Suicide Prevention with - PowerPoint Presentation

Slide1

Suicide Prevention with Service Members and Veterans

Kurt

Rossbach

, LCSW

Suicide Prevention Coordinator

Mann-

Grandstaff

VA Medical Center

Spokane, WASlide2

This presentation was developed in honor and remembrance of the many active duty service members and veterans who have lost their lives to death by suicide.Slide3

Goals of Presentation:

Present statistics related to military and veteran suicide.

Explain warning signs and risk factors

Discuss how military experience, including combat exposure , can contribute to a higher risk for suicide.

Our response. The resources and services available to help active duty service members and veterans.

Veterans Crisis Line; have you heard?Slide4

Suicide Statistics2010 – 38,400 US deaths from suicide per year among general population. (CDC)

2014 Civilian Suicide Rate:

13.4 per 100,000.

(CDC)

Idaho was ranked 11

th

in Nation with 18.7 per 100K.

Washington was ranked 21

st

in Nation with 14 per 100K

A

pproximately 20 deaths per day are Veterans.

Suicide

Data

Report, 2016 DVA Mental

Health

Services

Total Veteran Population:

25,000,000

VHA serves

6.8 million

veterans per year.Slide5

Suicide Statistics

2014 NIMH study: 30 per 100,000 rate for Army personnel deployed to Iraq and Afghanistan.

In

2014, an average of 20 Veterans died by suicide each day. Six of the 20 were users of VHA services

.

In

2014, Veterans accounted for 18 percent of all deaths by suicide among U.S. adults and constituted 8.5 percent of the U.S. adult population (ages 18+). Slide6
Slide7

Phenomenology of SuicideSuicide typically does not have a simple cause; it has a complex developmental history.

Suicide

is not a specific disorder, but a painful process

with

biological, psychological, social, and existential factors

.

Phenomenon: a rare or significant fact or event; an exceptional or unusual person, thing, or occurrence

Websters

Ninth New Collegiate DictionarySlide8

Phenomenology of SuicideThe Interpersonal Theory of Suicide (Thomas Joiner) proposes that three primary conditions need to exist in order for one to take her or his own life:

Sense of being a burden to others

Sense of thwarted

belongingness

Acquired capability to take ones own lifeSlide9

Desire to DieTwo primary psychological states must exist that create a desire to die:

Perceived Burdensomeness

Sense of Belongingness disrupted,

(feels disconnected

from

others

)Slide10

Acquired CapabilityIn order to attempt suicide, one must overcome …

fear of death

and

t

he instinct for self preservationSlide11

Acquired CapabilitySelf-reported fearlessness and pain insensitivity can differentiate suicide attempters and those who think about suicide , but don’t act (ideators

)Slide12

The Interpersonal Theory of Suicide

Disrupted Sense of Belongingness

Perceives self as a burden to othersSlide13

What Other Factors Increase Risk?Current ideation, intent, plan & access

Previous suicide attempt or

attempts

Family history – including

attempts

Alcohol/Substance

abuse

Previous history of psychiatric diagnosisSlide14

What Other Factors Increase Risk?Emotional & Social Losses: Financial, Relational, Employment, Incarceration

History of Abuse –physical, sexual or

emotional

Recent

discharge from

an inpatient psychiatric unit

Avoiding

support secondary to stigmaSlide15

Myths Versus Facts About SuicideMYTH:

People who talk about suicide don’t complete suicide.

FACT:

Many people who die by suicide have given definite warnings to family and friends of their intentions. Always take any comment about suicide seriously.Slide16

Combat ExperienceCombat increases fearlessness about death and the capability for suicide

Combat exposure and access to firearms are lethal combination for anyone contemplating suicide.

About 50% of soldier suicides are with guns. Figure rises to 93% among those deployed in war zones.Slide17

Trained FearlessnessCombat personnel are trained to use controlled violence and aggression, suppress strong emotional reactions, tolerate physical pain, and overcome fear of injury and death.Therefore, Soldiers/Warriors are more capable of killing themselves by consequence of professional training.

Basic training is highly effective mental and physical programming. Discharge from service does not delete the program. Slide18

Trained FearlessnessBasic training is highly effective

mental

and

physical programming.

Discharge

from service does not delete the program. Slide19

Loss of Identity

Many of the “jobs” during active duty bring a sense of importance and purpose not experienced in civilian life.

Loss of identity formed during military service can contribute to painful feelings of loss.Slide20

Loss of IdentityVeteran can feel alienated, disconnected, distrustful, fearful, and

misunderstood by non-veterans.

Trained to be mentally tough, they may try to avoid painful feelings through avoidance and emotional numbing with alcohol and other substances, fighting, and high risk behaviors. Slide21

“Mental Wounds of War”

Research suggests that it may take up to 3 years for stress of a

1 year

deployment to abate.

Cumulative effect of multiple deployments?

Recent evidence suggests mental health issues related to multiple deployments may be related to increase in military suicide rate. (

2009 Rand Study

)Slide22

“Mental Wounds of War”

Veterans generally have a higher incidence of Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI).

A 2009 Rand study commissioned by the DOD estimated that 30% of veterans meet the criteria for PTSD, compared to 8% incidence in general population. Slide23

“Mental Wounds of War”

Suicide rates among individuals with TBI are estimated between 2.7 – 4.0 time higher compared to general population. (Teasdale &Engberg, 2001)

2009 study on suicide and traumatic brain injury found veterans with TBI significantly reported, “loss of sense of self and feelings of

burdensomeness

.” (Brenner, & Homaifar, 2009) Slide24

“Mental Wounds of War”Sleep Problems

Anger when Driving

Problems with Crowds

Inappropriate Aggression/Anger

Hyper vigilance

Withdrawal, Detachment, Secretiveness

Control Issues

Compulsive Substance Use, Spending, Gambling

Ordering/Demanding Behaviors

Problems with Primary RelationshipsSlide25

Millennium Cohort StudyMore than 200,000 participantsCurrent or former military personnel from all branches, including active and Reserve / National Guard

Factors significantly associated with increased risk of suicide included

Male sex (2x)

Depression

Bipolar Disorder

Heavy or binge drinking

Alcohol-related problemsSlide26

PTSD and Alcohol

Worsens sleep disorders

Increases emotional numbing,

social isolation, anger, irritability,

depression, hyper vigilance

Increase in Anxiety Disorders

and Mood Disorders,

Disruptive Behavior,

A

buse of other substancesSlide27

Lethal Triangle

Depression

Access to Means to

Attempt Suicide

Alcohol/Drug Abuse

Current Suicidal IdeationSlide28

Keep In Mind

It can be difficult for veterans to ask for help

Veterans have a hard time trusting anyone other than fellow veterans

Veterans often experience self blame and self hatred for perceived lapses in judgment and/or mistakes that may have resulted in the death of their buddy

Experience Survivor Guilt

Feel broken and weak for needing helpSlide29

Our ResponsePreliminary evidence suggests that there are decreased rates in Veterans (men and women) aged 18-29 who use VA health care services compared with Veterans in the same age group who do not, since 2006.

DVA Suicide Data Report 2012

Access to care

IS Fundamental to reducing suicide riskSlide30

Helping Suicidal Service Members and VeteransVictor Montgomery coined the phrase “Heart to Heart Resuscitation” and talked about the importance of interacting with our veterans with

active listening

and genuine concern

.

Healing

Suicidal Veterans

, New Horizon Press (October 13, 2009)Slide31

Veterans Helping Veterans

“

“Who

then can so softly bind up the wound of another

as

he

who has felt the same wound himself?”

-Thomas

JeffersonSlide32

Veterans Helping Veterans

Website

:

http://sgtbrandi.com/

Gunnery Sgt. Andrew Brandi, United States Marine CorpSlide33

Veterans Helping VeteransVet Center Combat Call

Center

1-

877-WAR-VETS (927-8387)

Slide34

How Mental Health Professionals Can Help

Thank them for their service,

Honor Them

Establish

TRUST

Attitude of caring, ask; is this, (therapy) working for you?

It’s the

RELATIONSHIP

(Repeat as needed)

Create a safe place

Be transparent Slide35

How Mental Health Professionals Can Help

Don’t Rush. Take the time needed to

LISTEN

, demonstrate concern, and help them find their strengths.

Talk about readjustment as normal part of being a

W

arrior.

Demonstrate your desire to help, that they Deserve help, and that you’ve “got their back.”

Reach them with

genuineness

and

honestySlide36

What is a Warrior?“A warrior is a servant of civilization and its future, guiding, protecting, and passing on information

and wisdom.

A

warrior is devoted to causes he judges to be more important

and

greater than himself or any personal relationships or gain

.

Having

confronted death,

a

warrior knows how precious and fragile life is and does not abuse or profane it.”

War and the Soul

, Edward Tick

http://soldiersheart.netSlide37

How Friends and Family can HelpBe patient and understanding – let them talk over and over when needed.

LISTEN

Learn about PTSD

Anticipate and prepare for PTSD symptoms.

Don’t

take symptoms of PTSD personally.

Understand your Veteran feels distant, irritable, and disconnected from others.

There is a huge need for information and

education with the families of veterans.Slide38

How Friends and Family can Help

Don’t pressure to talk. Talking can sometimes make it worse.

LISTEN

Don’t ask for details of flashbacks – could bring one on

Let them know you are working to understand, and that you accept their experiences and feelings are real to them.Slide39

How Friends and Family can HelpCall

the

National Veterans Crisis Line

if you are concerned or need to know

where to get help.

1-800-273-8255

press 1

to be connected to the VA call center 24

hrs

per day, 7 days per week.

Learn what triggers your Veteran and help him or her to avoid those situations.

Take care of yourself and find understanding and support for

your

needs.Slide40

Veterans Affairs Suicide Prevention Initiative

Creation of National Veterans Crisis Line for Veterans

1-800-273-Talk (8255), Press one for Veteran

Confidential chat at VeteransCrisisLine.netSlide41

Veterans Affairs Suicide Prevention InitiativeSuicide Prevention Coordinators in every VAMC to coordinate and assure prompt access to Behavioral Health and Medical Services.

Identification

of Veterans at High Risk for Suicide and assuring regular suicide risk assessment, safety planning, and enhanced care

.

“Finding Solutions” Suicide Risk Reduction Group

Suicide Prevention “Guide” training for non-cliniciansSlide42

Veterans Affairs Suicide Prevention InitiativeCaring Letter Program

Community Outreach

Education and Training on Suicide Prevention and Intervention.

Training Law Enforcement on Veteran’s Mental Health and Post Deployment Issues.

Participation on Community Boards and Teams that promote Suicide Prevention, Intervention, and “

Postvention

.”Slide43
Slide44

Kurt

Rossbach

,

LCSW

Suicide

Prevention Coordinator

Mann-

Grandstaff

Veterans Affairs

Medical Center

4815 N Assembly St, Spokane, WA 99205

(509) 434-7288

k

urt.rossbach@va.gov