The Army Suicide Prevention Program

1
The Army Suicide Prevention Program

• Suicide Prevention and Awareness Training for the
  United States Army
• Prepared by
• The American Association of Suicidology
• And
• The U. S. Army Center for
• Health Promotion and Preventive Medicine

Cover Slide
2
Enabling Learning Objectives

• Describe primary, secondary and tertiary suicide
  prevention.
• Identify personal and environmental protective
  factors.
• Know information about local support resources
  and programs.

OH 1 a, pg 7
3
Enabling Learning Objectives

• 4. Promote cohesion and a sense of belonging.
• 5. Destigmatize and encourage help seeking.

OH 1 b, pg 7
4
The Army Suicide Prevention Program
TERTIARY
Recognizing and treating acute suicidal
behavioral
SECONDARY
Recognizing the signs of Crisis and providing
Caring support
PRIMARY
Anticipating peoples potential times of crisis
and structuring pre-emptive support systems
OH 2, pg 8
5
Structure
Secure (Tertiary)
Screen (Primary)
Spot (Secondary)
SUPPORT
OH 3, pg 9
6
Personal Protective Factors

• Easy temperament.
• Previous experience with self-mastery, problem
  solving, crisis resolution.
• Optimistic outlook.
• Social/emotional competence.
• High self esteem, self worth.

OH 4a , pg 9
7
Personal Protective Factors

• Decision making, problem solving skills.
• Sense of personal control, self efficacy.
• Sense of belonging to a group and/or
  organization.
• High and realistic expectations.
• High spiritual resiliency.

OH 4b, pg 9
8
Environmental Protective Factors

• Strong family relationships.
• Models of healthy coping.
• Encouragement of participation.
• Opportunities to make significant contributions

OH 5 a, pg 9
9
Environmental Protective Factors

• Available social supports.
• Available helping resources.
• Healthy spiritual/religious affiliation.
• Cultural and religious beliefs against suicide
  and in support of self-preservation.

OH 5 b, pg 9
10
Support

• The Reasons for Living Inventory, Linehan,
  Goodstein, Nielsen Chiles (1983)
• Spirituality and Resilience Assessment Packet,
  Version 4.2, Kass (2000)

OH 6, pg 9
11
Connections save lives.

• Spiritual connectedness
• Unit cohesiveness

OH 7, pg 10
12
Seeking help is a sign of effectively dealing
with problems, and of strength rather than
weakness.
OH 8, pg 11
13
A good leader does not expose those under his/her
command to unnecessary risk.
OH 9, pg 11
14
Support

• Promote a norm of mutual support among all
  military personnel we are our brothers
  keepers!
• Pay attention to warning signs and respond to
  those who need help.

OH 10 a, pg 11
15
Support

• Pay close attention to the personal needs of your
  people, and be on the lookout for signs of
  stress.
• Communicate in your words and actions that it is
  not only acceptable, but a sign of strength, to
  recognize life problems and get help to deal with
  them constructively.

OH 10 b, pg 11
16
Support

• Support and protect to the fullest extent
  possible those courageous people who seek help
  early, before a crisis develops.

OH 10 c, pg 11
17
Support

• Create a responsive, caring, and responsible
  community where individuals are motivated to seek
  help with personal struggles without fear of
  stigmatization.

OH 10 d, pg 11
18
Support

• Foster a social climate in your unit that
  communicates to everyone, you belong here.

OH 10 e, pg 11
19
Enabling Learning Objectives

• Understand the benefits of gated screening.
• Be informed about the confidentiality of
  screening results.
• Be informed about secondary screening instruments.

OH 1, pg 14
20
Screen

• The Army Structure makes screening viable.
• Screening must be gated.
• The Suicide Prevention Task Force collects and
  reports anonymous data.

OH 2, pg 15
21
Screen
Goldberg Well-Being Scale (1972)


Please
circle the most appropriate response In the
last two weeks have you

• Not No more
  A little more A lot more
• at all than usual
  than usual than usual

1 2 3 4 5 6 7 8 9 10 11 12

• Been able to concentrate on whatever youre
  doing?
• Lost much sleep over worry?
• Felt that you are playing a useful part in
  things?
• Felt capable of making decisions about things?
• Felt constantly under strain?
• Felt that you couldnt overcome your
  difficulties?
• Been able to enjoy your normal day-to-day
  activities?
• Been able to face up to your problems?
• Been feeling unhappy and depressed?
• Been losing confidence in yourself?

1 1 1 1 1 1 1 1 1 1 1 1
2 2 2 2 2 2 2 2 2 2 2 2
3 3 3 3 3 3 3 3 3 3 3 3
4 4 4 4 4 4 4 4 4 4 4 4
OH 3, pg 16
22
Screen

• Goldberg Well-being Scale information will be
  disclosed only to the individual and will be used
  only to assess and assist personnel during of
  times of distress
• Unit Trends may be reported to the Unit Commander
  as a gauge of his/her unit well-being

OH 4, pg 17
23
Screen

• Multidimensional Health Profile (MHP) Ruehlman,
  Lanyon Karoly
• Life Stressors and Social Resources Inventory
  (LISRES-Adult), Moos

OH 5, pg 17
24
Gatekeeper Lesson 1

• All Personnel

OH 1, pg 23
25
Gatekeeper Lesson 1Enabling Learning Objectives

• Understand The Suicide Model.
• Answer general questions about suicide.
• Identify common precipitants of suicide.
• Identify symptoms of depression.
• Identify myths about suicide.
• Identify warning signs of suicide.
• Take appropriate action in response to at-risk
  individual.

OH 2 , pg 23
26
Main Points

• The Suicide Model.
• What is suicide?
• Why should we know about suicide?
• Why do people commit suicide?
• Some stressful situations that can trigger
  suicidal feelings in the Army.
• Who commits suicide?

OH 3 a, pg 24
27
Main Points

• Groups with special problems that can cause
  suicidal feelings.
• Misconceptions about suicide.
• How can you tell if someone is thinking about
  committing suicide?
• Common symptoms of depression hopelessness.
• Referral procedures.

OH 3 b, pg 24
28
Suicide Model
Prevent The disorder before it occurs
(Depression, anxiety, and substance abuse)
Disorder
(Relationship losses, or career, legal and
financial trouble)
Stress Event
(Anger, anxiety, hopelessness, depression)
Mood Change
Access to method, acceptance of suicidal
behavior, isolation, impulse, loss of
close relationship by suicide, avoids treatment
No access to method, no acceptance of
suicide, support/ emotional expression, seeks
treatment
Inhibition
Facilitation
Survival
Suicide
Based on a model by David Shaffer, M.D.,
Columbia U.
OH 4, pg 25
29
The Problem of Suicide

• Serious suicidal thoughts or threats.
• Self destructive acts
• Attempts to harm, but not kill oneself.
• Attempts to commit suicide.
• Completed suicide.

OH 5, pg 25
30
Categories of Suicide

• Lack of control related to needs for achievement,
  order, or understanding.
• Problems with self-image related to frustrated
  needs for affiliation

OH 6a, pg 26
31
Categories of Suicide

• Problems with key relationships related to grief
  and loss in life.
• Excessive anger, rage, and hostility.

OH 6b, pg 26
32
Numbers and rates per 100,000 of Suicides in the
Army
OH 7, pg 28
33
Gatekeeper Lesson 2

• Officers NCOs

OH 1, pg 41
34
Gatekeeper Lesson 2Enabling Learning Objectives

• Inquire about suicide.
• Respond to phone callers.
• Obtain help for suicidal individuals.

OH 2, pg 41
35
Responding to Statements or Threats

• Stay calm.
• Send someone for help.
• Do not leave alone.
• Buy time.

OH 3 a, pg 42
36
Responding to Statements or Threats

• Acknowledge.
• Listen.
• Convey.

OH 3 b, pg 42
37
Responding to Statements or Threats

• Secure.
• Note the time.
• Take action.

OH 3 c, pg 42
38
Asking About Suicide

• Review your evidence.
• Inquire or state about feelings.
• Persist.
• Sometimes approach.

OH 4 a, pg 43
39
Asking About Suicide

• Ask directly.
• Get help.
• Convey concern.

OH 4 b, pg 43
40
The only thing that will save a human life is a
human relationship.
OH 5, pg 47
41
Gatekeeper Lesson 3

• Formal Gatekeepers

OH 1, pg 50
42
Gatekeeper Lesson 3Enabling Learning Objectives

• Identify Risk Factors for Suicide.
• Conduct Basic Risk Assessment.

OH 2, pg 50
43
Risk Assessment Questions

• Have you been thinking of killing yourself?
• What has happened that makes life not worth
  living?
• How will you do it?

OH 3 a, pg 52
44
Risk Assessment Questions

• How much do you want to die?
• How much do you want to live?
• How often do you have these thoughts?
• When you think of suicide, how long do the
  thoughts stay with you?

OH 3 b, pg 52
45
Risk Assessment Questions

• Have you ever attempted suicide?
• Have you been drinking heavily lately or taking
  drugs?
• Has anyone in your family committed or attempted
  suicide?
• Is there anyone or anything to stop you?
• On a scale of 1 to 10, what is the probability
  that you will kill yourself?

OH 3 c, pg 52
46
Secure
Health Care Professionals
OH1, pg56
47
Enabling Learning Objectives

• Become knowledgeable about Army suicide policies
  and procedures.
• Conduct Advanced Risk Assessment.

OH 2, pg 56
48
Local policies and procedures set by the Suicide
Prevention Task Force

• An individual suspected of being at risk for
  suicide.
• An individual who is talking about/threatening
  suicide.

OH 3 a pg 57
49
Local policies and procedures set by the Suicide
Prevention Task Force

• An individual who attempts suicide.
• A completed suicide.

OH 3 b, pg 57
50
Steps in Suicide Assessment

• Set the stage for the interview.
• Assess for risk factors and warning signs for
  suicide.
• Inquire about suicidal ideation.
• Determine the level of suicide risk.

OH 4, pg 58
51
Assessing the Suicide Plan

• Perturbation.
• Cognitive construction.
• Intentionality.
• Lethality of the plan.

OH 5, pg 58
52
Assessing the Suicide Plan

• Specificity.
• Method or means.
• Availability accessibility of means.

OH 6, pg 59
53
T Thoughts I Intent P Plan M Means
OH 7, pg 60