Transcript suicide-ahec-version-2014-4-0-1

Kurt Rossbach, LCSW
Suicide Prevention Coordinator
Mann-Grandstaff VA Medical Center
Spokane, WA
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.
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?
Suicide Statistics
 2010 – 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 11th in Nation with 18.7 per 100K.
 Washington was ranked 21st in Nation with 14 per 100K
 Approximately 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.
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+).
Phenomenology of Suicide
 Suicide 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 Dictionary
Phenomenology of Suicide
The 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 life
Desire to Die
Two primary psychological states
must exist that create a desire to
die:
 Perceived Burdensomeness
 Sense of Belongingness
disrupted,
(feels disconnected from others)
Acquired Capability
In order to attempt suicide, one
must overcome …
fear of death
and
the instinct for self preservation
Acquired Capability
 Self-reported
fearlessness and
pain insensitivity
can differentiate
suicide attempters
and those who think
about suicide , but
don’t act (ideators)
The Interpersonal
Theory of Suicide
Perceives self as a
burden to others
Disrupted Sense
of Belongingness
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 diagnosis
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 stigma
Myths Versus Facts About Suicide
 MYTH:
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.
Combat Experience
 Combat 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.
Trained Fearlessness
 Combat 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.
Trained Fearlessness
Basic training is highly effective mental
and physical programming.
Discharge from service does not delete the
program.
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.
Loss of Identity
 Veteran 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.
“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)
“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.
“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)
“Mental Wounds of War”
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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 Relationships
Millennium Cohort Study
 More than 200,000 participants
 Current 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 problems
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, Abuse of other substances
Lethal Triangle
Depression
Current Suicidal Ideation
Access to Means to
Attempt Suicide
Alcohol/Drug Abuse
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 help
Our Response
 Preliminary 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 risk
Helping Suicidal
Service Members and Veterans
 Victor 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)
Veterans Helping Veterans
“
“Who then can so softly bind up the wound of another as
he who has felt the same wound himself?”
-Thomas Jefferson
Veterans Helping Veterans
Website: http://sgtbrandi.com/
Gunnery Sgt. Andrew Brandi, United States Marine Corp
Veterans Helping Veterans
Vet Center Combat Call Center
1- 877-WAR-VETS (927-8387)
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
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
Warrior.
 Demonstrate your desire to help, that they Deserve
help, and that you’ve “got their back.”
 Reach them with genuineness and honesty
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.net
How Friends and Family can Help
 Be 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.
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.
How Friends and Family can Help
 Call 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
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.net
Veterans Affairs Suicide
Prevention Initiative
 Suicide 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-clinicians
Veterans Affairs Suicide Prevention
Initiative
 Caring 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.”
Kurt Rossbach, LCSW
Suicide Prevention Coordinator
Mann-Grandstaff Veterans Affairs
Medical Center
4815 N Assembly St, Spokane, WA
99205
(509) 434-7288
[email protected]