Suicide Prevention

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Suicide Prevention

• CH (MAJ) Kenneth Williams

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Terminal Learning Objective

• ACTION Identify elements of a unit suicide
  prevention program, to include warning signs
  precipitating events emotional disturbances and
  methods for addressing.
•  Conditions In a classroom
•  Standard Understand the seven step procedure is
  used to identify whether a soldier needs to be
  referred for professional help or not. And how
  action is taken to reduce the possibility of
  suicide by referring the individual to
  professional help.

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Administrative Data
Safety Considerations None Risk Assessment
Level Low Environmental Considerations
None Evaluation Foundations Exam
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Primary References

• AR 600-63, Army Health Promotion Program
• DA Pam 600-24, Suicide Prevention and
  Psychological Autopsy
• DA Pam 600-70, United States Army Guide to
  the Prevention of Suicide and
  Self-Destructive Behavior

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References, cont.

• American Association of Suicidology
  (http//www.suicidology.org)
• U.S. National Objectives in the area of suicide
  prevention (http//www.mentalhealth.
  org/suicideprevention/)
• American Foundation for Suicide Prevention
  (http//www.afsp.org)

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Can Suicide be Prevented?

• CHALLENGES Soldiers who complete suicide
• Rarely seek help through the chain of command,
  Chaplaincy or Behavioral Health
  (lt 1/5 of all completed
  suicides have seen BH).
• Often dont show classic warning signs of
  suicide in the unit.
• Frequently choose very lethal means and act
  privately, precluding rescue.

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Army Active Duty Suicides (Includes USAR /ARNG)
Completed Suicides
Calendar Years
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Army Suicide Rates(AC Only)
U.S. Adjusted Rate 19.8
Rates per 100k
Calendar Years
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CY 03 Suicides Rates(Rank - AC Only)
AC Rate
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CY 03 Suicides Rates(Age - AC Only)
AC Rate
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CY 03 AD Suicides (Gender)
In US - 80 of all suicides committed by
males (Official 2001 data provided by AAS)
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CY 03 AD Suicides (Race)

In US 90 of all suicides were white (Official
2001 data provided by AAS)
African
White American Hispanic Other Confirmed
50 9 6 6 Army
Rates 13.7 5.9 10.2 US
Rates 11.9 5.3 5.0
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CY 03 Suicides Rates(MOS - AC Only)
AC Rate
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Army U.S. Monthly Suicide Comparison
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Suicide is a symptom, not a disorder
gt 90 of people who complete suicide have
depression or another diagnosable mental or
substance abuse disorder.
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Suicide Analysis

• Youth Suicides
• Tend to be impulsive
• Poor life coping skills
• Substance abuse

• Middle Age Suicides
• Usually premeditated
• Facing major transition
• Relationship failure
• Alcohol dependence
• Major depression

• Training just on recognizing warning signs
  doesnt target younger cohort who tend to be more
  impulsive
• Need specialists trained in risk estimation
  skills readily available to advise the commander
  and to initiate the intervention process

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Suicide Strategies
Developing Life Coping Skills - Behavioral
Development - Mentors

• Youth Suicides
• Tend to be impulsive
• Poor life coping skills
• Substance abuse
• Middle Age Suicides
• Premeditated
• Facing major transition
• Relationship failure
• Alcohol dependence
• Major depression

Encouraging Help- seeking Behavior - Stigma
Reduction - Confidentiality
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Understanding Dysfunctional Health-Risk Behaviors
Visible to Command
Behaviors
NOT Visible to Command
Stressors
Current Environment
Developmental History
Genetic Vulnerability to Psychiatric Illness
The best predictor of future behavior is past
behavior.
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Consider our Inputs

• approx. 40 self-report having been raised in
  homes where they were physically /or sexually
  abused /or neglected
• gt 40 come from non-traditional homes without 2
  consistent parenting figures
• gt 20 of HS students had seriously considered
  attempting suicide during a 12 month period
• 8 of HS students reported making a suicide
  attempt in the preceding 12 month period

data from Naval Health Research
Center-Report 95-26 Pre-enlistment Maltreatment
Histories of US Navy Basic Trainees Prevalence
of Abusive Behavior data from Zill
Robinson, The Generation X, American
Demographics, April 1995, pp. 24-33 data from
Centers for Disease Control(CDC) Youth Risk
Behavior Surveillance 2000 data from National
Strategy for Suicide Prevention, US Public Health
Surgeon General, May 2001
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Psychological Reasons for Suicide

• Death as retaliatory abandonment
• Killing self to get back at person who
  abandoned you.
• Death as self-punishment
• Torturing/Killing self to atone for guilt/shame.

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Potential Triggers
Based upon psychological autopsies
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DoD Survey of Health Related Behavior
Stigma
Army Perceived
Need for Mental Health Counseling 17.8 Rec
eipt of Mental Health Counseling from military
Mental Health Professional 5.6 Perceived
Damage to Career Definitely Will 17.7
May or May Not 58.1 Definitely Will
Not 24.2
1996 Data
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Commanders/1SGs CSMs

• Conduct OPDs and NCOPDs that focus on some
  aspect of mental health
• Watch out for the first-line supervisors
• Promote life-coping skills development
  help-seeking behaviors
• Develop well-defined procedures for storing
  P.O.W.s
• Promote use of Army One-Source
• Ensure your UMT members other designated
  trusted agents are ASIST qualified

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Army One Source

• Assistance and information live 24/7 x 365, via a
  toll free number and Internet access
• Active, mobilized reserves (RC) soldiers,
  deployed civilians and their families worldwide
  are eligible
• Specialized teams conduct customized research to
  answer all your questions
• Comprehensive array of prepaid educational
  materials
• Nationwide network of licensed clinical social
  workers, licensed marital and family counselors,
  and licensed psychologists
• Privacy
• Quality assurance via mutually agreed upon
  follow-up by caller and consultant, access to
  ACS, COR

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Army One Source Access

• By phone

• From the United States
• 1-800-464-8107

• From outside the United States ONLY
• Toll free The OCONUS number is (access code)
  800-464-81077
• (please dial all 11 digits)

• TTY/TDD
• 800-346-9188

Or call collect 484-530-5889

• En Español
• 888-732-9020

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Army One Source Online
Online access

• LifeWorkshop Moderated Chat

Army One Source
Army One Source

• Self-Assessment Tool

My Army One Source
My Army One Source

• Calculators

• Online Locators

Army One Source

• Resource Rooms

• Other Military Resources

• Educational Materials

• Passwordonesource

Online access

• Userid Army

• URL
• http//www.armyonesource.com

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First Line Supervisors

• Get to know your soldiers
• Find out about your soldiers developmental
  history
• Assess solders life-coping skills
• Know when your soldiers are experiencing a life
  crisis
• Anticipate dysfunctional behavior
• Know potential suicide triggers warning signs
  for mental illness
• - especially alcohol and drug abuse
• Promote help-seeking behavior
• Encourage use of Army One-Source
• Assist in reducing stigma regarding mental health
• Set the example - take advantage of helping
  services

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All Soldiers

• Know suicidal danger and warning signs and
  leading causes for suicides
• Become aware of local helping services
• Take immediate action when suspecting someone is
  at risk for suicide
• Never ostracize any member of your team
• REMAIN VIGILANT!

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STATES WITH THE HIGHEST SUICIDE RATE (2001)

• 1. Nevada 22.3
• 2. Wyoming 20.4
• 3. Montana 18.4
• 4. New Mexico 18.3
• 5. Arizona 16.0
• 6. Alaska 15.5
• 7. Oklahoma 14.7
• 8. Idaho 14.5
• 9. Oregon 14.4
• 10. Colorado/Washington 14.2

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STATES WITH THE LOWEST SUICIDE RATE (1999)

• 1. District of Columbia 5.8
• 2. New York 6.6
• 3. New Jersey 6.9
• 4. Massachusetts 7.0
• 5. Connecticut 8.3
• 6. Illinois 8.4
• 7. Maryland 8.4
• 8. Minnesota 9.2
• 9. California 9.3
• 10. Rhode Island 9.7

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Summary

• Suicide is substantially preventable in the Army,
  IF
• we target those at risk of or currently suffering
  from treatable mental/behavioral disorders
  (primarily substance abuse/mood dz)
• we minimize stigma associated with accessing
  mental health care
• leaders know and care about their peers
  subordinate soldiers
• leaders constructively intervene early on in
  their soldiers problems
• leaders pay close attention provide
  constructive interventions to those small s of
  peers and subordinates facing major losses from
  legal, marital, occupational or financial
  problems

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QUESTIONS
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CONCLUSION

• SUICIDE IS A PERMANENT SOLUTION TO A TEMPORARY
  PROBLEM.

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CONCLUSION, cont.

• The one thing that will save a human life is a
  human relationship.