The Army Suicide The Army Suicide Prevention ProgramPrevention Program

Suicide Prevention and Awareness Suicide Prevention and Awareness Training for the United States ArmyTraining for the United States Army

Prepared byPrepared by

The American Association of Suicidology The American Association of Suicidology AndAnd

The U. S. Army Center for The U. S. Army Center for

Health Promotion and Preventive MedicineHealth Promotion and Preventive Medicine

Cover SlideCover Slide

Enabling Learning ObjectivesEnabling Learning Objectives

1.1. Describe primary, secondary and Describe primary, secondary and tertiary suicide prevention.tertiary suicide prevention.

2.2. Identify personal and environmental Identify personal and environmental protective factors.protective factors.

3.3. Know information about local Know information about local support resources and programs.support resources and programs.

OH 1 a, pg 7OH 1 a, pg 7

Enabling Learning ObjectivesEnabling Learning Objectives

44. . Promote cohesion and a sense of Promote cohesion and a sense of belonging. belonging.

5. Destigmatize and encourage help 5. Destigmatize and encourage help seeking.seeking.

OH 1 b, pg 7OH 1 b, pg 7

The Army Suicide Prevention Program

TERTIARYTERTIARY

SECONDARY SECONDARY

PRIMARYPRIMARY

Recognizing and treating

acute suicidal behavioral

Anticipating people’s potential times of crisis

and structuring pre-emptive support systems

Recognizing the signs of

Crisis and providing

Caring support

OH 2, pg 8OH 2, pg 8

StructureStructure

OH 3, pg 9OH 3, pg 9

Scree

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Personal Protective FactorsPersonal Protective Factors

• Easy temperament.Easy temperament.

• Previous experience with self-mastery, Previous experience with self-mastery, problem solving, crisis resolution.problem solving, crisis resolution.

• Optimistic outlook.Optimistic outlook.

• Social/emotional competence.Social/emotional competence.

• High self esteem, self worth.High self esteem, self worth.

OH 4a , pg 9OH 4a , pg 9

Personal Protective FactorsPersonal Protective Factors

• Decision making, problem solving skills.Decision making, problem solving skills.

• Sense of personal control, self efficacy.Sense of personal control, self efficacy.

• Sense of belonging to a group and/or Sense of belonging to a group and/or organization.organization.

• High and realistic expectations.High and realistic expectations.

• High spiritual resiliency.High spiritual resiliency.

OH 4b, pg 9OH 4b, pg 9

Environmental Protective FactorsEnvironmental Protective Factors

• Strong family relationships.Strong family relationships.

• Models of healthy coping.Models of healthy coping.

• Encouragement of participation.Encouragement of participation.

• Opportunities to make significant Opportunities to make significant contributionscontributions

OH 5 a, pg 9OH 5 a, pg 9

Environmental Protective FactorsEnvironmental Protective Factors

• Available social supports.Available social supports.

• Available helping resources.Available helping resources.

• Healthy spiritual/religious affiliation.Healthy spiritual/religious affiliation.

• Cultural and religious beliefs against suicide Cultural and religious beliefs against suicide and in support of self-preservation.and in support of self-preservation.

OH 5 b, pg 9OH 5 b, pg 9

SupportSupport

• The Reasons for Living Inventory, The Reasons for Living Inventory, Linehan, Goodstein, Nielsen & Chiles Linehan, Goodstein, Nielsen & Chiles (1983)(1983)

• Spirituality and Resilience Assessment Spirituality and Resilience Assessment Packet, Version 4.2, Kass (2000)Packet, Version 4.2, Kass (2000)

OH 6, pg 9OH 6, pg 9

Connections save lives.Connections save lives.

OH 7, pg 10OH 7, pg 10

•Spiritual connectedness

•Unit cohesiveness

Seeking help is a sign of Seeking help is a sign of effectively dealing with problems, effectively dealing with problems,

and of strength rather than and of strength rather than weakness.weakness.

OH 8, pg 11OH 8, pg 11

A good leader does not expose A good leader does not expose those under his/her command those under his/her command

to unnecessary risk.to unnecessary risk.

OH 9, pg 11OH 9, pg 11

SupportSupport

• Promote a norm of mutual support Promote a norm of mutual support among all military personnel: we among all military personnel: we areare our brother’s keepers!our brother’s keepers!

• Pay attention to warning signs and Pay attention to warning signs and respond to those who need help.respond to those who need help.

OH 10 a, pg 11OH 10 a, pg 11

SupportSupport

• Pay close attention to the personal needs Pay close attention to the personal needs of your people, and be on the lookout for of your people, and be on the lookout for signs of stress.signs of stress.

• Communicate in your words and actions Communicate in your words and actions that it is not only acceptable, but a sign of that it is not only acceptable, but a sign of strength, to recognize life problems and strength, to recognize life problems and get help to deal with them constructively.get help to deal with them constructively.

OH 10 b, pg 11OH 10 b, pg 11

SupportSupport

• Support and protect to the fullest Support and protect to the fullest extent possible those courageous extent possible those courageous people who seek help early, before a people who seek help early, before a crisis develops.crisis develops.

OH 10 c, pg 11OH 10 c, pg 11

SupportSupport

• Create a responsive, caring, and Create a responsive, caring, and responsible community where responsible community where individuals are motivated to seek individuals are motivated to seek help with personal struggles without help with personal struggles without fear of stigmatization.fear of stigmatization.

OH 10 d, pg 11OH 10 d, pg 11

SupportSupport

• Foster a social climate in your unit Foster a social climate in your unit that communicates to everyone, “you that communicates to everyone, “you belong here”.belong here”.

OH 10 e, pg 11OH 10 e, pg 11

• Understand the benefits of gated Understand the benefits of gated screening.screening.

• Be informed about the confidentiality Be informed about the confidentiality of screening results.of screening results.

• Be informed about secondary Be informed about secondary screening instruments.screening instruments.

OH 1, pg 14OH 1, pg 14

Enabling Learning ObjectivesEnabling Learning Objectives

ScreenScreen

• The Army Structure makes screening The Army Structure makes screening viable.viable.

• Screening must be gated.Screening must be gated.

• The Suicide Prevention Task Force The Suicide Prevention Task Force collects and reports anonymous collects and reports anonymous data.data.

OH 2, pg 15OH 2, pg 15

ScreenScreen

OH 3, pg 16OH 3, pg 16

Please circle the most appropriate response: In the last two weeks have you:

Been able to concentrate on whatever you’re doing?

Lost much sleep over worry?

Felt that you are playing a useful part in things?

Felt capable of making decisions about things?

Felt constantly under strain?

Felt that you couldn’t overcome your difficulties?

Been able to enjoy your normal day-to-day activities?

Been able to face up to your problems?

Been feeling unhappy and depressed?

Been losing confidence in yourself?

Been thinking of yourself as a useless person?

Been feeling reasonably happy, all things considered?

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Not No more A little more A lot more at all than usual than usual than usual

ScreenScreen

– Goldberg Well-being Scale information will be Goldberg Well-being Scale information will be disclosed only to the individual and will be disclosed only to the individual and will be used only to assess and assist personnel used only to assess and assist personnel during of times of distressduring of times of distress

– Unit Trends may be reported to the Unit Unit Trends may be reported to the Unit Commander as a gauge of his/her unit well-Commander as a gauge of his/her unit well-beingbeing

OH 4, pg 17OH 4, pg 17

ScreenScreen

OH 5, pg 17OH 5, pg 17

•Multidimensional Health Profile Multidimensional Health Profile (MHP) Ruehlman, Lanyon & Karoly(MHP) Ruehlman, Lanyon & Karoly

•Life Stressors and Social Resources Life Stressors and Social Resources Inventory (LISRES-Adult), MoosInventory (LISRES-Adult), Moos

Gatekeeper Lesson 1Gatekeeper Lesson 1

All PersonnelAll Personnel

OH 1, pg 23OH 1, pg 23

Gatekeeper Lesson 1Gatekeeper Lesson 1

Enabling Learning ObjectivesEnabling Learning Objectives

1.1. Understand The Suicide Model.Understand The Suicide Model.

2.2. Answer general questions about suicide.Answer general questions about suicide.

3.3. Identify common precipitants of suicide.Identify common precipitants of suicide.

4.4. Identify symptoms of depression.Identify symptoms of depression.

5.5. Identify myths about suicide.Identify myths about suicide.

6.6. Identify warning signs of suicide.Identify warning signs of suicide.

7.7. Take appropriate action in response to at-risk Take appropriate action in response to at-risk individual.individual.

OH 2 , pg 23OH 2 , pg 23

Main PointsMain Points

• The Suicide Model.The Suicide Model.

• What is suicide?What is suicide?

• Why should we know about suicide?Why should we know about suicide?

• Why do people commit suicide?Why do people commit suicide?

• Some stressful situations that can trigger Some stressful situations that can trigger suicidal feelings in the Army.suicidal feelings in the Army.

• Who commits suicide?Who commits suicide?

OH 3 a, pg 24OH 3 a, pg 24

Main PointsMain Points

• Groups with special problems that can Groups with special problems that can cause suicidal feelings. cause suicidal feelings.

• Misconceptions about suicide.Misconceptions about suicide.

• How can you tell if someone is thinking How can you tell if someone is thinking about committing suicide?about committing suicide?

• Common symptoms of depression & Common symptoms of depression & hopelessness.hopelessness.

• Referral procedures.Referral procedures.

OH 3 b, pg 24OH 3 b, pg 24

OH 4, pg 25OH 4, pg 25

Suicide Model*Suicide Model*Suicide Model*Suicide Model*

(**Depression, anxiety, and substance abuse)

(Relationship losses, or career, legal and financial trouble)

(Anger, anxiety, hopelessness, depression)

Disorder**

Stress Event

Mood Change

Inhibition

Survival

Facilitation

Suicide

*Based on a model by David Shaffer, M.D., Columbia U.

No access to method, no acceptanceof suicide,support/emotional expression, &seeks treatment

Prevent The disorder**

before it occurs

Access to method,acceptance of suicidal behavior,isolation, impulse,loss of closerelationship bysuicide, & avoidstreatment

The Problem of SuicideThe Problem of Suicide

• Serious suicidal thoughts or threats.Serious suicidal thoughts or threats.

• Self destructive actsSelf destructive acts

• Attempts to harm, but not kill oneself.Attempts to harm, but not kill oneself.

• Attempts to commit suicide.Attempts to commit suicide.

• Completed suicide.Completed suicide.

OH 5, pg 25OH 5, pg 25

Categories of SuicideCategories of Suicide

• Lack of control related to needs for Lack of control related to needs for achievement, order, or achievement, order, or understanding.understanding.

• Problems with self-image related to Problems with self-image related to frustrated needs for affiliationfrustrated needs for affiliation

OH 6a, pg 26OH 6a, pg 26

Categories of SuicideCategories of Suicide

• Problems with key relationships Problems with key relationships related to grief and loss in life.related to grief and loss in life.

• Excessive anger, rage, and hostility.Excessive anger, rage, and hostility.

OH 6b, pg 26OH 6b, pg 26

Numbers and rates per 100,000 Numbers and rates per 100,000 of Suicides in the Armyof Suicides in the Army

1990 –102 (13.5)1990 –102 (13.5) 1995 – 78 (14.2)1995 – 78 (14.2)

1991 – 102 (13.1)1991 – 102 (13.1) 1996 – 68 (13.8)1996 – 68 (13.8)

1992 – 87 (13.5)1992 – 87 (13.5) 1997 – 56 (11.5)1997 – 56 (11.5)

1993 – 90 (15.5)1993 – 90 (15.5) 1998 – 68 (14.4)1998 – 68 (14.4)

1994 – 80 (14.5)1994 – 80 (14.5) 1999 – 65 (13.8)1999 – 65 (13.8)

OH 7, pg 28OH 7, pg 28

Gatekeeper Lesson 2Gatekeeper Lesson 2

Officers & NCOsOfficers & NCOs

OH 1, pg 41OH 1, pg 41

Gatekeeper Lesson 2Gatekeeper Lesson 2

Enabling Learning ObjectivesEnabling Learning Objectives

1.1. Inquire about suicide.Inquire about suicide.

2.2. Respond to phone callers.Respond to phone callers.

3.3. Obtain help for suicidal individuals.Obtain help for suicidal individuals.

OH 2, pg 41OH 2, pg 41

Responding to Statements or Responding to Statements or ThreatsThreats

• Stay calm.Stay calm.

• Send someone for help.Send someone for help.

• Do not leave alone.Do not leave alone.

• Buy time.Buy time.

OH 3 a, pg 42OH 3 a, pg 42

Responding to Statements or Responding to Statements or ThreatsThreats

• Acknowledge.Acknowledge.

• Listen.Listen.

• Convey.Convey.

OH 3 b, pg 42OH 3 b, pg 42

Responding to Statements or Responding to Statements or ThreatsThreats

OH 3 c, pg 42OH 3 c, pg 42

• Secure.Secure.

• Note the time.Note the time.

• Take action.Take action.

Asking About SuicideAsking About Suicide

• Review your evidence.Review your evidence.

• Inquire or state about Inquire or state about feelings.feelings.

• Persist.Persist.

• ““Sometimes” approach.Sometimes” approach.

OH 4 a, pg 43OH 4 a, pg 43

Asking About SuicideAsking About Suicide

• Ask directly.Ask directly.

• Get help.Get help.

• Convey concern.Convey concern.

OH 4 b, pg 43OH 4 b, pg 43

The only thing that will save The only thing that will save a human life is a human a human life is a human

relationship.relationship.

OH 5, pg 47OH 5, pg 47

Gatekeeper Lesson 3Gatekeeper Lesson 3

Formal GatekeepersFormal Gatekeepers

OH 1, pg 50OH 1, pg 50

Gatekeeper Lesson 3Gatekeeper Lesson 3

Enabling Learning ObjectivesEnabling Learning Objectives

• Identify Risk Factors for Suicide.Identify Risk Factors for Suicide.

• Conduct Basic Risk Assessment.Conduct Basic Risk Assessment.

OH 2, pg 50OH 2, pg 50

Risk Assessment QuestionsRisk Assessment Questions

1.1. Have you been thinking of killing Have you been thinking of killing yourself?yourself?

2.2. What has happened that makes life What has happened that makes life not worth living?not worth living?

3.3. How will you do it?How will you do it?

OH 3 a, pg 52OH 3 a, pg 52

Risk Assessment QuestionsRisk Assessment Questions

4.4. How much do you want to die?How much do you want to die?

5.5. How much do you want to live?How much do you want to live?

6.6. How often do you have these How often do you have these thoughts?thoughts?

7.7. When you think of suicide, how long When you think of suicide, how long do the thoughts stay with you?do the thoughts stay with you?

OH 3 b, pg 52OH 3 b, pg 52

Risk Assessment QuestionsRisk Assessment Questions

8.8. Have you ever attempted suicide?Have you ever attempted suicide?

9.9. Have you been drinking heavily lately or Have you been drinking heavily lately or taking drugs?taking drugs?

10.10. Has anyone in your family committed or Has anyone in your family committed or attempted suicide?attempted suicide?

11.11. Is there anyone or anything to stop you?Is there anyone or anything to stop you?

12.12. On a scale of 1 to 10, what is the On a scale of 1 to 10, what is the probability that you will kill yourself?probability that you will kill yourself?

OH 3 c, pg 52OH 3 c, pg 52

SecureSecure

OH1, pg56OH1, pg56

Health Care ProfessionalsHealth Care Professionals

Enabling Learning ObjectivesEnabling Learning Objectives

1.1. Become knowledgeable about Army Become knowledgeable about Army suicide policies and procedures.suicide policies and procedures.

2.2. Conduct Advanced Risk Conduct Advanced Risk Assessment.Assessment.

OH 2, pg 56OH 2, pg 56

Local policies and procedures Local policies and procedures set by the Suicide Prevention set by the Suicide Prevention

Task ForceTask Force

• An individual suspected of being at An individual suspected of being at risk for suicide.risk for suicide.

• An individual who is talking An individual who is talking about/threatening suicide.about/threatening suicide.

OH 3 a pg 57OH 3 a pg 57

Local policies and procedures Local policies and procedures set by the Suicide Prevention set by the Suicide Prevention

Task ForceTask Force

• An individual who attempts suicide.An individual who attempts suicide.

• A completed suicide.A completed suicide.

OH 3 b, pg 57OH 3 b, pg 57

Steps in Suicide AssessmentSteps in Suicide Assessment

1.1. Set the stage for the interview.Set the stage for the interview.

2.2. Assess for risk factors and warning Assess for risk factors and warning signs for suicide.signs for suicide.

3.3. Inquire about suicidal ideation.Inquire about suicidal ideation.

4.4. Determine the level of suicide risk.Determine the level of suicide risk.

OH 4, pg 58OH 4, pg 58

Assessing the Suicide PlanAssessing the Suicide Plan

• Perturbation.Perturbation.

• Cognitive construction.Cognitive construction.

• Intentionality.Intentionality.

• Lethality of the plan.Lethality of the plan.

OH 5, pg 58OH 5, pg 58

Assessing the Suicide PlanAssessing the Suicide Plan

• Specificity.Specificity.

• Method or means.Method or means.

• Availability & accessibility of means.Availability & accessibility of means.

OH 6, pg 59OH 6, pg 59

TT = = TThoughtshoughts

II = = IIntentntent

PP = = PPlanlan

MM = = MMeanseans

OH 7, pg 60OH 7, pg 60