Understanding Suicide fr Instructrs Navy, Suicide Preventin Branch, OPNAV N171 Octber 2017
Agenda TOPIC NAME 1 Intrductin t N171 and Navy Suicides 2 Suicide Preventin Gals 3 Just the Facts 4 Thery f Suicide 5 Risk Factrs 6 Is Path Warm/Prtective Factrs 7 Resilience/Cnnecting the Dts 8 Seeking Help 9 Theretically Speaking 10 Helping a Suicidal Persn/Resurces 11 Clumbia Suicide Severity Rating Scale / VA Safety Plan 2
Navy Suicide Preventin Prgram The Navy Suicide Preventin Prgram prvides plicies and resurces t the Fleet, encuraging an rganizatinal climate that supprts and develps leaders, fsters resilience and prmtes Ttal Sailr Fitness. Every leader has a respnsibility t develp a cmmand climate that allws Sailrs t seek help, receive help and be welcmed back t the unit The prgram s gal is t reduce suicides by develping resilient Sailrs, encuraging help seeking behavirs and prviding supprt t thse in need.
Navy Suicides: Just The Facts Amng tp three causes f death in the Navy annually Average 2,000 suicide-related behavirs annually Navy rate is better than civilian rate Mst deaths ccur at hme r ff duty Barracks deaths are ften by hanging Annually, greater than 50% invlve a persnal firearm Mst victims are under the age f 25, male, and Caucasian Instructrs will interact mst with Sailrs at risk Sailrs in the schlhuse are in transient status, high stress envirnments and may be scially discnnected METHOD 2012 2013 2014 2015 2016 Firearm 60% [35] 54% [22] 56% [30] 60% [26] 60% [31] Hanging 21% [12] 29% [12] 28% [15] 30% [13] 15% [8] Jumping 7% [4] 5% [2] 11% [6] 5% [2] 12% [6] Other 12% [7] 12% [5] 6% [3] 5% [2] 13% [7] TOTAL/RATE 2012 2013 2014 2015 2016 Ttal Navy 66 46 69 57 62 15.9* 18.1 12.7 16.6 13.1 Navy AC rate/100k Prelim. Navy RC ttal 8 5 15 14 10 Civilian rate/100k (adjusted: males 17-60) 25.7 25.2 25.6 26.4 N/A
Why D Sme Chse T End Their Lives? Thwarted Belngingness Perceived Burdensmeness Capability fr Suicide Desire fr Suicide Deep Dive findings cnsistently reveal: Jiner s Suicide Thery: Suicide risk is higher when Sailrs are experiencing multiple stressrs, including transitins, relatinship issues, fall frm glry Missed pprtunities t cnnect the dts ahead f destructive behavirs, tipping pint Failure t cmmunicate the warning signs r risk factrs detected by cmmands, prviders, family members r peers (mst evident during transitin perids) Access t lethal means THWARTED BELONGINGNESS I am alne. Jiner, T. (2005) Why Peple Die by Suicide Cambridge, MA: Harvard University Press Desire fr PERCEIVED Suicide BURDENSOMENESS I am a burden. CAPABILITY FOR SUICIDE I am nt afraid t die. Suicide r Near-Lethal Suicide Attempt
Understanding Suicide Risk Factrs Navy Mirrrs Sciety Individual factrs Relatinships Culture Ecnmic Histry f abuse Substance abuse Mental health histry Legal prblems Access t care Barriers t seeking help Chrnic pain Sexual harassment, stracism Stressrs Unique t the Navy Unpredictability in jb Jb envirnment, lng hurs Navy and rating culture Lack f privacy Frequent transitin/pcs Stress n families, time away Reprting requirements Fear f career lss, failure Security clearances Chrnic sleep deprivatin Familiarity with weapns Excessive use f energy drinks Rage and suicide are HIGHLY crrelated.
Understanding Warning Signs IS Ideatin Substance Use PATH Purpselessness Anxiety Trapped Hpeless WARM Withdrawal Anger Reckless Md Changes Cnnecting the dts...
Prtective Factrs Individual Prtective Factrs Gd prblem-slving skills Cgnitive flexibility Cping skills Gd self-care Willing t seek help Psitive hbbies Spirituality Resilience Cmmand-level Prtective Factrs Unit chesin Belnging and purpse Peer supprt Strng relatinships Prperly trained fr jb Cmmunicatin Wrk-life balance Psitive envirnment 8
Prevent Suicide by Fcusing n Resilience Fcusing n the GREEN Fstering Resilience Operatinal stress cntrl, life skills, strengthen families, increase awareness, supprt Shipmates Risk Factrs Warning Signs Vigilance & Early Interventin Crisis Respnse A C T Suicide Behavirs Pst- Ventin
Cnnecting the Dts Wh is at Risk? Histry Histry f Abuse (Physical, Sexual, Emtinal): 22% Prir Suicide Related Behavir: 62% Mental Health Treatment in Past Year: 41% Prir Suicide Attempt: 19% Alchl Abuse: 35% Disrupted Scial Netwrk Transitin (Pending demtin/pcs/upcming Separatin frm the Navy, Retirement): 77% Judgment Factrs Sleep Prblems: 42% Recent event causing anger: 38% Under the Influence f Alchl: 30% Access t Lethal Means Access t Firearms: 62% *NAVADMIN 263/14 Histry Onging Stressrs Experienced Lss: 78% Intimate Relatinship Prblems: 75% Wrk Prblems: 58% Disciplinary/Legal Issues: 35% Financial Issues: 7% Life Event 78% Warning Signs Recent Event Causing Shame, Guilt, Lss f Status: 49% Recent Event Causing Feelings f Rejectin/Abandnment: 42% Feelings f Hpelessness: 38% Recent Event Causing Feelings f Helplessness: 35% *Missed Opprtunities t cnnect the dts Distrted Thinking + Lethal Actin Surce: 2014 Navy Suicide Preventin Annual Multi- Disciplinary Case Review 10
Why Sailrs Dn t r Wn t Seek Help Mst Sailrs believe they d receive help if they asked and their peers wuld be supprtive. Hwever Many believe they d be treated differently Many fear they wuld lse the trust f their leaders Many believe it wuld negatively impact their career Sme believe they d lse their security clearance Mst fear lss f privacy Mst fear gssip, being perceived as weak Discuraging cmmand climate, get ver it. Persn wuld receive help needed Shipmates wuld be suprtive Peple wuld treat persn differently It wuld negatively impact persn's career It wuld help persn's career Persn wuld be able t keep security clearance Nthing wuld happen Other Yes N
The Truth Abut Seeking Help SPREAD Psychlgical Health Treatment and SF86 Questin 21 TRUTH Standard Frm 86 (SF86) Questinnaire fr Natinal Security Psitins is used t evaluate individuals under cnsideratin fr Cnfidential, Secret, and Tp Secret security clearances. One f the many reasns service members chse nt t seek help fr psychlgical health cncerns is fear that ding s will jepardize their clearance eligibility and careers. Here are the facts abut answering Questin 21: It s kay t speak up when yu re dwn Less then 1% f security clearance denials and revcatins invlve psychlgical health cncerns. Seeking help t prmte persnal wellness and recvery may favrably impact a persn s security clearance eligibility. Nt all psychlgical health treatment is required t be reprted when answering questin 21. Any psychlgical health care yu reprt when answering Questin 21 is prtected by privacy rights. Discussing suicide penly and respnsibly encurages help-seeking Less than 1% f security clearances lst are due t mental health reasns Mst return t duty and remain in the Navy Mental health prviders can nly rutinely cmmunicate with yur dctr and yur Cmmanding Officer Language cunts Leaders set the tne
Recgnizing Risk in Students Listen t yur student: Life isn t wrth living. I d rather be dead; my family is better ff withut me. I ve failed at everything. I dn t knw what I m ging t d, I have n where t g. If I get ut f the Navy, I dn t knw what I ll d. Things t lk fr: Declining self-care (weight lss, disheveled appearance, n hbbies) Nt making plans, seems t have given up Scial media psts with increasing images f alchl, weapns and feelings f lneliness and rejectin
Theretically Speaking Thwarted Belngingness: Rejectin by r separatin frm unit Rejectin by r separatin frm friends and family Lss f relatinships (significant ther, children, mentr) Lss f identity (Navy status, culture, sciety, rganizatins) Emtinally discnnected Feeling stracized Fear f gssip and judgment
Theretically Speaking Perceived Burdensmeness: Others standing the watch, extra wrk lad fr peers Disappinting leaders, peers and family Added stress fr family Financial strain fr family Frequent r embarrassing mistakes at wrk Difficulty getting qualificatins r learning the jb
Theretically Speaking Acquired Capacity: Nearly all hands trained t use a weapn, sme use daily Many military wn private weapns Expsure t cmbat r death Prir traumatic experiences with near death r abuse High risk takers, impulsivity Preparatins fr death, rehearsals Prir suicide attempts
Helping A Suicidal Persn ASK: Are yu thinking abut suicide? D yu wish yu were dead? D yu wish yu wuldn t wake up? Have yu thught abut a way t kill yurself? Leading questins are kay, With this amunt f stress, it s cmmn fr peple t feel they d be better ff dead. Have yu had thse thughts? Ask the client if he/she is getting supprt, hw the unit is treating them, are they eating and sleeping r increasing alchl CARE: Listen withut judgment Dn t give yur pinins f suicide, dn t tell them that thers have it wrse TREAT: Get the persn t a prfessinal Take them t the ER, medical, the cmmand r call 911 Remve any weapns (guns, pills, knives, rpes), stay with the persn until safe It s kay t ask abut safety at every appintment Even with the best decisins and actins, tragedies d ccur Under NO circumstances shuld yu use a cntract fr safety!
Leadership Tips Updated Cmmand Directed Evaluatin Instructin NAVADMIN 263/14, Reducing Access t Lethal Means Medical cmmunicatin with line leaders Prtect privacy f Sailrs wh need help Knw the lcal resurces and supprt help seeking Prhibit repercussins, belittling, stracism Be careful f hw yu talk abut suicide The Sailr is yur Sailr until discharges/pcs 18
Clumbia-Suicide Severity Rating Scale (C-SSRS) Suicide Ideatin Definitins and Prmpts Ask questins that are blded and underlined. YES NO *Min f 3 Questins Ask Questins 1 and 2 1) Wish t be Dead: Have yu wished yu were dead r wished yu culd g t sleep and nt wake up? 2) Suicidal Thughts: Have yu actually had any thughts f killing yurself? If YES t questin 2, ask questins 3, 4, 5 and 6. If NO t 2, g directly t questin 6. 3) Suicidal thughts with methd (withut specific plan r intent t act): Have yu been thinking abut hw yu might kill yurself? 4) Suicidal Intent (withut specific plan): Have yu had these thughts and had sme intentin f acting n them? If 2 yes, ask 3-6 If 2 is NO g t 6 *Max f 6 Questins 5) Suicide Intent with Specific Plan: Have yu started t wrk ut r wrked ut the details f hw t kill yurself? D yu intend t carry ut this plan? 6) Suicide Behavir Questin: Have yu ever dne anything, started t d anything, r prepared t d anything t end yur life?
Administratin (1 f 3) Time frame fr Questins 1-5: Past mnth Ask questins that are in bld and underlined All receiving C-SSRS are asked Questins 1 and 2 Based n respnses, decisin tree is used t determine which additinal questins are asked 1) Wish t be Dead: Persn endrses thughts abut a wish t be dead r nt alive anymre, r wish t fall asleep and nt wake up? Have yu wished yu were dead r wished yu culd g t sleep and nt wake up? 2) Suicidal Thughts: General nn-specific thughts f wanting t end ne s life/cmmit suicide, I ve thught abut killing myself withut general thughts f ways t kill neself/assciated methds, intent, r plan. Have yu had any actual thughts f killing yurself? Cnsider frequent and recent thughts. 20
Administratin (2 f 3) If respnse t Questin 2 is YES, ask Questins 3-6 If respnse t Questin 2 is NO, g directly t Questin 6 3) Suicidal Thughts with Methd (withut Specific Plan r Intent t Act): Persn endrses thughts f suicide and has thught f a least ne methd during the assessment perid. This is different than a specific plan with time, place r methd details wrked ut. I thught abut taking an verdse but I never made a specific plan as t when where r hw I wuld actually d it.and I wuld never g thrugh with it. Have yu been thinking abut hw yu might d this? 4) Suicidal Intent (withut Specific Plan): Active suicidal thughts f killing neself and patient reprts having sme intent t act n such thughts, as ppse t I have the thughts but I definitely will nt d anything abut them. Have yu had these thughts and had sme intentin f acting n them? 5) Suicide Intent with Specific Plan: Thughts f killing neself with details f plan fully r partially wrked ut and persn has sme intent t carry it ut. Have yu started t wrk ut r wrked ut the details f hw t kill yurself? D yu intend t carry ut this plan? Ask abut lethal means. 21
Administratin (3 f 3) Time frames fr Questin 6: Lifetime and Past three mnths 6) Suicide Behavir Questin a. Have yu ever dne anything, started t d anything, r prepared t d anything t end yur life? Examples: cllected pills, btained a gun, gave away valuables, wrte a will r suicide nte, tk ut pills but didn t swallw any, held a gun but changed yur mind r it was grabbed frm yur hand, went t the rf but didn t jump; r actually tk pills, tried t sht yurself, cut yurself, tried t hang yurself, etc. If YES, ask: b. Was this within the past 3 mnths? The best predictr f future behavir is past behavirs. 22
General Guidelines HIGHEST YES RESPONSE RISK VARIABLE SEVERITY LEVEL POTENTIAL ACTION Q1 Yes Wish t die Lw Risk Rutine Behaviral Health Referral Assist t cnnect with behaviral health prvider. Mnitr, but next available appintment is acceptable. Q2 Yes Active thughts Mild Urgent Behaviral Health Referral Advcate fr pririty appintment (pririty behaviral health referral). Infrm prfessinal f circumstances and request service member be seen within a few days. Q3 Yes Methd(s) Mderate Urgent r Immediate Outpatient Behaviral Health Referral Pririty-, i.e. within few days r Immediate (tday) utpatient Behaviral Health referral. Emergency Rm (ER) nt therwise required. Q4 Yes Intent Severe Immediate evaluatin at MTF Outpatient r Emergency Rm Arrange 100% bservatin, send with written dcumentatin Q5 Yes Plan and intent Extreme Immediate evaluatin at MTF Outpatient r Emergency Rm Arrange 100% bservatin, send with written dcumentatin Q6 prvides infrmatin n histry f suicide related behavir and shuld heavily infrm risk level determinatin. *Use ALL details t infrm yur respnse. Level is nly ne piece f infrmatin!
Veteran s Affairs Safety Plan The Sailr s Plan SAFETY PLAN: VA VERSION Step 1: Warning signs: 1. 2. 3. Step 2: Internal cping strategies - Things I can d t take my mind ff my prblem withut cntacting anther persn: 1. 2. 3. Step 3: Peple and scial settings that prvide distractin: 1. Name Phne 2. Name Phne 3. Place 4. Place Step 4: Peple whm I can ask fr help: 1. Name Phne 2. Name Phne 3. Name Phne Step 5:Prfessinals r agencies I can cntact during a crisis: 1. Clinician Name Phne Clinician Pager r Emergency Cntact # 2. Clinician Name Phne Clinician Pager r Emergency Cntact # 3. Lcal Urgent Care Services Urgent Care Services Address Urgent Care Services Phne 4. VA Suicide Preventin Resurce Crdinatr Name VA Suicide Preventin Resurce Crdinatr Phne 5. VA Suicide Preventin Htline Phne: 1-800-273-TALK (8255), push 1 t reach a VA mental health clinician Step 6: Making the envirnment safe: 1. 2. Safety Plan Treatment Manual t Reduce Suicide Risk: Veteran Versin (Stanley & Brwn, 2008). Under NO circumstances shuld yu use a cntract fr safety! 24
Resurces fr Sailrs Lcal Resurces: Chain f cmmand fr supprt, mentrship and guidance Chaplains:100% cnfidentiality, CREDO, premarital & marital cunseling, spiritual guidance and supprt Fleet and Family Supprt Centers (FFSCs): cunseling, classes, educatin, supprt prgrams Primary Care Manager and Primary Care Mental Health Prvider Integrated Behaviral Health, assessments and treatment Natinal 24/7 Resurces: Military OneSurce: 1-800-342-9647 Natinal Suicide Preventin Lifeline: 1-800-273-8255 Veterans Military Crisis Line: 1-800-273-8255, Press 1 BeThere Peer Supprt Call & Outreach Center: 1-844-357- PEER DD Safe Helpline: 877-995-5247 Dn t be afraid t ask abut access t lethal means (firearms, medicatins, etc.). Free gun lcks are available at lcal FFSCs and NOSCs. Fr mre infrmatin, refer t NAVADMIN 263/14 r visit www.suicide.navy.mil. Be mindful f yur wn mental health when wrking with suicidal clients
Other Resurces General Suicide Preventin Resurces Navy Suicide Preventin: www.suicide.navy.mil Cntact infrmatin Facts and warning signs Infrmatinal prducts and resurces Suicide Preventin Resurce Center: www.sprc.rg Navy Operatinal Stress Cntrl Resurces Wrdpress blg: www.navynavstress.cm Twitter: www.twitter.cm/navstress Facebk: www.facebk.cm/navstress Clumbia Suicide Severity Rating Scale (C-SSRS) Training http://cssrs.clumbia.edu/training/training-ptins/