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Dr. Betz: Care of Suicidal Patients Takes Humans, Not Just Doctors

In podcast: Stress, lack of connection may impact increasing suicide rates

minute read

Written by Guest Contributor on October 22, 2019

In 2019, nearly 31,000 people have died due to gun violence. Suicide by firearm represents nearly two-thirds of those deaths. As an emergency physician at CU Anschutz, Emmy Betz, MD, sees multiple patients with suicidal thoughts on every ER shift. “It’s a huge part of my job,” Betz said. “Sometimes I have to stop being a doctor and just be a person, to let people know I’m glad they came in and that tomorrow will be better.”

On this episode of the CU Anschutz 360 podcast, you’ll hear about:

  • Two key questions to ask someone who is having suicidal thoughts;
  • The Colorado Firearm Safety Coalition’s gun storage map, which provides temporary, voluntary firearm storage;
  • What we need to teach kids about mental resilience and being “tough”;
  • Whether childbirth or giving a Tedx Mile High talk is worse;
  • How she practices self-care while dealing with an emotionally harrowing career.


Dr. Emmy Betz spoke on the topic of:

"How to talk about guns and suicide" at TEDxMileHigh.


Betz said, “As medical students and doctors we get really hung up on the order we’re supposed to ask things in, and in using the ‘right’ words.” But, she added, what you say isn’t as important as just saying something. “Life is hard. We all have our ups and downs, and mental illness is real—you can have everything on paper be perfect but be struggling with depression or anxiety. We need to make it okay to ask for help.”

That help might include temporarily and voluntarily limiting restricting access to guns, to create a safer environment. “Guns are lethal. They are meant to be lethal. With guns, 9 out of 10 people don’t get a chance to regret their choice,” Betz said.

Betz recently traveled to Washington, D.C., to serve on a panel of public health experts for a congressional gun violence prevention roundtable. The event was organized by U.S. Rep. Raul Ruiz, MD (CA), and included participation from House Speaker Nancy Pelosi with attendance by two members of the Gun Violence Prevention Task Force – Chairman Rep. Mike Thompson (CA) and Vice Chair Rep. Jason Crow (CO). 

Of participating in the congressional roundtable, Betz said, “It was humbling and thrilling to be able to share our work and promote collaborative solutions.”

Podcast with Dr. Emmy Betz:


Guest contributor: Shawna Matthews, a CU Anschutz postdoc


Episode Transcript 


Shawna Matthews Hello, I'm Shauna Matthews with the Office of Communications. I'm joined today by Dr. Emmy Betz, who is a practicing physician at the University of Colorado Emergency Department on the CU Anschutz Medical Campus. 

Dr. Betz is an associate professor of emergency medicine and co-founder of the Colorado Firearm Safety Coalition. Dr. Betz is a nationally recognized expert on lethal means restriction and the care of suicidal patients. She's federally funded by the National Institute of Mental Health and the National Institute of Aging and has 90 peer reviewed citations. First question, do you ever sleep?

Emmy Betz I actually sleep a lot. I really love naps (laughs). [Music fades]

Shawna Matthews (Laughs) Great. So you are one of the country's top experts on firearm suicides. How did you know that this particular torch was for you to carry, why you?

Emmy Betz I wish I had a sort of 'aha story' where it was clear to me from childhood. But I think it developed slowly. It was a convergence of really seeing a need in the emergency department and we care for a lot of patients with suicide risk and I want to do better for them. And then also once I learned the statistics about firearm suicide in particular was just sort of blown away and also realized it was something I could really have a voice in. It also has some personal meaning for me, we've lost family members and so it feels good on all fronts to be working on it.

Shawna Matthews When you're working in the ER, how frequently do you encounter patients with depression or suicidal thoughts?

Emmy Betz Every time, a couple a shift at least. It's a huge problem and I think some of that is that there aren't great outpatient resources for people, so people often end up in the ER. But it's also just much more common than we wanna talk about. We all go through ups and downs in life and we need to break down that stigma. But it's a huge part of my job.

Shawna Matthews Do you think it's increasing?

Emmy Betz I think so. And you know, we certainly know that suicide rates are increasing. I don't know why. In my own life, I will say, I feel like, you know, the phones and not connecting with people, and political stress, and climate change, and existential threats. And I think all those things. It feels like people are more stressed than maybe they used to be, but I don't know. You'd have to ask prior generations also.

Shawna Matthews Do you remember your first patient that came in who was suicidal?

Emmy Betz I was gonna say, I remember my very first patient actually had ringworm. But that was a long time (laughs), that was a long time ago. We see a lot of things in the ER. There's not really one that sticks in my mind because they in some ways blur together because there are so many commonalities, I think, in what people are going through. So I don't have that one standout story.

Shawna Matthews How did you learn to talk to people who are having suicidal thoughts?

Emmy Betz I think a lot of practice. And I think recognizing that one of the basic things we can do for patients - or our friends or family who are going through tough times - is give them hope. And so some of it was realizing that I needed to stop being a doctor and just be a person. And just be honest that: I'm glad they're there and I hope we can help, and tomorrow will be better.

Shawna Matthews So it seems like the general thinking is that if you take a gun away from someone, they will just find another method to try and hurt themselves. Do you find that to be the case?

Emmy Betz So I would say no - for we know from research that actually that is not the case. There's often this very short time period between when someone decides to try to kill themselves and takes action. Sometimes in the space of minutes to hours. It's not that it's impulsive, like completely out of the blue, that you suddenly decide to attempt suicide. I mean, there's usually something going on, whether it's mental illness or social stressors or both, but that very high risk period is often again, space of minutes to hours.

And so we know if someone gets through that period, they're unlikely to attempt suicide. In fact, we know from research that among people who survive a suicide attempt - only 10% later die by suicide. And at 10% fatality rate or at 90% survival rate: that's much better than a lot of cancers, Ebola, all these things we spend a lot of time thinking about. It is a very common misperception that people will automatically just find another way. It's really just not true.

Shawna Matthews The last thing I would say about that too, is that for the very small proportion who do try another method, it's far less likely to kill them. So firearms are lethal, they're supposed to be lethal. And so-

Shawna Matthews [Crosstalk] A second chance.

Emmy Betz Yeah, there's no second chance. There's no regretting what you just did. There's no regretting taking the medications and calling 911. They usually don't even get to the ER because they die at the scene. And so sometimes people say, "well, you're just picking on the guns, why are you only talking about the guns?" And that's why, because they're lethal. We should also be making sure medications are locked up and we should be putting barriers on bridges and those other kinds of things. But the firearms are the most lethal method, which is why we talk about them the most.

Shawna Matthews So your work on firearm suicide was the basis of your TEDxMileHigh Talk in 2015, and a TEDx Talk is not something that scientists and physicians typically do. In a scientific talk, you have figures and tables that if you forget what you're about to say, you can just go back to the data. Not the case with the TEDxMileHigh Talk. So whatever possessed you to say 'yes' and what was the experience like?

Emmy Betz Well, I will say, I probably say yes to too many things (laughs). I was really honored to be invited to do it. I think whenever I speak, even things like today, I consider this an opportunity to try to educate the public. And I think in clinical medicine and in science, we have a deep responsibility to do that. And so if I can try to do it, I always will. The TEDx Talk was really crazy. I think it's good I didn't know what I was getting into in some ways. I mean, I think there were 2,500 people there maybe, and it was at the Ellie Caulkins Opera House.

So I remember on the stage, you know, there's like the five levels of people. And there's no teleprompter, so you have to basically memorize it. And there were no slides. I did some speaking courses before it and I practiced a lot. And I'm so glad that I did it because it really made me realize, that maybe one way I can help in the epidemic of firearm suicide is by bringing a voice to it and helping educate.

Shawna Matthews Would you ever do another one if they asked you to come back?

Emmy Betz Sure. Yeah, yeah.

Shawna Matthews Did you forget any part?

Emmy Betz No, I didn't. I do remember I have a very vivid memory of standing backstage thinking, "Maybe I'll just not do it." (Laughs). And then saying, no, that's silly and-

Shawna Matthews Is that an option? Can you run, would they find you?

Emmy Betz I mean, you would look like pretty stupid probably 'cause it's a live audience.

Shawna Matthews (Laughs).

Emmy Betz But I would for sure do it again if I had the opportunity and I've done lots of other awesome, but odd things since. I think most recently the one that stressed me out the most, but was wonderful, was I was invited to go to Buckley Air Force Base. To talk about the same subject. And it ended up being in a gym with, I don't know, a couple hundred airmen talking to them about their guns. And it was sorta like a pep rally 'cause it was in a gym and we were all in jeans and it was like a totally different vibe, but it was awesome. So I'm up for anything (laughs).

Shawna Matthews So in your Ted Talk, you say something to the effect of: "When you're talking to someone who has suicidal thoughts, it's not so important, what you say, but that you say something at all." Can you talk more about that?

Emmy Betz So like I was saying about at times forgetting I'm a doctor and just being a person. And I think it's especially true in the clinical realm as medical students and doctors. We get really hung up on - the order we're supposed to ask things in, in the right words. And a lot of it is just about trying to connect with people.

I thought about this also in the context of firearm safety, generally when I was thinking about play dates and how do I ask parents if there are guns in the home and I was so stressed out about the right words. At the end of the day, a lot of it I really think is just about showing that you care about someone that you're not judging them. That you want everyone to be safe. And I think again for friends or family who might be having a tough time, helping them see that there's hope and that they can get better.

Shawna Matthews So not to put you on the spot, but in your Ted Talk, you say that there are two questions that you should ask somebody who is having suicidal thoughts. Do you remember what you said (laughs)?

Emmy Betz I do thankfully, phew.

No, so the one is that if you're worried about somebody, you should ask, if they're having thoughts of suicide. That won't trigger them to do something - it's okay to ask.

And then the second question is if they say 'yes,' to then ask if they have access to firearms. And if they say 'yes' to that, then you figure out what you can do to make their home a little safer. Just locking up the guns does not fix the problem. I wanna be clear about that. People need whatever kind of treatment it is. They need maybe it's substance abuse, maybe it's counseling, maybe it's medications, but the point is to make their home as safe as possible during that time.

Did I get them right? Was that the two questions [crosstalk]?

Shawna Matthews Yeah [crosstalk]

Emmy Betz Oh good (laughs).

Shawna Matthews You nailed it.

Emmy Betz [Both Laughing] Ok! Phew!

Shawna Matthews I thought about making you do the full thing just start to finish to see how much of it you could remember, but I passed.

Emmy Betz I probably could do a bunch of it, but I've sort of blocked it out also (laughs).

Shawna Matthews Yeah, that's fair. Like childbirth (laughs).

Emmy Betz Yes, it's exactly. I'm not sure which was worse. No, no, no, no, no (laughs).

Shawna Matthews So one of the many hats you wear is you are one of the co-founders of the Colorado Firearms Safety Coalition. You work with gun shop owners, range owners and their clients to basically educate about gun safety. So how do you think that changes the reach of your gun safety message?

Emmy Betz I mean, I am just so grateful for the group I've been working with. Because at the end of the day, the people who need this message are people with firearms in their home. And so by going through the trusted locations, the gun shops, the ranges, that is how we get that message out. And I think one of the other presentations, I was probably, again, more worried about than the TEDx Talk was: a ladies night at the gun club a couple years ago. And I remember like a hundred women there who'd come to shoot and there's not wine at ladies night. It's not book club (laughs).

So there's brownies and lemonade and things, but it was just awesome talking to these women who were all very gun smart, I would say. But they asked those same questions. Is it really okay to ask if someone is suicidal? What do I do if I'm worried about my teenager? The same questions that I think we all can have, but I just really felt like the public health community had not found a way to get the message to them yet.

Shawna Matthews Mm-hmm (affirmative).

Emmy Betz And so it just was awesome. I hope we'll do it again soon.

Shawna Matthews And so one of the key demographics at particular risk of suicide by firearm is white middle aged men. Do you have the answer why that's the case? And what can be done to speak to that group in particular?

Emmy Betz I don't have the magic answer. I think a lot of it has to do with cultural norms. Stigma against you know, men asking for help, admitting they're having trouble, right? All these, I would argue, outdated images we have of men as sort of tough and 'men don't cry' and all of that nonsense. We know that suicide rates in men are also higher because they tend to use firearms more than women. Then they're more likely to die. So I think part of it is that we need to be finding ways to engage men in these conversations earlier. And, 'Man Therapy' is a phenomenal project that I wish I had been part of. I just love it so I just talk about it. The State of Colorado developed it specifically to reach out to the sort of middle aged white men.

That it's not about therapy or suicide prevention or any things like that, but it's really a sort of funny way to address the risk factors. That if you're going through a tough time or substance abuse, I highly recommend people check it out. So I think part of it is about: how do we really engage men, and making it okay to acknowledge that they're going through tough times.

And then I think for the firearm piece of it, I think a lot of it is gonna be how do you engage them in looking out for each other? So I often use the analogy of the designated driver. Your sorta battle buddy. It often might not be the wife who they really wanna talk to, but maybe it's their good buddy who's like, "Hey man, let me, let me help you. Can I hang on to your guns for a while?" That kinda thing.

Shawna Matthews Mm-hmm (affirmative).

Emmy Betz But nobody's figured it out yet. It's one of the things we're working on.

Shawna Matthews What do you think we need to teach the next wave of boys that will become men? What do we need to teach them to keep this from being their cross to bear as well?

Emmy Betz Oh, that is a good question. I have two girls so in some ways I haven't had to think about this too much. But I mean, I think it's hard. There's this mix, right? You wanna teach people grit and resilience and overcoming adversity and not complaining about everything. But at the same time, we need to recognize that life is hard. And we all have our ups and downs and mental illness is a real thing. That is: you can have everything on paper, be perfect, but be struggling with depression or anxiety. And so we need to make it okay to ask for help for those things. And I think to recognize that mental health is just as important as physical health. And we need to stop separating them and stigmatizing one.

Shawna Matthews We have lots of ways to assess physical fitness, right? Do you have any ways on how to assess mental fitness?

Emmy Betz Gosh, that is a great question. I mean, it's not the area I work in so much, but I would say off the top of my head -what I think about is some things like Man Therapy actually have like assessments you can do for yourself to kinda see where you're at. But I think a lot of the programs, for example, for healthcare providers around like mindfulness and sort of ways to check in and assess yourself. And for providers checking in on things like burnout and the sort of secondary trauma of going through things with people. That's all really important. And we're definitely teaching it more, which is great, but I don't have some larger plan.

Shawna Matthews Recently the Colorado Firearm Safety Coalition released a gun storage map. So how's that going? How is it being received? Are you getting any push-back for that?

Emmy Betz No, actually since it came out we have had a few stores call in asking to be added. Which is awesome. And we have I think nine or 10 other states who are interested. So we now have a sort of set up for calls and we're gonna try to make a multi-state map of, kinda anyone who wants to add in their data so that we can keep growing it. You know, it was an unfunded side project, so we don't have the capacity to take on the whole country (laughs).

But, it was a great project and I hope it's useful. And I think it's useful to people looking for storage, but I think it's also opened up a bunch of issues and questions that nobody had thought about before. Like around liability, and in storing and returning, and the cost associated with it for law enforcement and so forth. So I hope it will help maybe settle some of those questions as well.

Shawna Matthews So the purpose of that is to have a safe place to store guns so they're not in the home?

Emmy Betz Correct. So we thought about it in the context specifically of suicide risks. If I, as a provider, I'm recommending that somebody temporarily voluntarily get their gun out of the home, where do you do that, right? And so we knew there's a map for opioid take back locations, right? Where you can see the pharmacies. And so we were like, "Oh, we should make one for firearms." And there's an awesome student on campus who is doing his masters in public health and then going back to med school. So he called hundreds of gun shops over the summer and got the data to make this map. So it's gun stores and law enforcement agencies that are willing to at least consider storage.

So we also said, "Look, it's still up to you case by case. You do what you want, you follow your own policies and so forth." And it, although we were thinking of it in the in the context of suicide risk, I think it could be useful for lots of circumstances, right? Like, let's say, you're going outta town for a month. You're renting your house on VRBO, your grandkids are coming, right? So it's not specific to suicide. But, hopefully it'll be useful and we've heard from at least one store that at least one person has called in asking for storage. So, that feels like a win (Laughs).

Shawna Matthews That's good. Yeah. (Laughs) Count the wins.

Emmy Betz Yeah.

Shawna Matthews So I wanna switch gears for just a second and talk about other things than work. So you have a family, you mentioned that you're a mom to two girls, so I'm not gonna ask about work life balance because I hate that question. But I wanna ask you about how you feel about work life balance. Does it bother you that women get asked that question more than men?

Emmy Betz Yeah, absolutely. My side work gig, I suppose, is I feel very passionate about equity issues on campus. Women's leadership and women supporting other women and issues within the workplace of women not being identified as physicians. 

I will say I'm raising two feisty little girls who do not take any nonsense. And you know, my husband has been along and onboard the whole time too. I mean, I think he was the one who was like, "We need to go to the women's march." And I don't really like crowds. So I was like, "Really?" And he's like, "We gotta go." And I was like, "Okay, yeah, you're right. We gotta go." (laughs) So, it's bit by bit.

And does it mean that our lives are perfectly balanced? Of course not. But I think having those conversations and talking with our kids about gender issues and race issues - we haven't figured it all out, but we're trying. And it's great to see how easily kids take to it and they get it. And then they're like, "Why did people use to think that crazy thing?" And it's like, "Yeah, that was 10 years ago, but you're right. It's crazy." (laughs).

Shawna Matthews

(Laughs) And then we have to explain the ‘sins of our fathers.’

Emmy Betz Yeah, yeah. But you know, it's real. My husband's an attorney. And we've had lots of conversations about how in many ways the legal profession is I think a little bit behind the medical profession. And I think it was easier for me to take parental leave than for him to take parental leave. Things that just, I hadn't really expected to run into. So, day by day.

Shawna Matthews So speaking of day by day, at the end of the day, how do you step down from the weight of your profession? You said that on every shift you encounter patients who are having suicidal thoughts, how do you take care of yourself to be able to go back and do it the next day?

Emmy Betz Yeah, it's- it's tough. I think it's taken me awhile to figure out what works for me. I think a lot of it is self compassion and recognizing. It takes me about two hours after a shift before I can care about anyone (laughs). 

So I used to get home from work and be useless as a spouse and a mom. And I literally would - just felt like I had to lie on the living room floor and stare at the ceiling. Then I would get really sad at myself. I was like, "Oh, I don't, I want to play with my kids and all that." And I've now realized it's really right around the two hour mark for me suddenly, I am back.

And so the, having the self compassion to recognize that's okay, and that is my wash out period that I need to transition. And you can't be everything at once and that's okay. And my kids get that too now. In the same way we talk about if you're angry, sometimes you just need to step away. So it's hard. It's hard as I get older too, I'm more tired I feel like, the sleep is harder (Laughs). But, I'm always looking for new strategies for how to balance that out and find the longevity - that it's a marathon and not a sprint.

Shawna Matthews So for the next phase of your marathon, you also have several publications and funding for research on aging patients and driving behaviors. Where do you see your career going from here?

Emmy Betz Yeah, so I now think of the work I do as patient centered injury prevention - is how I like to describe it. That I'm really interested in the clinical setting, how we work with patients to help them live their best lives by preventing injuries. So that includes: suicide, specifically the firearm piece, and older drivers making decisions about when to stop driving. Now we're doing some I think really interesting work around dementia and firearms and how people can make choices there. I seem to really tackle controversial subjects. And I've been really grateful over the past year or so to be doing more and more work in national organizations and work groups. And I hope that will continue. So I don't sorta know where it's going. I don't have some 10 year plan right now.

The science is really important to me because we need science to drive what we're doing and we should be doing evidence based work. At the same time I really love the speaking and engagement and working in different work groups and things. So someday will I have stopped doing the science myself, I don't know maybe? 

But I think for now, these three topics really are feeling great to me. And so as we sort of flesh them out and think about how we engage with providers and patients in the community...I don't know, I'll probably listen to this in a couple years and laugh. (Laughs) I wish I had a vision, but maybe that's part of having small kids - it's kind of a day at a time (Laughs).

Shawna Matthews Do your daughters want to be scientists?

Emmy Betz No, I don't know. They both love math. The funny thing is in my house, I am the one who's bad at math, which sort of cracks me up that I'm a scientist and they only go to their dad for math homework. Which is not a gender thing - it's just that the three of them are off the charts. But (laughs), I think one wants to be a vet. For a while, one wanted to be a singer or ballet dancer. So I don't know what the latest is, but I do love - I have a picture in my office that my daughter drew for me when she was probably five or six. And it's a picture of a person speaking to a big audience and also a picture of the person lying on a bed, listening to the radio.

And I said to her, "Oh, is that mommy speaking and you listening to me?"

And she looked at me and she said, "No, that's me speaking. And me listening to myself on the radio."

And I felt like I won, yeah (laughs). It was a good role model moment.

Shawna Matthews That's right, raising strong girls. (Laughs)

Emmy Betz Yeah. I mean just to have a voice and to make the world a little better somehow. That's what we're trying to instill in them. I don't actually care if they do science or medicine. I want them to feel like they should make each day a little better for other people.

Shawna Matthews Well, Dr. Betz, that is all I have. Thank you for taking the time to come be with us today.

Emmy Betz Oh, thank you so much.

Disclaimer: Transcripts are generated using a combination of speech recognition software and human transcribers. It may contain minor differences from the audio, including some edits for clarity in print. Please check the recording and with the Communications team before quoting in print.