,000 that's. That's a big chunk.

Speaker 2: 31:07

Yeah, yeah, yeah. So and, like I said, don't know no one's going to Google this, I promise. It's a lot.

Speaker 1: 31:23

No, but I mean that the rough estimate of 40,000, that's roughly 110 people a day.

Speaker 2: 31:28

Yeah, yeah. So we're talking, you know, every, every few minutes or so, and and then you think about not only the loss of that individual, but think of all the people affected by that. Right, there's probably a number somewhere with the average number affected in terms of close relationships. But if you think about you know, think about you, think about someone in your family, how many connections do they have in terms of other family members, co workers, friends, schoolmates the effect is, you know, tremendous, and you know, and and people can be, can have a secondary trauma from that right, from just experiencing that loss. So, yeah, there's just, you know, I'm sure there's some economic numbers that come with that too, but you know, I don't, I don't focus on that as much as in terms of the emotional and the the personal loss that people experience. So here I am I lost my first cousin in 2011, my dad in 2012, and then my other cousin in 2014, so within three years. It was just, it was kind of you know, and we got to a point where it's like, well, what is this going to stop? And it was. It was very tough, but even being this far away, we're talking, you know, a decade now. It's like you know. You know, I still think about them. You know, every day.

Speaker 1: 33:05

And it's.

Speaker 2: 33:06

it's what drives me, you know, because it just it makes me sad, it makes me angry, and you know, I got to do something to, to to this place, so not this place, but to channel that.

Speaker 1: 33:22

I mean I admire your courage and I think it takes a special person to live in this space. I mean you don't just Mullin's hearing it, you live, breathe and eat it for breakfast, lunch and dinner. It's your job now. Yeah, yeah, you're really in it. Yeah, and it's, it's quite the topic. You know it's not comfortable where other disease states or other pharmacy centric areas, professional areas of expertise. It might be a little less taboo ish, but that's only something. I mean, you've enlightened me a lot on this topic and I think pharmacists have a huge opportunity here. I mean, 110 people on average were losing a day. That's yeah. I mean one is too many, but 110. Yeah, that is, that's really stopped me in my tracks. I will say yeah.

Speaker 2: 34:18

Yeah, well and okay, I was just going to say to, like a lot of other issues we face as pharmacists, we know that they're complex and there's not a quick bandaid, right. So a lot of this, a lot of this work, is really about relationships, too, right? So knowing somebody well enough to know when maybe they're having an off day or an off moment, or noticing some something different about their behavior, their mannerism, right, that takes time. That isn't something that you can, you know, maybe they still have that talent, but most of us aren't going to be able to read somebody after an interaction or two. It takes that kind of, you know, longer term relationship to maybe understand that and the solutions and the ways to prevent. It's. It's a lot of work and it's long term and it's not a one and done again, like a lot of other things that we deal with in pharmacy. And you know once, you know once somebody goes into remission for cancer, we don't just say, oh, you're good for the rest of your life, right? No, you keep screening, you keep, you know, you keep on top of it to hopefully prevent another you know cancer from coming back. So, yeah, there's, there's a lot of similarities and it's, yeah, it is definitely a tough topic and one that people don't, you know, necessarily like to talk a lot about. But that's part of the reason I'm here and other people are here doing it, because we we've had the unfortunate and it's not everybody, but we've had them and we want we want people to learn what we've learned and then, you know, hopefully again, if we can save a life or prevent something from becoming more dangerous for somebody. That's that's what we're here for. We know we can't do it all. We talked about that a little bit earlier. We can't prevent it all. That's what we're working towards, you know that's that's the ultimate goal someday.

Speaker 1: 36:29

I think that's fantastic. I think what I've heard, what I've taken away, beyond just a lot of your data and your expertise, is pharmacists having awareness, the tools, the resources and the relationship building with the patients is is really needs to be at the forefront of our practice. We touch these patients in the community more than most healthcare professionals, if not the most. I mean there's data to show that we're most trusted, number one, that most successful healthcare provider and I think, with the data that you provided, it's just about resources. So I'm super grateful that you are here with us on your on this show. We're going to include all of the data sorry, all the links and data in our show notes ways for people to learn more about suicide and the roles of pharmacists. We at C impact create teaching resources, see teaching pharmacists just how to identify these types of patients. So really appreciate your time, your area of expertise. You know I'm terribly sorry to hear about your dad and your cousins. Thank you. A roller coaster I've experienced it myself and it's in a different capacity, but yeah, no, we're with you and we were. We really appreciate your expertise.

Speaker 2: 37:50

Yeah, yeah, and just to touch on that again to for anybody who's been affected as a suicide loss for survivor, you know, please, I know easier said than done. You know, please understand that, you know it's, it's. There are a lot of things you can't prevent and you know you have that kind of survivor guilt. There's some people do you know, just knowing that it wasn't. You know it's hard to internalize but it's, you know people need to know that that there's a lot more that goes into it. And you know, maybe you said some the last words, you shared with somebody what you were in a fight, or you know something, something else happened but it's not anybody's fault.

Speaker 1: 38:37

So I just I want to reiterate that for people who've had that experience, I think that's what we're summarizing, and thanks for saying that it's it's that's life changing done. So I appreciate your time, thank you.