SUICIDE PREVENTION LEADERS CHAIN TEACH

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SUICIDE PREVENTIONLEADERS CHAIN TEACH
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It is our responsibility to help our
soldiers and civilians understand how to identify
at-risk individuals, recognize warning signs and
know how to take direct action.
General Eric K. Shinseki
Army Chief of Staff
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One of the greatest challenges commanders
and leaders face is that of suicide prevention.
Soldiers who need our help must get it. We need
to erase the stigma attached to seeking mental
health care. Seeking help is not a career
stopping action - it is a potentially life-saving
one. Every soldier must be able to recognize the
warning signs, both in themselves and in their
fellow soldiers. General John N. Abrams
TRADOC Commander
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SUICIDE PREVENTION OVERVIEW

• HOW BIG A PROBLEM IS SUICIDE IN THE ARMY?
• CAN SUICIDE BE PREVENTED?
• WHO IS RESPONSIBLE FOR PREVENTING SUICIDE?
• WHO IS AT RISK FOR SUICIDE?
• CHARACTERISTICS OF SUICIDAL THINKING.
• HOW DO WE RECOGNIZE SOLDIERS AT RISK?
• HOW DO WE HELP SOLDIERS AT RISK?
• SUICIDE MYTHS.

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HOW BIG IS THE PROBLEM?

• 12-16 SUICIDES PER 100,000 SOLDIERS EACH YEAR, OR
  50-70 DEATHS PER YEAR.
• 40 SUICIDES AT FORT KNOX SINCE 1988, ABOUT 3 PER
  YEAR.
• ARMY INCIDENCE MAY BE INCREASING OVER PAST 2
  YEARS AFTER HAVING DECREASED THE PRECEEDING 4
  YEARS.
• SECOND LEADING CAUSE OF DEATH IN ARMY AFTER
  ACCIDENTS.
• SUICIDES IN THE ARMY ARE ALMOST ALL MALES.
• ARMY SUICIDES USUALLY BY HIGHLY LEATHAL/VIOLENT
  MEANS
• FIREARMS 66
• HANGING 18
• CARBON MONOXIDE 3
• OTHER 13

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HOW BIG IS THE PROBLEM?

• ONE SUICIDE IS ONE TOO MANY.

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CAN SUICIDE BE PREVENTED?

• IN RETROSPECT, 80 OF PEOPLE WHO KILL THEMSELVES
  GAVE CLEAR WARNING SIGNS.
• ALL OF THOSE 80 COULD HAVE BEEN PREVENTED, IF
  SOMEONE HAD RECOGNIZED THE WARNING SIGNS AND
  ACTED ON THEM.
• MANY SUICIDES IN THE ARMY ARE PREVENTED DUE TO
  COMMAND EMPHASIS AND A STRUCTURED SUICIDE
  PREVENTION PROGRAM. MOST CIVILIANS DO NOT
  RECEIVE SUICIDE PREVENTION TRAINING.
• SUICIDE INCIDENCE, U.S. MALES AGES 18-40
• US ARMY 14/100,000
• CIVILIAN 24/100,000

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CAN SUICIDE BE PREVENTED?

• PROBLEM Soldiers who complete suicide
• Rarely seek help through the chain of command,
  Chaplaincy or Mental Health.
• Often dont show classic warning signs of
  suicide in the unit.
• Frequently choose very lethal means and act
  privately, precluding rescue.
• WHY?
• Army culture - No Fear, Suck it Up!, Bite
  the Bullet!
• Stigma of going to Mental Health.
• Impulsivity and distorted thinking in crisis (No
  one can help, Its hopeless).
• Lack of awareness of available help.

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WHO IS RESPONSIBLE FOR SUICIDE PREVENTION?

• Remember what GEN Shinseki and GEN Abrams
  said...
• Each soldier is responsible for him/herself.
• Battle Buddy, associates, friends, family
  members.
• First line supervisors.
• NCO chain.
• Command chain.
• Chaplaincy.
• Mental Health.
• Community Agencies.
• Garrison/Installation Commanders.
• MACOM
• DA

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WHO IS RESPONSIBLE FOR SUICIDE PREVENTION?

• Suicide prevention is everyones responsibility.
• It will be successful in direct proportion to the
  extent that the entire community is committed to
  identifying and helping those at risk.

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WHOS AT RISK FOR SUICIDE?

• Almost everyone has thought about suicide at some
  time.
• Stress alone is not a key factor in suicide.
• Psychiatric disturbance combined with various
  stressors, especially significant loss or the
  threat of loss, appears to be the major
  precipitant of suicidal thinking and behavior.
• More than 1 in 4 Americans suffer from emotional
  problems severe enough to significantly affect
  their social and occupational functioning.
• Since we all experience stress, it could be said
  that
• More than 25 of Americans are at risk for
  suicide.
• Take-home message Under right conditions, ANY
  SOLDIER COULD BE AT RISK FOR SUICIDE.

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CHARACTERISTICS OF SUICIDAL THINKING

• Unmet needs in people who are stressed and
  emotionally vulnerable causes intolerable
  psychological pain with guilt, worthlessness,
  shame or aloneness.
• The stressors and the pain may appear trivial to
  observers.
• Distorted, constricted thinking and tunnel vision
  results
• Range of behavioral options becomes limited to
  either magical solutions or escape (dichotomous
  thinking).
• Goal of suicidal thinking is to escape the pain,
  not necessarily to die.
• Risk of serious suicide attempt and death is
  highest when
• The person sees no way out and fears things may
  get worse.
• The predominant emotion is hopelessness and
  helplessness.
• Thinking is constricted and dichotomous.
• Lethal means are available.
• Behavior can be impulsive (acute emotional
  reaction), planned (chronic condition), or
  communicative (does not want to die but
  incapable, unworthy or ignored when attempts to
  communicate in other ways).

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How Do We Recognize Suicide Risk?

• Risk Factors - Psychiatric Disturbance/Vulnerabil
  ity
• Prior suicide gestures or attempts.
• Psychiatric disorders
• Depression (47 of suicides).
• Anxiety Disorders (e.g. PTSD).
• Personality Disorders (9 of suicides).
• Substance abuse
• Alcohol Abuse (26 of suicides).
• Family history of suicide.
• Hopelessness/helplessness.
• Impulsivity.
• Real or perceived sense of isolation.

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How Do We Recognize Suicide Risk?

• Risk Factors - Life Stressors/Other Factors
• Recent or threatened loss of
• Love Relationship (up to 70 of suicides).
• Social support systems.
• Financial or social status.
• Disciplinary Problems/UCMJ/Imprisonment.
• Work Problems.
• Barriers to Treatment including stigma and
  military culture.
• Physical Illness.
• Access to lethal means.
• Influence of other suicides/media.

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How Do We Recognize Suicide Risk?

• Suicide Indicators
• Suicide gestures or verbal threats.
• Giving away possessions (rare), putting affairs
  in order, making a will.
• Talking or writing about death and suicide.
• Verbalizations about leaving, If Im still
  around then,Its no use, etc.
• Personality changes or sudden unexplained mood
  elevation.
• Symptoms of depression
• sadness, tearfulness, social isolation/withdrawal.
  
• changes in sleep, appetite, sex drive,
  concentration, hygiene.
• feelings of guilt, hopelessness/helplessness,
  loss of interest in usual activities.
• Increased alcohol/drug use.
• Deteriorating work performance.
• Frequent physical complaints and medical
  appointments.
• Stopping medications or saving a lethal supply.
• Purchasing weapons.

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How Do We Recognize Suicide Risk?

• Summary
• Understand and be alert for suicide risk factors
  (psychiatric vulnerabilities and life stressors)
  and suicide indicators. This is essential but
  not enough.
• Remember that many soldiers who commit suicide
  have risk factors but dont show them in the
  unit.
• Since they dont jump out at you- must actively
  look for them with thermal sights, magnification,
  and whatever other sensors you have.
• There are no unique predictors of suicide we can
  only attempt to detect and reduce risk.
• Any soldier with significant life issues is at
  potential risk...
• So dont forget the high speed/low drag good
  soldier who is cheerful, effective, motivated and
  good-to-go but may have some marital or financial
  problems to resolve. They need your attention
  too.
• Need to connect the dots to see the big
  picture,even in the absence of classic risk
  factors and indications of suicidality. This is
  just plain old taking care of soldiers.

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How Do We Recognize Suicide Risk?

• Risk Assessment
• Explore in depth, help develop solutions, provide
  support and reality check.
• If a soldier needs time off to go deal with a
  problem
• assess soldiers emotional stability.
• review his/her plan and options.
• assess support system in area to which soldier is
  going.
• consider contingency and failure plans--ask
  about suicide potential.
• ensure soldier can reach you or someone in unit
  who cares 24/7.
• instruct soldier to report telephonically at
  reasonable periods.
• ensure you have a reliable POC where the soldier
  is going.
• If you perform this risk assessment and are
  uneasy, do not let the soldier go
• keep the soldier with you, explain reasons, stay
  supportive.
• elevate the issue up the chain.
• get Chaplain or Mental Health consultation.

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How Do We Help?

• Command Message
• Everyone is important to the unit, even soldiers
  in trouble.
• Everyone needs outside help sometimes.
• Responsible people seek help early.
• I support and protect in any way possible
  soldiers who seek help responsibly.

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How Do We Help?

• Leader Roles
• Recognize problem.
• Understand what to do.
• Empower leaders and individuals.
• destigmatize seeking help.
• destigmatize mental health.
• Enable soldiers to seek help.
• provide time.
• educate regarding resources.
• mobilize/utilize all community resources.

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How Do We Help?

• Destigmatize Seeking Help
• Emphasize similarity of mental illness to
  physical illness.
• Focus on treatability to encourage self-referral.
• Use metaphor of PMCS for soldiers.
• Publicize fact that mental health referrals
  rarely result in separation.
• Let soldiers know that, with rare exceptions,
  they now have privileged communications with
  counselors.
• Increase visibility of Chaplains and Mental
  Health professionals in unit activities.

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How Do We Help?

• Specific Leader Actions
• Keep doing what you do best--training, leading,
  and taking care of soldiers.
• Ensure annual suicide prevention training in
  unit.
• Minimize unit stressors within your control--then
  focus on soldier responses to stress.
• Know suicide risk factors and indicators--but
  dont rely on them to exclusion of your knowing
  your soldiers.
• Do risk assessment on all soldiers with problems,
  especially your best soldiers!
• Destigmatize seeking help--lead by example!

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How Do We Help?

• Specific Leader Actions
• Request Unit Climate and Behavioral Health
  Surveys.
• Request Critical Event Debriefings after
  traumatic events affecting the unit.
• Make sure bad news and adverse actions arent
  given on Fridays or prior to holidays.
• Do not condone or minimize alcohol misuse. Refer
  to ADAPCP.
• Refer soldiers to Army Community Service for
  financial counseling and other vital life skills
  training.
• Emphasize importance of Battle Buddies in suicide
  prevention.

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How Do We Help?

• General Measures - Dos
• Take all threats, risk factors and indicators
  seriously.
• Take whatever steps are available to help
  decrease psychological pain - often thats all
  thats necessary.
• Answer obvious cries for help.
• Be a good listener, let the person talk.
• Ask questions.
• Encourage person to see Chaplain or Mental Health
  professional.

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How Do We Help?

• General Measures - Questions
• What do you feel you have to solve or get out of?
• What would you like to happen?
• Have you been thinking about harming yourself?
• How would you harm yourself?
• What would it take to keep you alive?
• Have you ever been in a situation like this
  before, what did you do, how was it resolved?
• Have your ever attempted suicide? When?
• Why now?

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How Do We Help?

• General Measures - Donts
• Panic.
• Ignore it or cooperate in hiding it.
• Act shocked.
• Debate the morality of suicide.
• Minimize their problem.
• Challenge person to do it.

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How Do We Help?

• The Acutely Suicidal Soldier
• Stay with soldier.
• Remove weapons and dangerous items.
• Treat with dignity and respect, restraining only
  if no other option.
• Arrange immediate evaluation by Mental Health
  professional.

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

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Myths About Suicide

• People who commit suicide are crazy.
• Good circumstances prevent suicide.
• People who talk about suicide will not commit
  suicide.
• People who threaten suicide, cut their wrists, or
  do not succeed with other attempts, are not at
  risk for suicide (10 will succeed if no changes).

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Myths About Suicide

• Talking about suicide to people who are upset
  will put the idea into their heads.
• People who are deeply depressed do not have the
  energy to commit suicide.
• People often commit suicide without warning.

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COMMUNITY RESOURCES

• Behavioral Medicine Clinic
  624-9960
• Social Work/Family Advocacy Program 624-9523
• ADAPCP
  624-0321
• On Call Chaplain
  624-4481/21
• Suicide Prevention Hot Line (24 Hour)
  624-HELP
• Army Community Service
  624-6291

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