Suicide Prevention in the Department of Veterans Affairs

1
Suicide Prevention in the Department of Veterans
Affairs

• Juli McNeil, LCSW
• Stephen Clark, LCSW
• Suicide Prevention Program
• Jack C. Montgomery VA Medical Center and Clinics

2
Objectives

• Initiation of Program
• Local Staff
• National and Local Program Overview
• Suicide Facts and Statistics
• Suicide Risk and Protective Factors
• Safety Planning
• Aggregate Review
• What to do to help someone
• VA Programs and Services

3
Initiation of Program

• 2007 Joshua Omvig Veterans Suicide Prevention Act
• The Joshua Omvig Suicide Prevention Act
  (H.R. 327) is designed to help address
• Post Traumatic Stress Disorder (PTSD) among
  veterans by requiring mental health training for
  Veterans Affairs staff
• Suicide Prevention Coordinator (SPC) at each VA
  medical facility
• MH screening and treatment for veterans receiving
  VA care
• Supports outreach and education for veterans and
  their families
• Peer support counseling
• Research into suicide prevention

4
Suicide Prevention Program Staff

• Juli McNeil, LCSW, 918-577-3087/3699/4144
• Program Manager-Suicide Prevention
• Stephen J. Clark, LCSW, 918-628-2659
• Tulsa Suicide Prevention Coordinator

5
Suicide Prevention Program Staff

• Alexa Youngblood, LCSW, 918-577-3672/3699/4144
• Suicide Prevention Case Manager
• Wendy Vogt, 918-577-4111/3699
• Suicide Prevention/
• IOP Administrative Assistant

6
Suicide Prevention Program

• Suicide Prevention efforts, such as the Suicide
  Hotline and hiring of Suicide Prevention
  Coordinators began in FY2007 with full
  implementation in FY08
• A 24/7 Suicide Prevention Hotline.
• 330,241 callers have called the hotline
• 200,531 of those callers have identified
  themselves as Veterans or family members/friends
  of Veterans
• Over 11,329 rescues of actively suicidal
  Veterans
• Online Chat Service
• Initiated in July 2009
• Over 9335 chatters 3761 mentioned suicide
• VISN 16 Total Calls YTD 2010 9742 (2nd highest)
• VISN 22 12365 (1st highest)

7
Suicide Prevention Program

• Development of two centers devoted to research,
  education, and clinical practice in the area of
  suicide prevention
• Center of Excellence in Canandaigua, NY
• Develops and tests clinical and public health
  intervention strategies for suicide prevention
• MIRECC in Denver, CO
• Focuses on clinical conditions and
  neurobiological underpinnings that can lead to
  increased risk as well as the implementation of
  interventions aimed at decreasing negative
  outcomes and training future leaders in the areas
  of VA Suicide Prevention.

8
Program Outreach

• VA Participation in Suicide Prevention Awareness
  Month
• Sponsoring public service announcements, web
  sites and display ads designed to inform Veterans
  and their families of the VA Suicide Prevention
  Hotline [phone]-TALK/8255)
• VA has been distributing Suicide Prevention
  materials
• Suicide Prevention Coordinators are required to
  do outreach activities in all of their local
  communities
• Family psycho-educational materials

9
Local Suicide Prevention Program

• Tracking High Risk Patients
• Ensuring they receive adequate care/case
  management
• Responding to Hotline Referrals
• Local Crisis Calls
• Mail Program
• Support to MH providers
• Aggregate Reviews
• Environment of Care Rounds on Inpatient and ER
• Training VA Staff
• Operation SAVE Training for non clinicians
• Operation SAVE for all new employees
• LMS Training for Clinicians
• Completion of Suicide Behavior Reports (SBRs)
• Suicide Risk Assessments
• Safety Planning
• High Risk for Suicide
• On new research and treatment regarding
  suicide/suicidal patients

10
Local Suicide Prevention Program

• Community Outreach
• Providing VA Guide training (Operation SAVE)
• Providing information about VA care and services
• Promoting Veteran and community suicide
  awareness
• Closely working with OEF/OIF VA Staff
• Assisting the VA and community agencies in the
  dissemination of new information about suicide
  and specific intervention strategies
• Providing local providers and staff with the
  appropriate resources

11
Important Facts about Suicide

• 32,000 US deaths from suicide/ year
• Centers for Disease Control and Prevention
• 91 people die from suicide every day/every 16
  minutes
• Suicide is the 11th leading cause of death in the
  US
• Suicide is the 2nd leading cause of death among
  25-34 year olds
• Suicide is the 3rd leading cause of death among
  15-24 year olds
• Highest suicide rate is among 65 and older.
  Older white males are at highest risk.
• 4 times as many men kill themselves compared to
  women, yet 3 times as many women attempt suicide
  as compared to men.
• Oklahoma is 10th in the Nation.

12
Facts about Veteran Suicide

• 30,000-32,000 US deaths from suicide/ year
• Centers for Disease Control and Prevention
• About 20 are Veterans
• National Violent Death Reporting System
• About 18 deaths from suicide per day are Veterans
• National Violent Death Reporting System
• About 5 deaths from suicide per day among
  Veterans receiving care in VHA VA Serious
  Mental Illness Treatment, Research and Evaluation
  Center
• Veterans are more likely to use firearms as a
  means for suicide
• -National Violent Death Reporting System
• About 950 attempts/month among Veterans receiving
  care in VHA as reported by VA Suicide Prevention
  Program Staff
• About 33 of recent Veteran suicides have a
  history of previous attempts- VA National Suicide
  Prevention Staff reports
• Preliminary data since 2006 show decreased
  suicide rates in Veterans aged 18-29 who use VA
  health care relative to Veterans in the same age
  group who do not. This decrease in rates
  translates to about 250 lives per year.
  National Violent Death Reporting System and VA
  Serious Mental Illness Treatment, Resource and
  Evaluation Center.

13
General Risk Factors

• Thoughts about harming self that include plan
  method
• Previous suicide attempts
• Alcohol or substance abuse
• History of mental illness
• Poor self-control
• Hopelessness
• Recent loss (e.g., loved one, job, relationship)
• Family history of suicide
• History of abuse
• Serious health problems
• Sexual identity concerns especially among men
  16-24
• Recent discharge from hospital, group home etc.
• Recent diagnosis of an illness
• Demographic factors White men over 70 years of
  age are at increased risk
• Burdensomeness, Isolation
• Chronic Pain , PTSD, TBI

14
Veteran Specific Risks

• Multiple deployments
• Length of deployments
• Deployments to hostile environments
• Exposure to extreme stress/death/combat
• Physical/sexual assault while in the service (not
  limited to women)
• Service related injuries (TBI, PTSD, other
  medical and mental health diagnoses)
• Familiarity with weapons

15
Protective Factors

• Positive social support
• History of adaptive coping skills
• Participating in treatment
• Veteran acknowledges hopefulness
• Religious beliefs that act as a barrier
• Life satisfaction (e.g., rating 1 to 10)
• Fear of suicide or death
• Family or friends that act as barrier to
  self-harm
• (Rudd, 2006)

16
Warning Signs

• Give Added Consideration to Warning Signs
• Prior suicide attempts/behavior
• Agitatation, Anxiety
• Hopelessness and Burdensomeness
• Trapped in physical/psychological pain
• Talking or writing about death
• Withdrawing and isolating
• Seeking means to kill themselves
• Acting reckless or engaging in risky activities
  without regard for safety or death

17
SAFETY PLANNING

• STEP 1 Warning Signs
• STEP 2 Internal Coping Strategies
• STEP 3 Social Contacts Who May Distract from
  the Crisis
• STEP 4 Family or Friends Who May Offer Help
• STEP 5 Professionals and Agencies to Contact
  for Help
• STEP 6 Making the Environment Safe

18
Aggregate Reviews

• 10/1/2008 to 6/30/2009
• 116 suicide attempts/behaviors (20 events, 18
  uniques reviewed for report)
• 51/116 were male other
• FOCUS OF REVIEW--20/51 OD on meds, meds other
  substances (alc, illegal drugs)
• 13/20 suicide attempts/behavior via gun
• Majority treated for pain, mood disorder and
  substance abuse
• 11 with a previous attempt/behavior
• ACTIONS
• Increase use in detailed suicide risk assessment
• Increase in use of safety plan
• Detailed treatment planning

19
Aggregate Reviews

• 10/1/2008 to 6/30/2009
• 1 suicide 2 accidental overdoses (ODs)
• ACTION
• Same actions as with attempts/behaviors plus
• Revamp Pain Management Board
• Establish a Pain Clinic

20
Aggregate Reviews

• 7/1/2009 to 3/31/2010
• 175 attempts/behaviors
• FOCUS-32 events, 29 uniques (Veterans that OD and
  had one or more previous attempts/behaviors)
• 98/175 male other
• 59/175 method OD
• 54/175 method Guns
• Veterans in focus had mood disorder, substance
  abuse and chronic pain.
• ACTIONS
• Limit number of dispensed meds at one time
• Drug screens/Appropriate drug screens
• Increase in Case Conferences
• Review/update/change policy regarding screens

21
Suicide is Preventable

• Become a partner in Suicide Prevention
• Ask Directly about Suicide
• Suicidal ideation
• Suicide plans
• Access to Means
• Suicidal ideation and behavior is often a
  process and habituation occurs to thoughts of
  death and the act of self harm.
• Talking about suicide does not cause a person to
  be suicidal. Asking shows compassion, reduces
  isolation and stigma.

22
VA Programs and Services

• OEF/OIF COMBAT CARE STAFF
• MH (PTSD, Substance Abuse, Military Sexual
  Trauma, Mental Health Intensive Case Mgmt,
  Homeless, etc.)
• TBI/Polytrauma, SCI
• Pain Education Group
• Spiritual Support
• Veteran Readjustment
• Counseling Centers