LETC Week 9 - Suicide awareness and prevention

The VA Suicide Prevention Program provides

an enhanced level of care for those Veterans identified as high risk.

High Risk PRFs are activated for

at least 90 days

DO ask the question if you've identified

warning signs or symptoms

18% of all deaths by suicide among U.S. adults

were Veterans

DON'T wait to ask the question

when he/she is halfway out the door

What should I do if I think someone is suicidal?

Don't keep the Veteran's suicidal behavior a secret Do not leave him or her alone Try to get the person to seek immediate help from his or her doctor or the nearest hospital emergency room

Things to remember when doing welfare checks:

Follow up with local police to obtain disposition Provide Disposition to person requesting welfare check

VETERAN-SPECIFIC RISKS

Frequent deployments Deployments to hostile environments Exposure to extreme stress Physical/sexual assault while in the service (not limited to women) Length of deployments Service-related injury

The Enhanced Care protocol includes:

High Risk Flag (90 day period- can be continued) Missed Appointment follow-up Weekly contacts from their Mental Health team for the first 30 days and then at least monthly for the next 60 days Safety Planning

Safety Plans utilize four evidenced based suicide risk reduction strategies:

Means reduction Increasing social support Provides emergency resource information Promotes problem solving skills

RISK FACTORS FOR SUICIDE include

Mental health diagnosis ( Depression, Bipolar, MST, TBI, Psychosis, Borderline PD) Alcohol and other substance abuse Impulsive behavior Previous suicide attempt Job or financial loss/ homelessness Loss of relationship Easy access to lethal means Family history of suicide History of abuse Serious health problems Sexual identity concerns: especially among men 16-24 Recent discharge from hospital, group home etc.

The acronym "S.A.V.E." helps one remember the important steps involved in suicide prevention:

Signs of suicidal thinking should be recognized Ask the most important question of all Validate the Veteran's experience Encourage treatment and Expedite getting help

Continue to ask more questions about suicidal thoughts

Suicidal Ideation Suicide Plan Suicide Intent

KNOW WHO TO CALL:

Suicide Prevention Coordinator Mental Health Response Team Emergency Department or Urgent Care Local VA Facility Crisis Line Veteran's Crisis Line: 1-800-273-8255 (TALK) Press 1 For suicide prevention promotional materials in your area, call you local Suicide Prevention Coordinator

VALIDATE THE VETERAN'S EXPERIENCE

Talk openly about suicide. Be willing to listen and allow the Veteran to express his or her feelings. Recognize that the situation is serious Do not pass judgment Reassure that help is available

WARNING SIGNS

Threatening to hurt or kill self Looking for ways to kill self Seeking access to pills, weapons or other means Talking or writing about death, dying or suicide Sleeping all the time/ Trouble sleeping Hopelessness Rage, anger ** Seeking revenge Acting reckless, engaging in risky activities**

Internal protective factors

ability to cope with stress, religious beliefs, frustration tolerance absence of psychosis Has problem solving/ coping skills Has religiosity/ spirituality Able to tolerate frustration Has responsibility to children or beloved pets Is pregnant Has positive therapeutic relationships Is motivated in treatment Has a good social/family support system Has economic security Has a sense of responsibility for family

External protective factors

responsibility to children or beloved pets, positive therapeutic relationships, Social supports

ask the most important question of all...

"Are you thinking about killing yourself?" " Are you thinking about suicide?"

The presence of any of the following signs requires immediate attention:

- Thinking about hurting or killing themselves - Looking for ways to die - Talking about death, dying, or suicide - Self-destructive or risk-taking behavior, especially when it involves alcohol, drugs or weapons

Suicide is the

10th leading cause of death in the U.S.

Women attempt suicide

3 times more often than men

One suicide attempt every

35 seconds

Men die by suicide almost

4 times more often than women

Physical Injury -

A bodily injury resulting from the physical or toxic effects of a self-directed violent act interacting with the body

Suicide Attempt -

A non-fatal self-inflicted potentially injurious behavior with any intent to die as a result of the behavior.

Interrupted By Self or Other -

A person takes steps to injure self but is stopped by self or another person prior to fatal injury. The interruption may occur at any point.

Preparatory Behavior -

Acts or preparation towards engaging in Self-Directed Violence, but before potential for injury has begun. This can include anything beyond a verbalization or thought, such as assembling a method (e.g., buying a gun, collecting pills) or preparing for one's death by suicide (e.g., writing a suicide note, giving things away).

Suicidal Self-Directed Violence -

Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself with evidence, whether implicit or explicit, of suicidal intent.

Suicide -

Death caused by self-inflicted injurious behavior with any intent to die as a result of the behavior.

Veterans with High Risk PRFs will receive

Enhanced Care Services ( increased frequency of contacts with mental health, formal treatment plan, and suicide safety plan)

HOW CAN LAW ENFORCEMENT ASSIST?

Reducing the Potential for Use of Lethal Means

Suicidal Intent -

There is past or present evidence (implicit or explicit) that an individual wishes to die, means to kill him/herself, and understands the probable consequences of his/her actions or potential actions. Suicidal intent can be determined retrospectively and inferred in the absence of suicidal behavior.

Suicidal Ideation -

Thoughts of engaging in suicide-related behavior. (Various degrees of frequency, intensity, and duration.)

This process is consistent with the Recovery Model, which views

Veterans as collaborators in their treatment and fosters empowerment, hope, and individual potential.

Veterans who have a High Risk for Suicide Patient Record Flag require

a CURRENT Safety Plan

Ask questions about having

access to means? - Firearms, weapons, medications

In 2014, about 65 percent of all Veterans who died by suicide were

age 50 or older.

Veterans are more likely than the general population to use

firearms as a means for suicide

An estimated 9.8 million adults reported

having suicidal thoughts in the past year.

A staff member may ask you to do a welfare check

if indicated. (Remember: A staff member will not ask you to initiate a welfare check if it is not indicated.)

Many Veterans may not show any signs of

intent to harm or kill themselves before doing so

Alcohol and other substance abuse

is a risk factor for suicide.

Protective factors, even if present, may

not counteract significant acute risk

Remember the Time To Develop plan with a high probability of success is

not during the crisis.

It is estimated that close to

one million people make a suicide attempt each year

Veterans in crisis may

show behaviors that indicate a risk of harming or killing themselves

When a Veteran at risk for suicide leaves your facility, provide

suicide prevention information to the Veteran and his or her family

A suicidal person must be

taken seriously and referred for evaluation and treatment.

DO ask the question in such a way

that is natural and flows with the conversation

In 2014, about 67 percent of all Veteran deaths by suicide were

the result of firearm injuries

DON'T ask the question as

though you are looking for a "no" answer. "You aren't thinking of killing yourself are you?"