Ing Says: Sometimes its the simple things
Trauma-Informed Care in Action Episode 3: Flagstaff Medical Center Suicide Assessment
This is part of an ongoing series on trauma-informed care. Read [Episode 1: I Was Wedged in a Corner Clutching a Sweater] and [Episode 2: They Broke the Law and Got the De-Escalation Right. Both Things Are True.] Or start with [What Is Trauma-Informed Care?]
The ER at Flagstaff Medical Center has met me while suicidal several times now.
By now, several members of their suicide assessment team know how I communicate.
Which is to say: I usually tell them exactly where I’m at. I don’t hide it. I assess my own risk levels clearly, because I can. Because I know myself. That kind of self-knowledge — hard-won, sometimes brutal — is one of the few things this process has given me that I’d actually keep.
Wednesday, June 18, 2025, was harder.
I knew I had held the means in my hands of my own demise, multiple times in the past 18 hours, preparing to follow through.
I knew the only thing that stopped me was Cinnamon.
And I also knew that the immediate danger had passed. I had cried, dissociated, begged to disappear — but by the time I got to the ER, I was looking ahead again. Making other plans. Choosing life, even if shakily.
Still — the ER had caught wind that this visit was more than dehydration and overheating. Which meant a suicide assessment before discharge.
The Assessment
Cinnamon was draped across my legs, calm and steady, when the assessor came in. Someone who had evaluated me before. Someone who already knew that I don’t perform wellness and I don’t perform crisis — I just tell you what’s actually happening.
Him: “Okay, Malene. How bad is it?”
That question. Four words, no preamble, no clipboard-voice. Just: how bad is it?
That is trauma-informed care before a single principle has been formally applied. It is the recognition that I am a person who can answer that question honestly — and the choice to ask it like I can.
Me: “Ideation, yes. But no intent.”
Him: “Are you looking for inpatient? We’re out of beds upstairs.”
Me: “I think the quiet of the forest is better for me right now. I might’ve taken a bed, but I’m safe. I just need the quiet.”
We did a few more rounds — risk factors, intent, means, protective factors. The kind of assessment that can feel like an interrogation when it’s done wrong, and feels like a conversation when it’s done right.
This was a conversation.
And then, finally, with a wry smile I did not plan:
Me: “If I were going to kill myself, I would’ve yesterday.”
Him: (a slight chuckle)
Not because it wasn’t serious. Because it was — and because we both knew it, and because sometimes that kind of dark honesty is the only thing that accurately describes where you are. He didn’t flinch. He didn’t over-correct into clinical concern-face. He heard it for what it was: the truth, delivered by someone who had made it through the night and was sitting in front of him to prove it.
He left to speak with the doctor. When he returned, he offered me options. I declined. The quiet of the forest was the right call — then and now.
About thirty minutes later, Cinnamon and I were in the front lobby, waiting for our ride.
Why This Was Trauma-Informed Care
There were no grand gestures here. No one knelt on the floor. No one had to de-escalate a room full of staff. It was quieter than that.
It was Safety — in the form of a familiar face who already knew my communication style and met me inside it, not outside it.
It was Trustworthiness and Transparency — “Are you looking for inpatient? We’re out of beds upstairs” is honest. It doesn’t dress the situation up. It gives me real information so I can make a real decision.
It was Empowerment, Voice, and Choice — he offered options. I declined. That was allowed. My assessment of my own safety was treated as valid input, not as something to be overridden.
It was Collaboration and Mutuality — we did the assessment together. He asked. I answered. He listened to the answers. The decision that came out of it reflected both of our understanding of where I actually was.
And it was something harder to name but just as important: it was being treated like someone who knows herself. Like someone whose self-assessment is data, not obstruction. Like a person, not a liability.
That is rarer than it should be.
The Contrast
I write about trauma-informed care mostly because I’ve survived the kind that wasn’t.
Every episode in this series exists because of what happened at The Guidance Center — because Nurse Kylie Hansard, also known as Nurse Kaia Marie Manas, made a series of choices that ended in restraint, in violation, in harm. And because the system around her let it happen.
These episodes — the nurse who knelt down, the EMTs who stepped back, the assessor who asked “how bad is it?” like I could answer — exist to show that it doesn’t have to go that way. The same system. The same institutional constraints. Different choices.
The difference is possible. I know it is possible because I have lived it — on both sides.
If you have experienced the suicidal assessment that is not cooperative –
You are not alone. What happened to you was not inevitable. It was a choice made by a provider or a facility — and choices can be documented, reported, and challenged.
File with your state’s licensing board, the Office of Civil Rights, and the Attorney General. File knowing that these bodies rarely impose meaningful consequences — because the record matters regardless.
And then come to us. Between Trust and Trauma documents what happened, names the providers and facilities responsible, and connects survivors who experienced the same pattern of harm.
One incident is enough. One person harmed is enough. We document it because it happened — not because we need a pattern to justify your pain.
“Nothing About Us Without Us.”
