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Suicide Prevention, Assessment, and Intervention

The Role of a First Responder. Lisa Schwartz, LSW and Kathleen Kowalski, LCSW. Suicide Prevention Coordinators. Erie VAMC. 814-860-2038. Objectives. . 1. Identify the mental health, medical, and psychosocial factors that place individuals, especially Veterans, at risk for suicidal ideation and behavior. .

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Suicide Prevention, Assessment, and Intervention




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Suicide Prevention, Assessment, and Intervention The Role of a First Responder

Lisa Schwartz, LSW and Kathleen Kowalski, LCSWSuicide Prevention CoordinatorsErie VAMC814-860-2038Slide2

Objectives 1. Identify the mental health, medical, and psychosocial factors that place individuals, especially Veterans, at risk for suicidal ideation and behavior. 2. Identify warning signs and appropriate responses to suicidal ideation to ensure safe intervention and treatment. 3. Identify role of first responders in dealing with a suicidal individual4. Review 24/7 crisis resources available to VeteransSlide3

StatisticsVeterans have >2x greater risk & account for 1 in 5 suicides in the US.Access to firearms- a major factor (guns are used in approximately 58% of completed suicides).Slide4

Current Suicide Rates Among Veterans (2011)18 Veteran suicides a day950 suicide attempts per month among Veterans receiving care at a VA 7% of suicide attempts resulted in death in FY 200911% of those who attempted suicide in FY 2009 (and did not die as a result of this attempt) made a repeat suicide attempt with an average of 9 months of follow-upSlide5

Total number of soldiers who have been deployed during OEF/OIF1.6 millionSlide6

Total number of soldiers who have been deployed to a war zone twice or more700,000+Slide7

86% know someone who was seriously injured or killed.Slide8

77% have shot at ordirected fire at the enemy.Slide9

68% have seen deador seriously injured Americans.Slide10

“Never before have we asked so few citizen soldiers to do so much in war time, while knowing they and their families have great psychosocial needs.” Dr. Charles R. Figley Slide11

Nearly 1/3 of U.S. military personnel from the war in Iraq access mental health services after their return home….Col. Charles HogeMarch 1, JAMASlide12

25% of individuals who die by suicide were intoxicated at the time of their deathAlcohol was involved in 64% of attemptsDrug overdose deaths are typically ruled accidental in the absence of information confirming suicide12Suicide and Alcohol/DrugsSlide13

Newest Veterans Face TBI as a primary injuryPatients with traumatic brain injuries may be at increased risk for suicide. TBI survivors are at increased risk for suicide ideation (Simpson and Tate, 2002), suicide attempts (Silver et al. 2001) and suicide completions (Teasdale and Engberg, 2001). Most concerning residual factor: ImpulsivitySlide14

Risk Factors Among VeteransHigh gun ownershipDebilitating injuriesMental health issuesSlide15

Highest Risk Factors…Suicidal ideation reportedSuicidal intention reportedSuicidal plan with means reportedSlide16

The ultimate aim of suicide prevention is to reduce deaths by suicide; however, it is equally important to reduce the frequency and severity of suicide attempts.Slide17

First RespondersPolice officers, firefighters and other first line responders are increasingly called upon in situations involving mental health emergencies, such as suicidal crises.First responders are in a unique position to determine the course and outcome of suicidal crises.They are often the first to be involved in situations where suicidal behaviors, such as a suicide threat, suicide attempt or completed suicide, have occurred.Slide18

Awareness of risk When faced with a mentally ill person or offender, first interveners must be alert to the possibility of a suicidal act as well as the possibility of danger to others (including being personally attacked). Slide19

Involuntary admission Police can determine if an individual is in need of psychiatric care and they can transport to a local emergency room for medical /psychiatric assessment and treatment.Slide20

Suicide by deadly force One of the most difficult crisis situations for police to address occurs when an individual engages in life-threatening behavior to provoke officers to fire, either to protect themselves or a civilian bystander. This has been termed "police-assisted suicide" or "suicide by cop”.Slide21

Recognizing this potential outcome, being able to identify the signs and symptoms of seriously mentally disordered behavior and following locally established inter-agency guidelines for the management and de-escalation of such crises will help to minimize lethal outcomes.Slide22

First RespondersHELPING SOMEONE WHO IS SUICIDALPeople who feel suicidal often express hopelessness and depression. They see suicide as the only way to solve their problems and eliminate their suffering. Although suicide is difficult to predict, a large proportion of those who eventually kill themselves will give warning signs of their suicidal intentions in the weeks or months prior to their death. These are not harmless bids for attention, but important cries for help that should be taken seriously.Slide23

Warning signs include both behavioral and verbal clues:Hopelessness/helplessnessWithdrawn from family/friendsAnger, rageGiving away possessionsHistory of suicide attemptsDrug and/or alcohol abuseA change in healthSlide24

Warning signs continued…..Constantly dwelling on problems for which there seem to be no solutions;Expressing a lack of support or belief in the system;Giving some other indication of a suicide plan.Slide25

Approach all situations involving someone who is suicidal as a psychiatric emergency and act accordingly. Never assume that suicidal ideas or gestures are harmless bids for attention or an attempt to manipulate others.Slide26

Assessing the riskEngage the individual. Encourage the person to talk. Most suicidal people are ambivalent about dying. Asking someone if they are suicidal will not “tip them over the edge”, but will provide a sense of relief and a starting point for a solution. To assess intent, ask if the individual has a plan, access to lethal means, or has decided when to act.Slide27

HELPING SOMEONE WHO IS SUICIDALNever leave a potentially suicidal individual alone based on their promise to visit their mental health worker or the hospital. Ensure that family members or significant others are on the scene and accept responsibility for help seeking.Slide28

Everyone’s role:Be availableBe awareOffer hopeSlide29

Veterans Crisis LineNational Number: 1-800-273-8255Press #1 for Veteran or family of Veteran Crisis Line is available 24/7 and staffed by VA mental health professionalsIn an emergency, Crisis Line staff will assist with immediate referral to community resources including:Local Police DepartmentsCounty Crisis ServicesIf non-emergent, the Veteran will be referred to the closest VA within 24hrs.