Jasleen Chhatwal, MBBS, MD, serves as Chief Medical Officer and Director of the Mood Disorders Program at Sierra Tucson. She is a board-certified psychiatrist, integrative medicine, and addiction medicine physician with experience treating complex mental health disorders in inpatient, residential, and outpatient settings. She is intentional in treating the whole person, using psychotherapy, allopathic, neuro-therapeutic, integrative, evidence-based, and evidence-informed treatments. She believes each individual has a unique, authentic story and is grateful to all those who have entrusted her with their stories.
As Chief Medical Officer, Dr. Chhatwal is responsible for managing the medical department, which includes psychiatrists, physicians, physician assistants, nurse practitioners, as well as overseeing the teams that provide integrative care, pharmacy, experiential therapy, nutrition services, applied neuroscience services, psychology services and treatment outcomes. She strives to ensure consistent, high-quality patient care through the optimization of internal processes that help increase provider face time with patients. She also serves on the facility’s executive leadership team with an identified mission to expand access to high quality mental health care across the continuum of care.
She is active in the medical community, advocating for her patients’, colleagues, and profession through elected and appointed positions in state, regional and national organizations. Amongst her service roles, she is Past President of the Arizona Psychiatric Society (APS), the Arizona Representative to the American Psychiatric Association (APA) Assembly, Assistant Professor at the University of Arizona College of Medicine and sits on various state government and non-profit boards.
Dr. Chhatwal’s dedication and contribution to the mental health field have been recognized in the form of a Presidential Awards for Leadership and a Presidential Service Award from APS, Assembly Mentor Award and Distinguished Fellowship in the APA, a Walk the Talk Award from the Arizona Medical Association (ArMA) as well as various educator awards.
Echoing naturalistic healing disciplines, Dr. Chhatwal believes that the human body has the inherent capacity to heal itself when provided with a nurturing environment for the mind, body, and spirit. In her practice, in collaboration with colleagues from various disciplines, she attempts to recreate that nurturing environment so residents can start their journey towards a healthier, more wholesome life. As a firm believer that staff care is important to providing optimal patient care, she aims to also assist Sierra Tucson medical staff to prioritize their own self-care while building sustainable professional careers.
Dr. Chhatwal’s treatment philosophy includes intervening early, providing holistic, culturally competent, gender-affirming and evidence-based care. She envisions Sierra Tucson as a healing sanctuary where intensive biological, psychological, and integrative therapies help restore the vital essence of each person’s unique and authentic story.
Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.
Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.
To book Gabe for your next event or learn more about him, please visit gabehoward.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.
Gabe: Hey everybody, welcome to the podcast. I’m your host Gabe Howard calling into the show today. We have Doctor Jasleen Chhatwal. She is the chief medical officer and director of the Mood Disorders Program at Sierra Tucson. She is a board-certified psychiatrist who believes each individual has a unique, authentic story to tell, and she has shared that it is her honor to be entrusted with those stories. Dr. Chhatwal, thank you so much for being here, and welcome to the podcast.
Jasleen Chhatwal, MBBS, MD: Thanks, Gabe. I’m delighted to be here. Joining you again.
Gabe: Oh, thank you so much. Now today we’re going to be discussing trauma informed mental health treatment as it relates to suicide prevention. Now, I’m I’m fairly certain that most of our listeners understand the concept of suicide prevention, but trauma informed mental health treatment isn’t as widely understood. Can you help our listeners understand what trauma informed mental health care is, and why it’s so important to suicide prevention?
Jasleen Chhatwal, MBBS, MD: Absolutely. Trauma informed care really developed as a service delivery model, which is meant for people who have been traumatized in some way, shape or form in their lives to provide them a safe environment to seek care. So it really tries to be responsive to the needs of individuals by giving them a sense of safety, providing them some sense of control, and also empowering them to be really engaged in their treatment. And one of the main reasons this is so important is that most people, when they engage with the health care system, whether they’re going to the emergency room or even sometimes going to their primary care doctor or they’re actually admitted to the hospital. You’re in a place where you have some level of uncertainty. You’re not an expert in health realm, and you’re worried about yourself and or your loved one for some reason. So really, the the main goal of this trauma informed care approach is to make it that people can more fully engage and get the best out of the healthcare system, rather than feeling that they got silenced or did not get heard and feel that they actually might be feeling worse now, like they have the health care issue already, and now they feel like they’re, you know, being bullied or not really being heard by the healthcare system even, which is a complex system to operate within.
Gabe: Just out of curiosity, it sort of seems obvious, right? Treat people with respect. Make sure that they’re comfortable and safe. Don’t scare them. Don’t traumatize them. Hasn’t this been the standard of care all along? Did we really need to switch or write this down or put this into words. Were we doing something different before this concept came along?
Jasleen Chhatwal, MBBS, MD: While healthcare has had so many different iterations, right? Like right from the time of bloodletting, where doctors would bleed people out as a way of curing them, of infections and such. So really, in the beginning, medicine was developed. And I think over the course of time we lost that philosophical spiritual healing component to medicine and became more and more just scientifically driven, where we’re just saying just do the right thing. But maybe we forgot that we needed to do it also the right way. And so not to say that people were not holding this tenet, but I think sometimes it is that you really want to make a thing very, very clear, give some clear guidelines around how to do it so that it becomes important and central to delivering care so that the doing doesn’t become the most important thing. But how you show up in doing the care is also important. So if nothing else, you know, trauma informed care being developed as an approach is a way to add some intentionality into how you show up as a caregiver.
Gabe: One of the things that I’ve noticed, Dr. Chhatwal, is we used to have something called, like, doctor’s orders, right? You can’t do that because of doctor’s orders. And and I know many of us are thinking about things like, you know, heart attacks or surgery. Right? You get the doctor’s orders. But let’s apply this to mental illness. Let’s apply this to mental health crises. Let’s apply this to situations where your mind is not working 100%. And then you have an authority figure, someone with control barking orders at you, telling you to do something, and in some cases you may even be locked in a psychiatric ward. You may have to be chemically or even physically restrained because of your behavior. All things that are, well, frankly, frightening. And they should be frightening. Was there really no concept before this that that was scary? That people suffering from mental illness who were in a hospital setting, or being seen by an authority figure who was telling them what to do, that they would be terrified?
Jasleen Chhatwal, MBBS, MD: Yeah, I think your points are really well made. And, you know, that’s where when I approached the mental health care system and I became a psychiatrist, I started to notice that the way we approached people, yes, we were always doing it with the intention of helping, but that may be the ways we did things was not as helpful to that person long term. And so even when I would see patients on an involuntary status, I would always think to myself, is the way I’m approaching this person going to make them more likely or less likely to continue wanting to engage in mental health care after the involuntary component is gone, right? And there are times, say, when somebody is imminently suicidal and maybe trying to harm themselves or put themselves in harm’s way actively, that maybe one has to lower the threshold of what’s going to happen in the future, because right now you need to keep that person safe. And I hope that we as caregivers can have a level of like metacognition, like an extra level of thinking to say, okay, how I’m approaching this, is this going to lead to long term harms that I’m not maybe actively thinking about? And I think, you know, to your broader question of were people not thinking about it? I don’t know, I’m not all people. Right. But we do know that.
Jasleen Chhatwal, MBBS, MD: Sometimes the way structures are set up makes it that it can have unintended consequences. So so when we think back to deinstitutionalization in the 1970s and 80s, they really thought, oh, we should remove people who have mental health conditions, specifically severe mental illness, from these institutions of mental health care, and they’ll get care in the community. But we never really built out a solid community treatment structure. So now we have so many people who are having to deal with things like Houselessness and don’t really have resources. And and now I think if we think about it, some of us as psychiatrists might say, wow, the institutions were better because at least people were in a clean, caring environment to a degree. And we also know that there were institutions that were not treating people well. So it’s no matter what structure you have. Each area, like, you know, a different state or different city might have a different type of setup. And I again think that no matter what or where, we’re giving care, the way we show up individually as clinicians and then also how our systems of care are set up. So I think one of the big trauma informed changes systematically that have happened is the introduction of 988, whereas previously, whether it was a crime or a mental health crisis, we were calling 911. Now, at least for a mental health crisis, we’re getting to call a separate line with maybe people more specifically trained in a more trauma informed approach to addressing the crises of mental health care and crises of, you know, somebody dealing with suicide or having other acute mental health symptoms versus calling 911 where we were calling the police or the fire department.
Gabe: When I think about trauma informed care as it relates to suicide prevention, one of the things that that really seems front and center is thinking about the person. And if I if I may, Dr. Chhatwal, I know that you have a personal story to share, and I think our listeners would like to hear it. I know that your father passed away by suicide, and you have talked before about how this has informed your work and informed you even becoming a psychiatrist. Can you share with our listeners why this is so important and a little bit of your personal story?
Jasleen Chhatwal, MBBS, MD: Absolutely. Yeah. When I was just completing medical school in India, I moved back home for my internship, which is essentially one year of clinical work that we do before we get our medical degree in India. And as I was home, I think I came early part of the year. January, February. A few months in, me and my dad had a little bit of a disagreement and I was very upset. And that was actually the first time I learned from my mom that he had bipolar disorder. And she tried to come tell me, you know, he’s a little irritable right now. This is not his usual state, so don’t be upset because I wasn’t really being able to understand why he was behaving so differently. Whereas he and I had been so close, always. And then sadly, six months later, he was in an acute depressive episode and in spite of trying to get adequate care ended up taking his own life. And for me, that was a very shocking event. As one would guess, I was in my early 20s and didn’t really know how to make sense of it. Thankfully, I did know about his diagnosis, but even as somebody who was completing medical school didn’t fully understand what that meant. And so it’s really become a part of my mission to try and educate people and especially educate families about how to make sense of mental health conditions.
Jasleen Chhatwal, MBBS, MD: And what ended up happening is that a lot of people around us, including our family members who didn’t understand mental health conditions, started to try and find other stories or other whys of his his death. And really, the lesson to me was that when people are dealing with their own grief, they show up in ways that may not be their ideal selves, and they may say or do things that are not supportive. And as I started doing more medical care in India, I started to see that there were a lot of people with mental health issues, which previously I must have been blind to, right? Because I completed medical school and didn’t quite get it. And now that I’d had this personal experience and I was reading more about psychiatry. I was starting to see so many people with mental health issues. And I think it speaks to that issue where we sometimes in healthcare settings, you know, hear that so-and-so is a mental health patient. It’s like, no, everybody has mental health. And sometimes our mental health is not good and sometimes it’s better. But yes, there are people who have mental health disorders or mental health diagnoses that they carry. But even for them, there’s good days and bad days.
Jasleen Chhatwal, MBBS, MD: And so really, when we start to think about mental health as a broader topic, we all have to consider that each of us can have a mental health condition at some point or the other. Nobody is immune and really showing up with kindness and being able to recognize it as a health condition, just like diabetes, like cancer you know, like a urinary tract infection. Like it’s all the same, that these are still health conditions that need treatment. And I think when it comes to suicide loss, there are so many people impacted because not only, you know, was my dad impacted and then me and my mom being his immediate family. But then till date, we hear from extended family and friends and his colleagues whom his death impacted. So every time we think about suicide prevention, I think about the one person who maybe is dealing with thoughts of suicide. But then, you know, the many, many other people in their lives who are impacted. And no wonder it’s such an important thing for us as a community and a culture to think about that. Really, if we are thinking about trauma, the number of people who are traumatized by that type of unexpected loss can be so vast for every person who dies by suicide.
Gabe: One of the things that I think about when I think about trauma informed mental health care is the way that we talk about suicide. Now, we’ve been talking about suicide prevention, but you sort of touched on briefly about people saying the wrong things or doing the wrong things in the wake of a completed suicide. Can you talk for a moment about what people could say, or maybe some ways that they should think about it?
Jasleen Chhatwal, MBBS, MD: When you lose a loved one, what do you want somebody to say? Often it’s not a whole lot because nothing really makes a difference. However, I always think about the old adage like if you don’t have anything nice to say, don’t say anything at all. And I think when anybody has a loss, no matter for what reason, the best way to really show up is to say, you know, I’m here for you no matter what you need, you know, and just be there. Do the same things that you would do, like set up a meal, train, provide support, ask them, you know, if they want to talk at any point, and really always trying to stay away from providing solutions to people unless they ask for it. And I think in this case, especially when people try to start digging around for what could be the cause, like, oh, but what caused it? Like what led the person to having thoughts of suicide? That can be pretty hurtful. It’s such a huge loss for the survivors that just being present and, you know, saying, I’m here for you, let me know What I can do to support you is all you really need to do. So in some ways, less is more.
Gabe: Is that what really helped you in the wake of your father’s death? People just being present and asking you what you needed versus offering advice or trying to, you know, figure out how this happened or how we got here. But just being mindful and present in the moment with you.
Jasleen Chhatwal, MBBS, MD: I would say that the few people who are able to do that were definitely the reason. I feel I was able to get through that time. But I did have some very close friends and a few others who were able to be present. And I always think about that resilience factor, like sometimes you just need a handful of really supportive people who can help you through a bad time. And I think it helped teach me a thing or two about boundaries and having more steady boundaries and learning to cut out people, or reduce my interaction with people who were unhelpful and who I felt were damaging to my mental health and my wellbeing at the time.
Gabe: I think so many people believe that asking somebody if they’re planning on killing themselves or contemplating suicide would cause them trauma. It must be traumatizing to hear that somebody that you love thinks that you want to end your life, etc.. So when we think about trauma informed mental health care, I think maybe the average listener might think, oh well, that would just be very traumatizing for mom, dad and uncle grandma, grandpa, brother, sister, best friend to say, hey, I think that you want to kill yourself and I just want to check in. But the research doesn’t show that it’s actually not traumatizing at all. It’s very supportive, and I think that that’s not necessarily intuitive. Can you talk on that for a moment? Because many people believe that once suicide enters the conversation, trauma must follow.
Jasleen Chhatwal, MBBS, MD: Yeah. And that is, you know, that same thing where we’re putting our emotional tenor or our feelings, we’re layering those on top of the other person. The person who is likely dealing with thoughts of suicide is already feeling so alone, overwhelmed, and finding themselves in such a dark place that actually being seen, or them realizing that somebody actually gets how they’re feeling, is why there can be this reported sense of relief when somebody clearly asks you that. And so instead of, you know, the goal is not to say, I think or I know you’re thinking about suicide, it’s more to say I, you know, I know a lot is going on or I know you’ve been dealing with depression or just to say, you know, on seeing you, you look different. Are you having any thoughts of killing yourself? We’re really trying to give them the opportunity to answer that question. Rather than saying, I know you are, because, again, not knowing how they perceive the relationship or where they’re really feeling, it could then feel accusatory. But I think if we ask, are you that that is a good place to be? Because really trauma informed care talks about collaborating and, you know, giving the person empowerment to share and work through what type of clinical care they want or what type of care they want. So in some ways, what we’re really doing is telling them, I see that you’re struggling and are you having these thoughts? And if they were to say yes, then there needs to be a follow up to say, you know, can you come with me so we can get you some help? Rather than saying, oh, you know, you should call the number on the back of your insurance card and try and get a psychiatrist want you to then actually hold their hand and help them to the next level, whether that’s deciding that you want to help them go to the emergency room and waiting for them with them till they get seen, or if they have a psychiatrist or a therapist making a call together to that practitioner to say, you know, let’s get your clinician involved and see what the next steps are. So it’s not just asking the question, but then it’s also taking the next step with the person. If they were to share that they are struggling with those thoughts.
Gabe: How important is it to acknowledge that this is traumatizing? It seems like in mental health care we have this. Well, it was for your own good. Or the ends justify the means or oh, I’m sorry you’re so traumatized, but what were we supposed to do? You have no idea how you were acting. There doesn’t seem to be a lot of desire or appetite to actually acknowledge that something can both be in your best interest and traumatizing.
Jasleen Chhatwal, MBBS, MD: Yeah. And I think that’s very unfortunate. I do see a gradual shift. It’s not as fast or as absolute as one may want it to be. And I think about, you know, improv, which is this and that. It’s not this or that. So it can be, yes. This is what steps had to be taken to imminently keep you safe. And I can see how that could have been overwhelming and traumatizing because at the end of the day, what is trauma? Trauma is anything that overwhelms that individual’s capacity to cope in the moment. So what is traumatizing for you may not be traumatizing to me, and what’s traumatizing to me may not be traumatizing to you. So. So really, even trying to understand what that person’s experience was is a place to be to say, you know, I know yesterday when you were having these intense thoughts of suicide and this involuntary process had to be started. It was a really hectic day. How are you doing in the aftermath of that? Like would you like to talk more about it? So once that person is sort of on the other side of that acute crisis, in some ways you’re trying to get them to talk about it, to process it, to work through it.
Gabe: Dr. Chhatwal, thank you so much for this. And I know we’re almost out of time, but I saved a very big question for the end. Is there anything that our listeners can do to help lower the suicide rate?
Jasleen Chhatwal, MBBS, MD: Thank you for asking that question, Gabe. I think it’s a very important one because this is how we as a community, we as a people, come together to keep each other safe. I think one of the big things is to reach out if you know a loved one who is undergoing something very stressful or, you know, they have a mental health condition and, you know, they’re in an acute exacerbation of anxiety, depression, psychosis. It’s really important just to reach out and reach out with a willingness to listen, talk and listen and ask them how they’re doing. Approaching that with a non-judgmental stance, you know, and again, the same thing we were talking about earlier, there’s little need often to give advice unless something very imminent or of concern is about to happen, but really asking them how they’re doing. Asking them how they’re seeking care. Are they seeking any care? Asking them about if they’re having any thoughts of suicide or ending their life. Help them connect with supports. I think all of us can pretty easily remember a three digit number nine, eight, eight. Like if you don’t know what else to do, maybe have your loved one call 988.
Jasleen Chhatwal, MBBS, MD: If you’re the one thinking about suicide or having thoughts of death. Thoughts of wanting to end your life again, call 988 yourself. There’s also a text helpline, which is I think it’s 741741, and you can text “HOME.” That’s also another way to get help. Reassuring the person that oftentimes, no matter what is going on, it will get better over time. And then helping connect them with resources becomes important. So really taking all of that is important. And then if there’s any concern about suicide or even harm to somebody else, removing all means of harm, like any lethal weapons, any medications, etc., that the person may have becomes really important. We call it, you know, removing access to lethal means. And that’s a very, very important component as well. If the person is acutely struggling, don’t leave them alone. I think, you know, at the at the end of the day, we really sometimes forget how much impact just connection can have. So being there, connecting. And for the person to know that you’re somebody who they can get some support from can be sometimes the biggest things we can do.
Gabe: Dr. Chhatwal, thank you so much for being here. Where can folks learn more or find you online?
Jasleen Chhatwal, MBBS, MD: I work at Sierra Tucson, which is a residential treatment center at Tucson, Arizona, or north of Tucson, Arizona. You can find me on their website, which is SierraTucson.com. And then I’m also active on LinkedIn, Instagram as just some places where I try to provide some mental health resources and can be reached.
Gabe: Dr. Chhatwal, thank you so much for being here.
Jasleen Chhatwal, MBBS, MD: Thank you so much for having me. And this is one of my favorite podcasts to be on ever. And thanks for all that you do for the mental health community, Gabe.
Gabe: Oh, thank you so much. My name is Gabe Howard, and I’m an award-winning public speaker who could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon. However, you can get a signed copy with free show swag or learn more about me just by heading over to my website, gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and you don’t want to miss a thing. And hey, can you do me a favor? Share the show. Share your favorite episode on social media. Send somebody an email. Send somebody a text message. Mention it in a support group. Sharing the show with the people we know is how we’re going to grow. I will see everybody next time on Inside Mental Health.
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