1 Army Suicide Prevention. 2 SuicidePrevention Suicide PreventionOverview Personal Experience ...

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Army Army SuicideSuicidePrevention

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SuicideSuicide PreventionPreventionOvervieOvervie

wwPersonal ExperienceMythsThe Problem – Increase in SuicideShoulder to Shoulder VideoRisk Factors – Review of Training Tip CardBalancing Stress of LifeSymptoms of RiskRed FlagsVignettes/ACE cardStigmaKey IdeasConfidential Resources

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Personal Personal ExperienceExperienceHow many of you have had How many of you have had personal experience with personal experience with someone who has attempted someone who has attempted suicide?suicide?How many of you have had How many of you have had personal experience with someone personal experience with someone who has been successful in suicide?who has been successful in suicide?

You are welcome to share your story if you You are welcome to share your story if you like. If, at the end of our time together, you like. If, at the end of our time together, you

have painful memories that have been have painful memories that have been stirred, please stay after class. Do not carry stirred, please stay after class. Do not carry

them out with you.them out with you.

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MythsMythsPeople who People who commit suicide are commit suicide are mentally illmentally ill

Talking about Talking about suicide will put suicide will put the idea into the idea into another another person’s headperson’s head

Good circumstances Good circumstances prevent suicideprevent suicidePeople who talk People who talk about suicide won’t about suicide won’t commit suicidecommit suicidePeople who People who threaten suicide, threaten suicide, cut their wrists, or cut their wrists, or don’t succeed with don’t succeed with other attempts are other attempts are not a risk for not a risk for suicidesuicide

People who are People who are deeply depressed deeply depressed don’t have the don’t have the energy to commit energy to commit suicidesuicidePeople often People often commit suicide commit suicide without warningwithout warning

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The Problem -Increase in Suicides in the Army

Recently, the Army has seen an increase in suicides and suicidal behavior over the last few years.The loss of any Soldier impacts not only that Soldier’s family and friends but hurts unit morale and unit cohesion. The entire Army hurts when a Soldier dies from suicide.The key to preventing suicides is for all Soldiers and DAC employees to help each other.

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Risk Risk FactorsFactors

Alcohol and Drug Alcohol and Drug AbuseAbuse

Financial Financial ProblemsProblemsLegal ProblemsLegal Problems

Family ViolenceFamily Violence

Poor Job Poor Job PerformancePerformance

Relationship Relationship DifficultiesDifficulties Inability to CopeInability to Cope

Disciplinary ActionsDisciplinary Actions

Under InvestigationUnder Investigation

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Balancing the stress Balancing the stress of Life is a difficult of Life is a difficult

challengechallenge

ScaleScale

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It doesn’t take a lot to It doesn’t take a lot to throw life out of throw life out of

balancebalance

ScaleScale

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Symptoms of Symptoms of RiskRisk

Suicide Gestures Suicide Gestures

Pessimistic OutlookPessimistic OutlookGiving Away ItemsGiving Away Items

Talking About SuicideTalking About Suicide

Talking About DeathTalking About Death

FarewellsFarewells

Increased Alcohol UseIncreased Alcohol Use

Weeping EasilyWeeping Easily

Change in Eating Change in Eating Habits- Weight Loss Habits- Weight Loss

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Symptoms of Risk Symptoms of Risk ContinuedContinued

Drop in Drop in PerformancePerformance

Increased IrritabilityIncreased Irritability

Loss of Sense of HumorLoss of Sense of HumorSocial WithdrawalSocial WithdrawalContinual SadnessContinual Sadness

Feeling Hopeless/HelplessFeeling Hopeless/Helpless

Change in Sleeping Change in Sleeping HabitsHabits

Chronic Chronic Illness/PainIllness/Pain

Loss of HealthLoss of Health

VIGNETTESVIGNETTES

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Vignette QuestionsVignette Questions What warning signs or symptoms presented in the What warning signs or symptoms presented in the

vignette indicated that the Soldier/employee was vignette indicated that the Soldier/employee was experiencing problems?experiencing problems?

What courses of actions could you have taken to What courses of actions could you have taken to help this Soldier/employee?help this Soldier/employee?

What are some barriers, attitudes, and problems What are some barriers, attitudes, and problems that Soldiers /employees might face from that Soldiers /employees might face from leaders/supervisors when asking for help?leaders/supervisors when asking for help?

Who could you have referred this Soldier/employee Who could you have referred this Soldier/employee for help?for help?

What problems do you have as leaders/supervisors What problems do you have as leaders/supervisors in dealing with Soldiers/employees who exhibit in dealing with Soldiers/employees who exhibit behavioral and emotional problems?behavioral and emotional problems?

INTERVENTIONINTERVENTIONACEACE

Ask your Buddy/Co-worker– Have the courage to ask the

question, but stay calm– Ask the question directly,

e.g. Are you thinking of killing yourself?

Care for your Buddy/Co-worker– Remove any means that

could be used for self-injury– Calmly control the situation;

do not use force Escort your Buddy/Co-worker

– Never leave you’re the person alone

– Escort to the chain of command, a Chaplain, a behavioral health professional, EAP or a primary care provider

Suicide Vignette #1Suicide Vignette #1

PVT Smith was a 22 year-old single, black PVT Smith was a 22 year-old single, black male who was three months into his first male who was three months into his first deployment. While surfing deployment. While surfing MySpace.com, he learned that his MySpace.com, he learned that his deployed girlfriend was involved in deployed girlfriend was involved in another relationship. After that, PVT another relationship. After that, PVT Smith began to abuse alcohol. One Smith began to abuse alcohol. One evening, PVT Smith refused to go to the evening, PVT Smith refused to go to the gym with his buddies, which was gym with his buddies, which was unusual. That night, Private Smith shot unusual. That night, Private Smith shot himself to death.himself to death.

Can you list the warning signs? Can you list the warning signs?

Suicide Vignette #1 - Suicide Vignette #1 - ResponseResponse

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Given that you know PVT Smith, and are aware of his distress, which of the following would be the best response?

1.Wait and see how things go because it’s not a good idea to interfere in anotherSoldier’s personal matters. He might get angry.

2.If I knew about his girlfriend problems, I would talk to him to see if he was alright. I would ask him if he felt suicidal. If he said yes, I would escort him to see the commander.

3.Because of his alcohol abuse, I would inform the Platoon SGT that something was troubling PVT Smith i.e., he was drinking too much. I would suggest that the Platoon SGT talk to him.

SPC Rhodes was a 25 year-old, single white female, 91W, who has deployed three different times: twice to Iraq and once to Afghanistan. During a current deployment, her TMC experienced a mass casualty in which SPC Rhodes watched several Soldiers from her unit die. She was neither well-liked nor disliked by others. She frequently talked about her boyfriend back home and their plans to marry. About a week before she died, she received a letter from her boyfriend indicating that he wanted to terminate their relationship. SPC Rhodes was discovered in her bunk dead from a drug overdose.

Can you list the warning signs?

Suicide Vignette #2


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Given that you know SPC Rhodes, and are aware of her distress, which of the following would be the best response?

1. “ Dear John or Dear Joan” letters are common during deployments. It is best to wait and see how a Soldier will respond to such a letter. You don’t want to ask intrusive questions unnecessarily because the Soldier could get angry.

2. If I had known about her boyfriend problems, I would have asked one of her girlfriends to talk to her. Girls relate better to each other. She would never tell a guy if she was suicidal.

3. Both the mass casualty and the loss of her boyfriend were concerns. I would talk to her to see if she was alright. As her buddy, I would make sure she talked to either the unit Chaplain or COSC team about her losses.

PFC Morgan was a 19 year-old, single, white male, 11B, PFC Morgan was a 19 year-old, single, white male, 11B, who had deployed twice to Iraq with significant combat who had deployed twice to Iraq with significant combat exposure. PFC Morgan had difficulties learning new exposure. PFC Morgan had difficulties learning new Soldiers’ skills. Because of his slowness, he was often Soldiers’ skills. Because of his slowness, he was often ridiculed by peers and leadership. Everyone believed ridiculed by peers and leadership. Everyone believed that he accepted the treatment as good natured ribbing. that he accepted the treatment as good natured ribbing. Prior to his death, he gave away some personal Prior to his death, he gave away some personal belongings. About one day before his death, he also belongings. About one day before his death, he also told a buddy that he had “had enough”. This was told a buddy that he had “had enough”. This was interpreted as simple frustration. PFC Morgan was interpreted as simple frustration. PFC Morgan was found dead in his car by carbon monoxide poisoning. found dead in his car by carbon monoxide poisoning.

Can you list the warning signs?Can you list the warning signs?



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Given that you know PFC Morgan, and aware of his distress, which of the following would be the best response?

1.If I had known he was angry about being “teased”, I would talk to him to see if he was alright. I would ask him if he felt suicidal. If he said yes, I would convince him to see a behavioral health provider in the morning. After he made a commitment, I would tell him that I would pick him up the next day.2.In the Army, people are always joking with each other. That’s how we all deal with the stress. If you can’t handle the ribbing, you should get out of the Army.3.When I heard that he had had enough, I would immediately ask him if he was thinking of suicide. If he said yes, I would stay with him, and inform the chain of command. I would never leave him alone until he saw a helping provider.


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Marilyn is a civilian government employee. She is a single mom of two little girls. Last year her husband of 10 years left her for another woman. Marilyn has had a history of depression but seems quite cheerful the last couple of days. She recently increased her life insurance limits and was excited to tell co-workers about how this increase would provide for her girls in the future. This past week she went around to each department saying “goodbye” to her co-workers.



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Given that you know Marilyn, what would be the best response?

1.Give her a hug and assume she is saying “goodbye” until tomorrow.2.Plan to call her supervisor tomorrow to see if Marilyn is leaving the company.3.Ask Marilyn what she means by “goodbye”. Ask Marilyn if she is planning on committing suicide. If Marilyn indicates she is having suicidal thoughts ESCORT Marilyn to the Employee Assistance Program, Emergency Room or other suicide intervention resource.

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What coping What coping mechanisms do you mechanisms do you find helpful in find helpful in dealing with your dealing with your life’s stress?life’s stress?

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Red Flags...Red Flags...

If someone displays a dramatic If someone displays a dramatic

behavior or personality change it is behavior or personality change it is

vital for supervisors and co-workers vital for supervisors and co-workers

to find out what is going on--to find out what is going on--

Always AskAlways Ask the individualthe individual““Are you considering Are you considering

suicide?”suicide?”

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If You Suspect The Person Is If You Suspect The Person Is SuicidalSuicidal Save Their ‘Save Their ‘LIFE’LIFE’

LLocate Help: Supervisor, Chapel Staff, ocate Help: Supervisor, Chapel Staff, Medical Staff, EAP, Friend .Medical Staff, EAP, Friend .IInform Chain of Command/Supervisornform Chain of Command/Supervisor

FFind Someone to Stay with the Personind Someone to Stay with the Person

EExpedite Intervention--xpedite Intervention--

Get Help ImmediatelyGet Help Immediately

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What To Do If You Suspect What To Do If You Suspect TroubleTrouble When When NotNot Serving on Duty Serving on Duty Status Status

Save Their ‘Save Their ‘LIFE’LIFE’

LLocate Help: Crisis line, Hospital Emergency ocate Help: Crisis line, Hospital Emergency Room, Friend, Family, Police, Chaplain, ClergyRoom, Friend, Family, Police, Chaplain, Clergy

IInform Family and Individual’s Support Networknform Family and Individual’s Support Network

FFind Someone to Stay with the Personind Someone to Stay with the Person

EExpedite--Get Help Immediatelyxpedite--Get Help Immediately

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What To Avoid Doing What To Avoid Doing If You If You Suspect Trouble: Suspect Trouble: Don’t Don’t Ignore Warning SignsIgnore Warning Signs

Warn Against Seeking HelpWarn Against Seeking Help

Assume Minor Troubles are UnimportantAssume Minor Troubles are Unimportant

Give Advice/False ReassuranceGive Advice/False Reassurance

Assume Someone is Immune from Self-harmAssume Someone is Immune from Self-harm

Advise Drug/Alcohol UseAdvise Drug/Alcohol Use

Challenge the Individual to “Just Do It”Challenge the Individual to “Just Do It”

Leaders and Supervisors Can Leaders and Supervisors Can Reduce Stigma by: Reduce Stigma by:

Not discriminating against Soldiers/employees who Not discriminating against Soldiers/employees who receive mental health counseling. receive mental health counseling.

Supporting confidentiality between the Soldier/employee Supporting confidentiality between the Soldier/employee and their behavioral health care provider. and their behavioral health care provider.

Reviewing unit policies and procedures that could Reviewing unit policies and procedures that could preclude Soldiers/employees from receiving all preclude Soldiers/employees from receiving all necessary and indicated assistance. necessary and indicated assistance.

Educating all Soldiers/employees and family members Educating all Soldiers/employees and family members about anxiety, stress, depression, and treatment.about anxiety, stress, depression, and treatment.

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Key IdeasKey Ideas

Everyone is encouraged to seek help Everyone is encouraged to seek help before letting their feelings get out of before letting their feelings get out of controlcontrol

Seeking help is a sign of strength, not weaknessSeeking help is a sign of strength, not weakness

Seeking help doesn’t necessarily end Seeking help doesn’t necessarily end one’s career—Not seeking help when one’s career—Not seeking help when needed needed willwill end a career end a career

People are the Army’s greatest asset People are the Army’s greatest asset and we want to preserve their careers and we want to preserve their careers by helping them deal with life’s stressby helping them deal with life’s stress

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Confidential Confidential ResourcesResourcesThe Chaplain can be a The Chaplain can be a

tremendous source of help and tremendous source of help and support by offering confidentiality support by offering confidentiality to you when talking about to you when talking about personal issues. personal issues.

The Employee Assistance The Employee Assistance Program is available to Civilians Program is available to Civilians going through crisis.going through crisis.

Ft. Detrick resources can be Ft. Detrick resources can be found at found at http://www.detrick.army.mil/asap/suicideprevention.cfm . .

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This Concludes the This Concludes the Presentation on Suicide Presentation on Suicide

PreventionPrevention

Do You Have Any Do You Have Any Questions?Questions?

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Printable Vignette Pages

Suicide Vignette #1Suicide Vignette #1PVT Smith was a 22 year-old single, black male who was three months into his firstPVT Smith was a 22 year-old single, black male who was three months into his firstdeployment. While surfing MySpace.com, he learned that his deployed girlfriend deployment. While surfing MySpace.com, he learned that his deployed girlfriend

was was involved in another relationship. After that, PVT Smith began to abuse alcohol. One involved in another relationship. After that, PVT Smith began to abuse alcohol. One evening, PVT Smith refused to go to the gym with his buddies, which was unusual. evening, PVT Smith refused to go to the gym with his buddies, which was unusual.

ThatThatnight, Private Smith shot himself to death.night, Private Smith shot himself to death.

Can you list the warning signs? Can you list the warning signs?

Given that you know PVT Smith, and are aware of his distress, which of the Given that you know PVT Smith, and are aware of his distress, which of the following following

would be the best response?would be the best response?1.1. Wait and see how things go because it’s not a good idea to interfere in anotherWait and see how things go because it’s not a good idea to interfere in another

Soldier’s personal matters. He might get angry.Soldier’s personal matters. He might get angry.2.2. If I knew about his girlfriend problems, I would talk to him to see if he was If I knew about his girlfriend problems, I would talk to him to see if he was

alright. I would ask him if he felt suicidal. If he said yes, I would escort him to alright. I would ask him if he felt suicidal. If he said yes, I would escort him to see the commander.see the commander.

3.3. Because of his alcohol abuse, I would inform the Platoon SGT that something Because of his alcohol abuse, I would inform the Platoon SGT that something was troubling PVT Smith i.e., he was drinking too much. I would suggest that was troubling PVT Smith i.e., he was drinking too much. I would suggest that the Platoon SGT talk to him.the Platoon SGT talk to him.

SPC Rhodes was a 25 year-old, single white female, 91W, who has deployed three

different times: twice to Iraq and once to Afghanistan. During a current deployment,

her TMC experienced a mass casualty in which SPC Rhodes watched several

Soldiers from her unit die. She was neither well-liked nor disliked by others. She

frequently talked about her boyfriend back home and their plans to marry. About a

week before she died, she received a letter from her boyfriend indicating that he

wanted to terminate their relationship. SPC Rhodes was discovered in her bunk dead

from a drug overdose.


Given that you know SPC Rhodes, and are aware of her distress, which of the

following would be the best response?1. “ Dear John or Dear Joan” letters are common during

deployments. It is best to wait and see how a Soldier will respond to such a letter. You don’t want to ask intrusive questions unnecessarily because the Soldier could get angry.

2. If I had known about her boyfriend problems, I would have asked one of her girlfriends to talk to her. Girls relate better to each other. She would never tell a guy if she was suicidal.

3. Both the mass casualty and the loss of her boyfriend were concerns. I would talk to her to see if she was alright. As her buddy, I would make sure she talked to either the unit Chaplain or COSC team about her losses.

Suicide Vignette #2

PFC Morgan was a 19 year-old, single, white male, 11B, who had deployed twice to Iraq with significant PFC Morgan was a 19 year-old, single, white male, 11B, who had deployed twice to Iraq with significant

combat exposure. PFC Morgan had difficulties learning new Soldiers’ skills. Because of his slowness,combat exposure. PFC Morgan had difficulties learning new Soldiers’ skills. Because of his slowness,

he was often ridiculed by peers and leadership. Everyone believed that he accepted the treatment ashe was often ridiculed by peers and leadership. Everyone believed that he accepted the treatment as

good natured ribbing. Prior to his death, he gave away some personal belongings. About one day before good natured ribbing. Prior to his death, he gave away some personal belongings. About one day before

his death, he also told a buddy that he had “had enough”. This was interpreted as simple frustration.his death, he also told a buddy that he had “had enough”. This was interpreted as simple frustration.

PFC Morgan was found dead in his car by carbon monoxide poisoning. PFC Morgan was found dead in his car by carbon monoxide poisoning.

Can you list the warning signs?Can you list the warning signs?

Given that you know PFC Morgan, and aware of his distress, which of the following would be the best Given that you know PFC Morgan, and aware of his distress, which of the following would be the best

Response?Response?

1.1. If I had known he was angry about being “teased”, I would talk to him to see if he was alright. I would If I had known he was angry about being “teased”, I would talk to him to see if he was alright. I would ask him if he felt suicidal. If he said yes, I would convince him to see a behavioral health provider in the ask him if he felt suicidal. If he said yes, I would convince him to see a behavioral health provider in the morning. After he made a commitment, I would tell him that I would pick him up the next day.morning. After he made a commitment, I would tell him that I would pick him up the next day.

2.2. In the Army, people are always joking with each other. That’s how we all deal with the stress. If you In the Army, people are always joking with each other. That’s how we all deal with the stress. If you can’t handle the ribbing, you should get out of the Army.can’t handle the ribbing, you should get out of the Army.

3.3. When I heard that he had had enough, I would immediately ask him if he was thinking of suicide. If he When I heard that he had had enough, I would immediately ask him if he was thinking of suicide. If he said yes, I would stay with him, and inform the chain of command. I would never leave him alone until he said yes, I would stay with him, and inform the chain of command. I would never leave him alone until he saw a helping provider. saw a helping provider.



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Marilyn is a civilian government employee. She is a single mom of two little girls. Last year her husband of 10 years left her for another woman. Marilyn has had a history of depression but seems quite cheerful the last couple of days. She recently increased her life insurance limits and was excited to tell co-workers about how thisincrease would provide for her girls in the future. This past week she went around to each department saying “goodbye” to her co-workers.


Given that you know Marilyn, what would be the best response?

1.Give her a hug and assume she is saying “goodbye” until tomorrow.2.Plan to call her supervisor tomorrow to see if Marilyn is leaving the company.3.Ask Marilyn what she means by “goodbye”. Ask Marilyn if she is planning on

committing suicide. If Marilyn indicates she is having suicidal thoughts ESCORT Marilyn to the Employee Assistance Program, , Emergency Room or other suicide intervention resource.

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