Military Suicide: Prevention, Assessment, …...Military Suicide PAIR Certification Course Light...

MilitarySuicide:Prevention,

Assessment,Intervention

andRecovery

P.O.Box739•Forest,VA24551•1-800-526-8673•www.AACC.net

MilitarySuicidePAIRCertificationCourse

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Welcome to Light University and the “Military Suicide: Prevention, Assessment, InterventionandAftercare”programofstudy.Our prayer is that you will be blessed by your studies and increase your effectiveness inreaching out to others. We believe you will find this program to be academically sound,clinicallyexcellentandbiblically-based.Our faculty represents some of the best in their field – including professors, counselors andministers who provide students with current, practical instruction relevant to the needs oftoday’sgenerations.We have alsoworked hard to provide youwith a program that is convenient and flexible –givingyoutheadvantageof“classroominstruction”onlineandallowingyoutocompleteyourtrainingonyourowntimeandscheduleinthecomfortofyourhomeoroffice.Thetestmaterialcanbefoundatwww.lightuniversity.comandmaybetakenopenbook.Onceyouhavesuccessfullycompletedthetest,whichcoverstheunitswithinthiscourse,youwillbeawardedacertificateofcompletionsignifyingyouhavecompletedthisprogramofstudy.Thank you for your interest in this program of study. Our prayer is that you will grow inknowledge,discernment,andpeople-skillsthroughoutthiscourseofstudy.Sincerely,

RonHawkinsDean,LightUniversity


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Co-Sponsoredby:

TheleadershipofHopeQuestMinistryhasapassiontosharetheloveofGodto

others throughexhibiting care, compassion, and support to thosewhoarehurt

and broken. HopeQuest Ministry Group works to help individuals repair and

restorerelationships intheir lives.HopeQueststrivestobuildcommunitywhere

relationshipsareformedandpeoplearepropelledtobecomeleaders.Individuals

are provided a framework and direction in order to assist them in facilitating

positive life changes. The ministry offered through HopeQuest extends

accountability and support to individuals as they experience the stressors and

challengesoflife.Inordertomakeservicesmostaccessible,HopeQuestoperates

asanon-profitorganizationandhasdevelopedstrategiestokeepthecostslower

andmoreaffordable.

MailingAddress:

TheHopeQuestMinistryGroup,Inc.

PostOfficeBox2699

Woodstock,Georgia30188

WebSite:http://hopequestgroup.org/

MainOfficePhoneNumber:(678)391-5950


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TheAmericanAssociationofChristianCounselors

• Represents the largestorganizedmembership (nearly50,000)ofChristian counselorsandcaregiversintheworld,havingjustcelebratedits25thanniversaryin2011.

• Known for its top-tier publications (Christian Counseling Today, the Christian CounselingConnectionandChristianCoachingToday),professionalcredentialingopportunitiesofferedthroughtheInternationalBoardofChristianCare(IBCC),excellenceinChristiancounselingeducation, an arrayof broad-based conferences and live training events, radioprograms,regulatoryandadvocacyeffortsonbehalfofChristianprofessionals,apeer-reviewedEthicsCode, and collaborative partnerships such as Compassion International, the NationalHispanic Christian Leadership Conference and Care Net (to name a few), the AACC hasbecomethefaceofChristiancounselingtoday.

• With the needed vision and practical support necessary, the AACC helped launch the

International Christian Coaching Association (ICCA) in 2011, which now represents thelargest Christian life coaching organization in the world with over 2,000 members andgrowing.

OurMission

The AACC is committed to assisting Christian counselors, the entire “community of care,”licensedprofessionals,pastors,and laychurchmemberswith littleorno formal training. It isourintentiontoequipclinical,pastoral,andlaycaregiverswithbiblicaltruthandpsychosocialinsights that minister to hurting persons and helps them move to personal wholeness,interpersonalcompetence,mentalstability,andspiritualmaturity.

OurVision


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TheAACC’svisionhastwocriticaldimensions:First,wedesiretoservetheworldwideChristianChurch by helping foster maturity in Christ. Secondly, we aim to serve, educate, and equip1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the nextdecade.WearecommittedtohelpingtheChurchequipGod’speopletoloveandcareforoneanother.We recognize Christian counseling as a unique form of Christian discipleship, assisting thechurch in its call to bring believers to maturity in the lifelong process of sanctification—ofgrowingtomaturityinChristandexperiencingabundantlife.Werecognizesomearegiftedtodosointhecontextofaclinical,professionaland/orpastoralmanner.Wealsobelieveselected laypeoplearecalledtocareforothersandthattheyneedtheappropriatetrainingandmentoringtodoso.WebelievetheroleofthehelpingministryintheChurchmustbesupportedbythreestrongcords:thepastor,thelayhelper,andtheclinicalprofessional.ItistothesethreerolesthattheAACCisdedicatedtoserve(Ephesians4:11-13).

OurCoreValues

InthenameofChrist,theAmericanAssociationofChristianCounselorsabidesbythefollowingvalues:

VALUE1:OURSOURCEWearecommittedtohonorJesusChristandglorifyGod,remainingflexibleandresponsivetotheHolySpiritinallthatHehascalledustobeanddo.VALUE2:OURSTRENGTHWearecommittedtobiblicaltruths,andtoclinicalexcellenceandunityinthedeliveryofallourresources,services,trainingandbenefits.VALUE3:OURSERVICEWeare committed toeffectivelyandcompetently serve the communityof careworldwide—bothourmembership and the churchat large—withexcellenceand timeliness, andbyover-deliveryonourpromises.VALUE4:OURSTAFFWearecommittedtovalueandinvestinourpeopleaspartnersinourmissiontohelpotherseffectivelyprovideChrist-centeredcounselingandsoulcareforhurtingpeople.VALUE5:OURSTEWARDSHIPWe are committed to profitably steward the resourcesGod gives to us in order to continueservingtheneedsofhurtingpeople.


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LightUniversity• Establishedin1999undertheleadershipofDr.TimClinton—hasnowseennearly200,000

students from around the world (including lay caregivers, pastors and chaplains, crisisresponders,lifecoaches,andlicensedmentalhealthpractitioners)enrollincoursesthataredelivered via multiple formats (live conference and webinar presentations, video-basedcertificationtraining,andastate-of-theartonlinedistanceteachingplatform).

• Thesepresentations,courses,andcertificateanddiplomaprograms,offeroneofthemostcomprehensive orientations to Christian counseling anywhere. The strength of LightUniversity is partially determined by its world-class faculty—over 150 of the leadingChristianeducators,authors,mentalhealthcliniciansandlifecoachingexpertsintheUnitedStates. This core groupof facultymembers represents a literal “Who’sWho” inChristiancounseling. No other university in the world has pulled together such a diverse andcomprehensivegroupofprofessionals.

• Educational and training materials cover over 40 relevant core areas in Christian—

counseling, lifecoaching,mediation,andcrisis response—equippingcompetentcaregiversand ministry leaders who are making a difference in their churches, communities, andorganizations.

OurMissionStatement

TotrainonemillionBiblicalCounselors,ChristianLifeCoaches,andChristianCrisisRespondersbyeducating,equipping,andservingtoday’sChristianleaders.

AcademicallySound•ClinicallyExcellent•DistinctivelyChristian


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Video-basedCurriculum

• UtilizesDVDpresentations that incorporateover 150 of the leading Christian educators,authors,mentalhealthclinicians,andlifecoachingexpertsintheUnitedStates.

• Eachpresentationisapproximately50-60minutesinlengthandmostareaccompaniedbyacorrespondingtext(inoutlineformat)anda10-questionexaminationtomeasurelearningoutcomes.Therearenearly1,000uniquepresentationsthatareavailableandorganizedinvariouscourseofferings.

• Learning is self-directed and pacing is determined according to the individual time

parameters/scheduleofeachparticipant.• With the successful completion of each program course, participants receive an official

Certificate of Completion. In addition to the normal Certificate of Completion that eachparticipant receives, Regular and Advanced Diplomas in Biblical Counseling are alsoavailable.

Ø TheRegularDiploma isawardedbytakingCaringForPeopleGod’sWay,BreakingFreeandoneadditionalElectiveamongtheavailableCoreCourses.

Ø TheAdvancedDiplomaisawardedbytakingCaringForPeopleGod’sWay,BreakingFree,andanythreeElectivesamongtheavailableCoreCourses.

Credentialing

• LightUniversitycourses,programs,certificatesanddiplomasarerecognizedandendorsedbytheInternationalBoardofChristianCare(IBCC)anditsthreeaffiliateBoards:theBoardofChristianProfessional&PastoralCounselors(BCPPC);theBoardofChristianLifeCoaching(BCLC);andtheBoardofChristianCrisis&TraumaResponse(BCCTR).

• Credentialing is a separateprocess from certificate or diploma completion.However, theIBCC accepts Light University and Light University Online programs as meeting theacademic requirements for credentialing purposes. Graduates are eligible to apply forcredentialinginmostcases.

Ø Credentialinginvolvesanapplication,attestation,andpersonalreferences.

Ø CredentialrenewalsincludeContinuingEducationrequirements,re-attestation,andoccureitherannuallyorbienniallydependingonthespecificBoard.


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OnlineTestingTheURLfortakingallquizzesforthiscourseis:http://www.lightuniversity.com/my-account/.

• TOLOGINTOYOURACCOUNT

Ø You should have received an email upon checkout that included your username,password,andalinktologintoyouraccountonline.

• MYDASHBOARDPAGE

Ø Once registered, youwill see theMyDVD Course Dashboard link by placing yourmousepointerovertheMyAccountmenuinthetopbarofthewebsite.Thispagewill include studentPROFILE informationand theREGISTEREDCOURSES forwhichyouareregistered.TheLOG-OUTandMYDASHBOARDtabswillbeinthetoprightofeachscreen.Clickingonthe>nexttothecoursewilltakeyoutothecoursepagecontainingthequizzes.

• QUIZZES

Ø Simplyclickonthefirstquiztobegin.• PRINTCERTIFICATE

Afterallquizzesaresuccessfullycompleted,a“PrintYourCertificate”buttonwillappearnearthetopofthecoursepage.YouwillnowbeabletoprintoutaCertificateofCompletion.Yournameandthecourseinformationarepre-populated.ContinuingEducationThe AACC is approved by the American Psychological Association (APA) to offer continuingeducationforpsychologists.TheAACCisaco-sponsorofthistrainingcurriculumandaNationalBoard of Certified Counselors (NBCC)ApprovedContinuing Education Provider (ACEPTM). TheAACC may award NBCC approved clock hours for events or programs that meet NBCCrequirements. The AACCmaintains responsibility for the content of this training curriculum,whichalsomeetsthequalificationsforcontinuingeducationcreditforMFTsand/orLCSWsasrequired by the California Board of Behavioral Science (#3552). The AACC offers continuingeducation credit for play therapists through theAssociation for Play Therapy (APTApprovedProvider#14-373), so longas the trainingelement is specificallyapplicable to thepracticeofplaytherapy.It remains the responsibility of each individual to be aware of his/her state licensure andContinuing Education requirements. A letter certifying participation will be mailed to thoseindividuals who submit a Continuing Education request and have successfully completed allcourserequirements.


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Presentersfor

MilitarySuicide:Prevention,Assessment,Intervention

andRecovery


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PresenterBiographiesGlenBloomstrom,M.Div., is currently theMilitaryDirector and FaithCommunity Liaison forLivingWorksEducation,aninternationalsuicideinterventiontrainingcompany.PriortojoiningLivingWorks,GlenservedasaU.S.ArmychaplainatalllevelsfrombattaliontotheArmystaff,retiringasaColonelafter30yearsofactiveduty.WhileservingatthePentagonfortheArmyChiefofChaplains,Glenhelpeddevelopandfieldinnovativesoldierandfamilyministry,suicideprevention,andchaplainprofessionaldevelopmentprograms.Hiscombatdeploymentsincludethe initial invasionofPanamaand tours in IraqandAfghanistan.Inaddition tohisworkwithLivingWorks,Glen servesas a consultantwith theU.S. SpecialOperationsCommandand theU.S. Navy, where he oversaw their 2015 Professional Development Training Conference:“Pastoral Care in Suicide Prevention Intervention and Postvention.” Glen also serves as anadjunctprofessoratBethlehemSeminaryinMinneapolis,MN,helpingtrainthenextgenerationofpastorsandchaplains.TimClinton,Ed.D.,Ed.D., isPresidentof thenearly50,000-memberAmericanAssociationofChristian Counselors (AACC), the largest andmost diverse Christian counseling association intheworld.HeisProfessorofCounselingandPastoralCare,andExecutiveDirectoroftheCenterforCounselingandFamilyStudiesat LibertyUniversity.He is recognizedasaworld leader infaithandmentalhealthissuesandhasauthoredover20booksincludingBreakthrough:WhentoGiveIn,WhentoPushBack.Jennifer Cisney Ellers, M.A. is a Professional Counselor, life coach, crisis response trainer,authorandspeaker.Sheconductstraining,counselingandcoaching inthefieldofgrief,crisisandtraumathroughtheInstituteforCompassionateCare.Jenniferisanapprovedinstructorforthe International Critical Incident Stress Foundation, teaching several CISM courses. Also,Jenniferprovidesdivorcecoaching,trainingandspeakingthroughEmergeVictorious,aministryfor women rebuilding their lives after divorce. She is the co-author of The First 48 Hours:SpiritualCaregiversasFirstResponders,withherhusband,Dr.KevinEllers.Inaddition,Jenniferco-authored, Emerge Victorious: AWoman’s Transformational Guide after Her Divorce, withSandraDopfLee.KevinEllers,D.Min., istheTerritorialDisasterServicesCoordinatorforTheSalvationArmyintheU.S.A.CentralTerritory.HeisalsopresidentoftheInstituteforCompassionateCare,whichisdedicatedtoeducation,traininganddirectcare.Dr.Ellers isanassociatechaplainwiththeIllinoisFraternalOrderofPolice,servesas faculty for the InternationalCritical IncidentStressFoundation,adjunctprofessoratOlivetNazareneUniversity,andisamemberoftheAmericanAssociation of Christian Counselors Crisis Response Training Team. He has extensive trainingandexperienceinthefieldsofcrisisresponse,grief,trauma,disastermanagement,chaplaincy,pastoralministries,marriageandfamilytherapy,andsocialservices.Asanauthorandspeaker,heteachesbroadlyintheserelatedtopics.


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DavidP.Mikkelson,Ph.D.,grewupinaMarineCorpsfamilyandlaterservedasaMarineCorpsartilleryofficerfor10yearsandanArmychaplainfor17years,including15monthsincombatin Iraq. He established and directed a pastoral counseling training center at Ft. Bragg, NC,wherehecounseledmanysoldiersandfamiliesaffectedbycombat.Davidretiredin2013andiscurrently in private practice in North Carolina as a LicensedMarriage and Family Therapist,clinicalsupervisor,andconsultantonthetopicsofmilitarycounseling,Christiancounseling,andPTSD.Heandhiswife,Dr.SuzanneMikkelson,liveinHighPoint,NC.SuzanneE.Mikkelson,Ph.D., isaLicensedMarriageandFamilyTherapistwithmorethan20years of experience counseling military and civilian couples and families, primarily in faith-based settings.Her clinical specialties are trauma recovery, adultery recovery,marital issues,andparenting.She isanEMDRIAApprovedConsultant forEMDRtrauma therapy.Suzanne isalsoanAAMFTApprovedSupervisor,providingclinicalsupervisionfortherapistsintraining.Sheandherhusband,Dr.DavidMikkelson,are inprivatepracticetogetherand live inHighPoint,NC.Theyhavebeenmarried31yearsandhavethreeadultsons.LindaMintle,Ph.D.,isaLicensedMarriageandFamilyTherapist(LMFT),LicensedClinicalSocialWorker (LCSW), professor, author, and national speaker. She serves as Chair of BehavioralHealthattheCollegeofOsteopathicMedicineatLibertyUniversityinLynchburg,Virginia.With30yearsofclinicalexperienceworkingwithcouples,familiesandindividuals,sheisanexpertonrelationshipsandthepsychologyoffood,weight,andbodyimage.Dr.Mintlealsoservesasanationalnewsconsultant,BeliefNetblogger,andradioshowhost.Sheisabest-sellingauthorwith 19 book titles, including I Married You, Not Your Family and Divorce Proofing YourMarriage.Eric Scalise, Ph.D., is the former Vice President for Professional Development with theAmericanAssociationofChristianCounselors,aswellasacurrentconsultantandtheirSeniorEditor.HeisalsothePresidentofLIVEnterprises&Consulting,LLC,andaLicensedProfessionalCounselor and LicensedMarriage&Family Therapistwithmore than35yearsof clinical andprofessionalexperienceinthementalhealthfield.Specialtyareasincludeprofessional/pastoralstress and burnout, combat trauma and PTSD, marriage and family issues, leadershipdevelopment, addictions, and lay counselor training. He is an author, a national andinternational conference speaker, and frequently consults with organizations, clinicians,ministryleaders,andchurchesonavarietyofissues.


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GarySibcy,Ph.D.,isProfessorofCounselingandDirectorofthePh.D.programinProfessionalCounselingandPastoralCounselingattheCenterforCounselingandFamilyStudiesatLibertyUniversity, where he teaches courses in advanced psychopathology and its treatment. He isboth a Licensed Clinical Psychologist (LCP) and a Licensed Professional Counselor (LPC), hasbeen in private clinical practice for more than 20 years, and currently works at PiedmontPsychiatricCenter.Dr.Sibcyspecializesinanxietydisorders,includingOCDandpanicdisorder,andchronicdepressioninadults,aswellasthediagnosisandtreatmentofchildrenwithseveremooddysregulation.Heiscurrentlydevelopinganempiricallysupportedtreatmentwithintheframework of interpersonal neurobiology and attachment theory. Dr. Sibcy has co-authoredseveralbookswithDr.TimClinton,includingAttachmentsandWhyYouDotheThingsYouDo.Frank Page, Ph.D., is president and CEO of the SBC Executive Committee. His mission is toencourageBaptistseverywheretoparticipateinoursharedtaskofreachingmen,women,andchildren with the life-changing message of salvation through Jesus Christ. He has served inministryfor35years.HeistheauthorofMelissaaswellasseveralotherpublications.Dr.PageholdsaPh.D.inSociologyfromtheUniversityofUtah.Miriam Parent, Ph.D., holds a Ph.D. from Rosemead Graduate School. She has served as acounseloreducatorformorethantwentyyears.PriortocomingtoTrinityin1993,shetaughtatLibertyUniversity in the School of Religion. Dr. Parent is a licensed clinical psychologist. Shepracticed full-time for several years prior to teaching; since then she has maintained acounselingpracticeprovidingindividualandmaritalcounseling,aswellasdiagnosticevaluationand assessment. Over the years her speaking and writing have focused on areas such asspiritualformation,stressmanagement,burnout,andministryandprofessionalethics.Shealsoenjoys speaking inwomen’s groups and church retreats on a variety of Bible and counselingtopics. Her areas of interest include professional ethics, diagnosis and treatment planning,stressmanagement,women’sissues,andspiritualformation.


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MilitarySuicide:Prevention,Assessment,InterventionandRecoveryTableofContents:

MSIP101:TheDynamicsofSuicide:What,Why,WhoandHow...........................................15JenniferCisneyEllers,M.A.MSIP102:ChoosingtoDie:AModelofUnderstanding.........................................................26JenniferCisneyEllers,M.A.

MSIP103:ATheologyofSuicide:BiblicalPrinciplesandaChristianResponse.......................36FrankPage,Ph.D.

MSIP104:CombatStress,PTSD,ReintegrationandSuicide...................................................45GlenBlomstrom,M.Div.MSIP105:MentalIllnessandtheEpidemiologyofSuicide....................................................59LindaMintle,Ph.D.

MSIP106:TheEthicsofSuicideIntervention.........................................................................73MiriamParent,Ph.D.MSIP107:MilitarySuicide,PreventionandIntervention:WhatYouNeedtoKnow...............82GlenBloomstrom,M.Div.MSIP108:ConductingaSuicideAssessment:UsingtheSafe-TModel(withroleplays)..........95GarySibcy,Ph.D.

MSIP109:FamiliesinCrisis:TheFirst48HoursFollowingSuicide........................................102JenniferCisneyEllers,M.A.andKevinEllers,D.Min.

MSIP110:TheImpactofSuicideonMilitaryMarriagesandFamilies...................................109DavidMikkelson,Ph.D.,andSuzanneMikkelson,Ph.D.MSIP111:GrievingaSuicide:Long-termSupportforSurvivorsandLovedOnes..................120JenniferCisneyEllers,M.A.andEricScalise,Ph.D.

MSIP112:CaregiversinCrisis:WhenClientsTakeTheirLives..............................................128EricScalise,Ph.D.andJenniferCisneyEllers,M.A.


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BonusMaterial:MSIPBonusSession1:TheEthicsofSuicideInterventionforEducatorsandChurchandCommunityLeaders.............................................................................................................135MiriamParent,Ph.D.MSIPBonusSession2:ConductingaSuicideIntervention:TheRoleofMinistryLeadersandCaregivers(withdemonstrations)........................................................................................145GarySibcy,Ph.D.Appendix1.........................................................................................................................150GarySibcy,Ph.D.


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MSIP101:

TheDynamicsofSuicide:

What,Why,WhoandHow

JenniferCisneyEllers,M.A.


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AbstractA spiritual battle takes place every day between light and dark, and suicide risk is a

battleground. Studies show suicide is on the increase with attempts outnumbering

completions.Therearecertainfactorsthatincreasesomeone’sriskforcommittingsuicide,such

asage,gender,marital status, raceandethnicity,andgeographical regionby state.Methods

include firearms, suffocation, jumping from bridges and other high places, and walking or

driving in front of a train.Mental illness, substance abuse, personality disorders, chronic or

terminalmedicalconditions,afamilyorpersonalhistory,environmentalfactors,thecontagion

effect, and access to lethalmethods are all risk factors for suicide.Help is available through

mental healthcare, positive connections, and the development of problem solving skills.

Spiritual factors, such as the power of prayer, God, and the Holy Spirit, are available in

equippingmentalhealthprofessionalswiththetoolstohelpthoseatriskforsuicide.

LearningObjectives

1. Participantswillidentifythosemostatriskforsuicidebylookingatfactorssuchasage,

gender,maritalstatus,raceandethnicity,andgeographicalregion.

2. Participants will define various methods used in the attempt and/or completion of

suicide.

3. Participantswillexploredifferentriskfactorsinvolvedinsuicide,suchasmentalillness,

substanceabuse,personalitydisorders,chronicorterminalmedicalconditions,familyor

personal history, environmental factors, the contagion effect, and access to lethal

methods.


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I. Introduction

A. ASpiritualBattle

1. Suicideisthebattlegroundinthebattlebetweendarkandlight.

2. Satanhasahandinconvincingpeopletheywanttotaketheirownlives.

3. Muchofthehealinginvolvedinsuicideisofaspiritualnature.

B. PersonalImpact

1. Caregivers are powerfully impacted when someone in their care attempts or

completessuicide.

2. Caregivers are also powerfully impacted when working with the loved ones or

familiesintheaftermathofasuicide.

3. Often caregivers have been impacted personally by suicide when loved ones and

familymembersstruggle.

II. TheNumbersSurroundingSuicide

A. AnIncrease(LookingatSuicideintheU.S.)

1. Suicideismoreprevalentinthenews,andresearchsupportsthatthisisanaccurate

portrayalofincreasedideation,attempts,andcompletedsuicides.

2. StatisticsfromtheCenterforDiseaseControl(CDC)2013

• In2013,therewere41,149suicides.

• Suicideisthe10thleadingcauseofdeathintheUnitedStates.

• In2013,someonediedbysuicideevery12.8minutes.


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B. ThePercentages

1. From1986-2000,therewasadecreaseinsuicideratesfrom12.5%to10.4%.

2. In2001,thenumbersstartedtoincrease.

3. Therehasbeenaslow,butsteady,increaseto12.6%currently(2013).

C. Attemptsvs.Completion

1. Aninfinitelylargernumberofpeopleattemptsuicidethancompletesuicide.

2. Itisestimatedthatthereare864,950suicideattemptseachyear.

3. Manyattemptsarenotreported.

III. WhoisMostatRisk?

A. Age

1. Currently, the middle aged group (ages 45-64) has the highest rate of suicide at

19.1%.

2. Suicidehasincreasedby28%amongthemiddleagedinthelast10years.

3. The economic crisis is one of the factors that has led to the increase in this age

group’srateofsuicide.

4. Stresslevelsareveryhighforthemiddleaged.


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B. Gender

1. Womenattemptsuicidemorethanmen.

• Threetoonemorethanmen.

• Uselesslethalmeans–poisoningoroverdose.

2. Mencompletesuicidemorethanwomen.

• Mencompletesuicideonetofourtimesmoreoftenthanwomen.

• Thisisduetomen’suseofmorelethalmeans–firearms.

C. MaritalStatus

1. Bythenumbers,mostofthepeoplewhocompletesuicidearemarried.

2. Whenlookingatsuicidebyrate,peoplewhoaredivorcedhavethehighestrateof

suicidefollowedbythosewhoarewidowedandthenbythosewhoaresingle.

3. Marriedpeopleactuallyhavethelowestrateofsuicideoverall.

4. Livingaloneandbeingalonesignificantlyincreasestheriskforsuicide.

D. RaceandEthnicity

1. Caucasianshavethehighestsuiciderate.

2. AmericanIndianshavethesecondhighestrateofsuicide.

3. Black,Hispanic,andAsianpopulationshavethelowestsuiciderate.

• Duetofactorsofresilience

• Duetoreligiousfaithandparticipationinafaithcommunity

• Duetostrongfamilyconnectionsandsocialsupport


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E. Patterns

1. Middleagedandolderwhitemalesarethehighestriskgroupfordeathbysuicide.

2. In2013,whitemalesaccountedfor70%ofallcompletedsuicides.

F. GeographicalRegion

1. The stateswith the highest suicide rates are in theWest:Montana, Alaska,Utah,

NewMexico,Idaho,Nevada,Colorado,andSouthDakota.

2. Stateswith the lowest rates are D.C., New Jersey, New York,Massachusetts, and

Connecticut.

3. Oneconjectureas towhysuicide ratesarehigher in theWest is that firearmsare

morereadilyavailable.

IV. SuicideDeathsbyMethod(2013)

A. Firearms

1. IntheU.S.,firearmsarethemostlethalandfrequentlyusedmethodofsuicide.

2. In2013,51.5%ofsuicideswerewiththeuseoffirearms.

B. Suffocation

1. 24.5%usedsomemethodofsuffocation.

2. Thisincludeshanging.


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C. OtherMethods

1. Theseothermethodsmakeup8%ofsuicides.

2. Theseothermethodsincludejumpingfrombridgesorotherhighplaces(theGolden

GateBridge)andwalkingordrivinginfrontofatrain.

D. Overview

1. WorldHealthOrganization–suicideinothercountries.

2. Firearmsarenottheleadingmethodofsuicideinothercountriesbecausepeopledo

nothavetheaccessibilitytofirearmsthatwehaveintheU.S.

3. Overdose

• Thereispotentiallyalargetimeframewheresomeonecanintervene/provide

medicalattention.

• Our bodies have a tremendous ability to overcome even large levels of

toxicity.

• Thereisawindowofopportunityforpeopletoreconsidersuicide.

4. Firearms

• Littleopportunitytoreconsider.

• Thisaquickdecisionwithnoturningback.

• Thelethalityofthemeansisverysignificantwhenassessingrisk.

V. RiskFactorsforSuicideA. MentalIllness

1. Itisestimatedthat90%ofthosewhocommitsuicidehaveatreatablementalillness

atthetimeoftheirdeaths.


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2. Mentalillnessisthemostreliableandconsistentriskfactorforsuicide.

3. Mentalillnesseswithanincreasedriskforsuicide.

• Majordepression–Thisistreatablewithmedicationandcounseling.

• BipolarDisorder–Thisisalsotreatablebutcannotbecured.

B. SubstanceAbuse

C. PersonalityDisorders

1. Borderlinepersonalitydisorder

2. Antisocialpersonalitydisorder

3. Conductdisorderinyouth

4. Psychoticdisorders

5. Anxietydisorders

6. Post-traumaticstressdisorder

7. Thesedisordersareatanespeciallyhighriskforsuicidewhentheygoundiagnosed

anduntreated.

D. ChronicorTerminalMedicalConditions

1. Depressioncanfollowcertainmedicalillnesses.

• Cancer

• Pneumonia


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2. Peoplewith terminalmedical conditionsmaybelieve that taking theirown lives is

betterthanburdeningfamilymembersorsufferingthroughanextendedillness.

3. Fearofpainanddeathcanmakepeoplesuicidal.

• Chronicmigraines

• Fibromyalgia

• Chronicjointpain

• Chronicbackandneckpain

E. Family History of Suicide Attempts or Completed Suicide and Personal History of

Attempts

1. Otherthanmentalillness,thisisthehighestriskfactorforsuicide.

2. Itisimportantformentalhealthprofessionalstoaskaboutfamilyhistoryofsuicide.

3. Researchhasshownsuicideriskcanbeinherited.

F. EnvironmentalFactors

1. Stressfullifeeventssuchasthedeathofacloselovedone

2. Financialloss

3. Legaltrouble

4. Chronicstressfulsituationssuchaslong-termunemployment

5. Seriousrelationshipconflictsuchasabreakupordivorce

6. Harassmentorbullying


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G. ContagionEffect

1. Exposuretoanotherperson’ssuicidecanmakeonemorevulnerabletobeingatrisk

forsuicide.

2. Only1%ofsuicidesareattributedtothecontagioneffect,butitissignificantenough

thatweneedtobeaware.

3. Thisexposurecanbedirectorindirect.

4. This is true with spouses, close friends, siblings, family members, and even

celebrities.

5. Donotromanticizeorsensationalizetheactofsuicide.

6. Teensaresignificantlymorevulnerabletothecontagioneffect.

H. AccesstoLethalMethodsatTimesofIncreasedRisk

1. Access to handguns should be strictly controlled among high risk suicide

populations,suchas thosewithseriousmental illnessesthathavebeencorrelated

withhighsuiciderate.

2. 70-75%offamilieswhoareaskedtoremovefirearmsfromthehomechoosenotto

removethem.

3. Takeextrastepstoprotectindividualsvulnerabletosuicidefromaccesstofirearms.

VI. ProtectiveFactorsforSuicideA. ReceivingMentalHealthcare


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B. Positive Connections with Family, Friends, and Peers Through Social Institutions of

HealthyMarriagesandOurFaithCommunities

C. HelpingPeopleDevelopSkillsandAbilitiestoSolveProblems

VII. NeurobiologyofSuicide

A. PostmortemStudies

B. BrainSystemsinChargeofMood,ThinkingandStressResponse

VIII. SpiritualFactors

A. PowerofGod

B. FightingAgainstthePowersofDarkness

C. ConnectionThroughPrayer

D. PoweroftheHolySpirit


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MSIP102:

ChoosingtoDie:AModelofUnderstanding



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AbstractJenniferCisneyEllersreviewsDr.ThomasJoiner’smodelofunderstandinghowandwhysuicide

occurs.Thedesiretodiebecauseofaperceivedburdensomenessandalowlevelofbelonging

orsocialconnectednessandtheabilitytotakeone’sownlifeleadapersontobelievesuicideis

thebestsolution.Suicidalpeopletendtobelievetheyareaburdentotheir lovedones.Their

senseofvalueandself-worthhasbeenundermined.Satanistheauthorofthisultimatelie,but

caregiverscanintervenebyreassuringpeopleoftheirvalue,helpingthemfeelproductive,and

relaying the message that care and concern are not a burden. Suicidal people also have a

thwartedconnectedness—asensetheydonotbelong.Thisfeelingofisolationcanbehelpedby

treating depression, fostering and building social connection, enhancing family relationships,

buildingsocialandrelationalskills,anddialoguingaboutstruggles.Peoplehaveastrongdesire

forself-preservation,buttherearefactorsthatcontributetosomeoneacquiringtheabilityto

enactself-injury.It is importantforcaregiverstoprovidepreventativesupport,educationand

traininginthesesituations.

LearningObjectives

1. Participants will identify the factors that lead a person to believe suicide is the best

solution.

2. Participants will list steps in intervening when a person experiences perceived

burdensomenessandathwartedconnectedness.

3. Participants will explore situations that lead someone to acquire the ability to enact

lethalself-injury.


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I. Introduction

A. TheAmericanFoundationforSuicidePrevention(Webpage)

1. Quote: “Our effectiveness in preventing suicide ultimately depends onmore fully

understandinghowandwhysuicideoccurs.”

2. Whatisgoingonintheheartsandmindsofthosethinkingaboutsuicide?

3. PreventionandInterventiondependsonmorefullyunderstandingpeople.

B. Dr.ThomasJoiner

1. Book:WhyPeopleDiebySuicide

2. Personallyimpactedbysuicidewhenhisfathercommittedsuicide.

3. TheInterpersonalPsychologicalTheoryofSuicidalBehavior

C. Dr.EdSchneidman

1. Definition of suicide: “Suicide is a conscious act of self-induced annihilation best

understood as amultidimensionalmalaise in a needful individual who defines an

issueforwhichsuicideisperceivedasthebestsolution.”

2. Wehavetomakeaconcentratedefforttounderstandwhatisgoingoninthemind

ofasuicidalperson.


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II. WhatLeadsaPersontoBelieveSuicideistheBestSolution?

A. TheDesiretoDie

1. PerceivedBurdensomeness–“Iamaburdentosocietyandmylovedones.”

2. Lowlevelofbelongingorsocialconnectedness.

• Thwartedconnectedness

• Feelsociallyalienated

B. TheAbilitytoTakeTheirOwnLives

III. PerceivedBurdensomeness

A. Definition

1. Thesensethatoneisaburden

2. Thekeywordisperceived.

3. Loved ones see the suicidal person’s pain as the burden, not the person as the

burden.

B. WhyPerceivedBurdensomeness?

1. MentalIllness

• Depression

• Bipolardisorder

2. Chronicphysicalillness


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3. Chronicpainconditionsordisabilities

4. Terminalillness

5. Situationalissues

• Relationshipproblems

• Financialloss

• Jobloss

• Legalproblems

C. MotivationtoLive

1. Perceived burdensomeness undermines our sense of value and self-worth.

2. We want to sense we are bringing something important to the world.

3. Man’sSearchforMeaningbyVictorFrankl

4. Ifamanhasawhy,hecanwithstandanyhow.

D. Suicide–ASelfishAct?

1. Suicidalpeoplebelievetheyarecommittingaselflessact.

2. Theyfeeltheyaretakingawayaburdenforthosetheylove.

3. IammakingachoicethatwillultimatelybebestforeveryoneIlovebecauseIama

burden.


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E. SpiritualElements

1. Suicidalpeoplestrugglewithfalsebeliefsandliesaboutthemselves.

2. Satanbeginstoconvincesomeonethattheyareworthless.

3. Satan’sultimatelie–Theworldwouldbebetteroffwithoutyou.

F. Dr.Joiner'sStudy

1. Dr. Thomas Joiner and his team confirmed perceived burdensomeness is one of

thefactorsmostcloselyassociatedwithsuicidalbehavior.

2. The link between perceived burdensomeness and suicidality is just as strong as

thelinkbetweenhopelessnessandsuicidality.

G. HowDoWeIntervene?

1. Reassurepeopleoftheirvalue.

2. Peopleneedtofeelproductive.

3. Peopleneedtounderstandcareandconcernarenotaburden.

4. StoryofJenniferCisneyEllerscaringforhermother.

IV. ThwartedConnectednessA. Definition

1. Thesensethatonedoesnotbelong.


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2. Frombirth to death, deep andmeaningful connections to others is critical to our

mental,physical,andspiritualwell-being.

B. Connectedness

1. Aprimaryfactorinconnectednessisface-to-faceinteractionswithotherpeople.

2. Additionally,afeelingofbeingcaredaboutiscrucialtoconnectedness.

C. FailuretoThrive

1. Canhappenwithinfantsandseniors.

2. This phenomenon leads us to an observation of how important connection is in

relationships.

D. DepressionandIsolation

1. Depressedpeoplemakelesseyecontact.

2. Depressedpeopleengageinlesshead-noddingduringconversation.

E. TimesofNationalCrisis

1. Peopleoftenpulltogetherandtheirsenseofbelongingincreases.

2. AssassinationofJFK

3. Terroristattacksof9/11


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F. MMPI–PredictorsforDeathbySuicide

1. Self-blameScale

2. SocialIntroversionScale

G. HowDoWeIntervene?

1. Treatdepression.

2. Fosterandbuildsocialconnectionasprevention.

3. Enhancefamilyrelationships.

4. Helpsociallyisolatedindividualsbuildsocialandrelationalskills.

5. Bemoreopentodialogueaboutstrugglesandlifechallenges.

V. AbilitytoEnactLethalSelf-injuryA. Self-preservation

1. AllmammalsaredesignedbyGodtoprotectandsavetheirlives.

• Strongimmunesystems

• Ourbodieshaveanincredibleabilitytoheal.

2. Psychologicalmechanism

• Peopleareprogrammedforsurvival.

• Fightorflightresponse


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B. HowDoesOneAcquiretheAbilitytoEnactLethalSelf-injury?

1. Previousattemptsorprevioussuicidalbehaviors

2. Fantasyactingout–thinkingaboutandplanningsuicide

3. Engaginginnonlethalactsofself-injury

• Cutting

• Burning

• Canbeagatewaytolethalself-injury

4. Childhood physical and sexual abuse or other painful, repeated experiences in

childhood

5. Involvementinviolence

6. Anythingthathabituatessomeonetopainandinjury

7. Peoplewhoareexposedtothepainandinjuryofotherpeopleintheirprofessions

C. HowDoWeIntervene?

1. Considerallofthefactorsinsuicideassessments.

2. Preventative support for peoplewhohave the experiences thatmight lower their

resistance

3. Educationandtrainingwithgoodself-care


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D. VideoofDr.KevinEllers

1. Thereisahugemisunderstandingofmentalillness.

2. Satanicforcesareatworkduringsuicide.

3. Sometimes suicide is a choice, but sometimes the one committing suicide truly

believeshe/sheisdoingthebestthingfortheoneswhoareliving.


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MSIP103:

ATheologyofSuicide:BiblicalPrinciples

andaChristianResponse

FrankPage,Ph.D.


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AbstractSuicideisadevastatingissueinourworldtoday,yethasbeenanage-oldtragedyformankind.

One can look back at history to see examples of suicide. Scripture records seven suicides:

Abimelech, Samson, King Saul, Saul’s armor bearer, Ahithophel, Zimri, and Judas. Although

Scripturedoesnotgiveusanyspecificwordaboutsuicide,itdoesindicatethatGodisthegiver

oflifeandonlyHehastherighttotakeitaway.Weneedtofollowthebiblicalprinciplesthat

Godhasagreatplanforourlives;thesolutiontodespairandhopelessnessisfaithinHim;and

thoughtroublecontinuesinlife,theLordwillneverleaveus.OurChristianresponsetosuicide

needs tobeoneof confrontingbad theologyand thinking; encouragingpeopleagainstusing

tritestatementsand,instead,urginggoodtheologyandpractices;andpracticingtheministryof

presence.Ultimately,wecantrusttheLordandknowHisloveispowerful.

LearningObjectives

1. ParticipantswillbeabletoexploresevensuicidesmentionedinScripture.

2. Participantswillidentifybiblicalprinciplessurroundingtheissueofsuicide.

3. ParticipantswilldefineaChristian’sresponsetosuicide.


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I. Introduction

A. ExamplefromMarkTwain’sTheAdventuresofTomSawyer

1. Tomandhisfriendsaregonefromhomeforalongtimepretendingtobepirateson

theriverbank.

2. ThetownspeoplebelieveTomandhisfriendsaredead.

3. Tomandhisfriendssneakintotownandattendtheirownfuneral.

4. The story ends happily with the boys revealing their whereabouts and everyone

beingthrilledtoseetheyarealive.

B. SuicideStatistics

1. In our country, suicide is one of the leading causes of death, particularly among

teenagers.

2. Moresoldiersarebeinglosttosuicidethancombat.

3. Suicidehasrisenamongyoungwomen.

C. HistoricalExamplesofSuicide

1. MasadainIsrael

2. MasssuicidesfromthewallsofGamlainGalilee

3. SuicidesoftheJapaneseduringWorldWarIItoevadecapturebytheAmericans


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4. MasssuicidesduringtheJonestowntragedies(JimJones)

5. Orientalculturesglorifyingsuicidesratherthansurrendering

6. SuicidebombersintheMiddleEast

II. SuicidesMentionedinScripture

A. Abimelech

1. Judges9:52-54

2. Abimelechcommittedsuicideinatimeofpersonalcrisis.

B. Samson

1. Judges16:25-30

2. Samsondiedforacausehebelievedin,butalsoforrevengeuponthePhilistines.

C. KingSaul

1. 1Samuel31:4

2. Whatcouldhavebeenagreatlifeofvictoryturnedintoaterribletimeofdefeatand

sadness.

D. Saul’sArmorBearer

1. 1Samuel31:5

2. Followedtheexampleofhisking


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3. Impulsivedecision

4. Apermanentsolutiontowhatcouldhavebeenatemporaryproblem

E. Ahithophel

1. 2Samuel17:23

2. Bitternessanddepressionwerefactorsinhisdecision.

F. Zimri

1. 1Kings16:15-20

2. Bitternessbecameastrongholdinhislife.

G. Judas

1. Matthew27:3-5

2. Depression,greed,personalfailure,andregretledtoJudas’suicide.

III. ATheologyofLifeA. WhatdoestheBibleSay?

1. TheBibledoesnotgiveanyspecificwordaboutsuicide.

2. Scripturedoes indicateGod is thegiverof lifeandonlyHehas the right to take it

away.


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B. Job1:21

“Hesaid,‘NakedIcamefrommymother’swomb,andnakedIshallreturnthere.The

LordgaveandtheLordhastakenaway.BlessedbethenameoftheLord.’”

C. 1Corinthians6:19-20

“Or do you not know that your body is a temple of the Holy Spiritwho is in you,

whom you have from God, and that you are not your own? For you have been

boughtwithaprice:thereforeglorifyGodinyourbody.”

IV. BiblicalPrinciplesA. GodHasaGreatPlanforyourLife

1. God’spurposeshouldtakeprecedentoverouragendas.

2. Jeremiah29:11–“ForIknowtheplansthatIhaveforyou,declarestheLord,plans

forwelfareandnotforcalamitytogiveyouafutureandahope.”

B. God’sPlanisforLife,notDeath

1. Romans6:23–“Forthewagesofsinisdeath,butthefreegiftofGodiseternallifein

ChristJesusourLord.”

2. John10:10–“The thief comesonly to stealandkill anddestroy; I came that they

mayhavelife,andhaveitabundantly.”

C. TheSolutiontoDespairandHopelessnessisNotSuicide,butFaithinGod

1. Psalm33:20-22–“OursoulwaitsfortheLord;Heisourhelpandourshield.Forour

heartrejoicesinHim,becausewetrustinHisholyname.Letyourlovingkindness,O

Lord,beuponus,AccordingaswehavehopedinYou.”


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2. ScripturepointstoourultimatefaithinGodasoursalvation.

D. ThoughTroubleContinuesinthisLife,OurLordWillNeverLeaveUs

1. John16:22–“Thereforeyoutoohavegriefnow;but Iwillseeyouagain,andyour

heartwillrejoice,andnoonewilltakeyourjoyawayfromyou.”

2. Matthew11:28–“CometoMe,allwhoarewearyandheavy-laden,andIwillgive

yourest.”

V. ChristianResponseA. ConfrontBadTheology

1. Thereisagreatdealofmisunderstandingwhenitcomestotheissueofsuicide.

2. Severalfaithgroupsteachthatonewhocommitssuicidecannotgetintoheaven.

3. Mostpeoplewhocommitsuicidehavereachedapointintheirlifewheretheyhave

losttouchwithreality.

4. TheBibledoesnotteachthatthosewhocommitsuicidegotohell(Romans5:8).

5. Scripturedoesteachaccountability.

• Ezekiel18

• Leviticus4:22

6. Peoplewhocommitsuicidegotoheaven if theyhaveapersonal relationshipwith

Christ.

7. Scripturedoesteachtherealityofdemonicoppressionandpossession.

8. Satancanusestrongholdsinamentallyillperson’slifetomakeasituationworse.


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B. ConfrontBadThinking

1. Whilecharacterflawsandbadparentingcancausedifficultyineverylife,struggles

are also found among people of tremendous character and in homes where

parentinghasbeendevoted,loving,andcaring.

2. Mentalillness,emotionalstruggles,anddepressionarenotmerelycharacterissues.

C. EncouragePeopleAgainstUsingTritePlatitudes

1. Donotsay,“Theyareinabetterplacenow.”

2. Donotsay,“Snapoutofit.”

D. EncourageGoodTheologyandGoodPractices

1. WeneedtoputourhopeinGod,andwecandothisthroughprayer.

2. Psalm46:1-3

3. Hebrews13:6

4. Isaiah26:3

E. PracticetheMinistryofPresence

1. StoryofFrankPage’sdaughter’ssuicide

2. ThepresenceofHisWord

3. ThepresenceoftheLord


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4. ThepresenceofGod’speople

5. There is a need for immediate action when there has been a suicide or suicide

attempt,butthatministryneedstobeongoing.

6. Do not let an awkward situation dissuade you from active Christian ministry to

hurtingpeople.

7. Behonestandbethereforthehurtingpeople.

8. Letthehurtingpersonexpresshis/herangerandconfusion.

9. Beabuilderofencouragement,notatransmitterofhurt.

VI. ConclusionA. WeCanTrusttheLord

B. God’sLoveisPowerful

C. 2Corinthians1:3-5


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MSIP104:

CombatStress,PTSD,

ReintegrationandSuicide

GlenBloomstrom,M.Div.


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Abstract

When learning about the area ofmilitary related suicide, it is vital that a thorough study of

trauma is completed. There are numerous ways trauma can occur in the life of a

servicememberandmanyreasonsmilitarypersonnelmaystruggleafterexperiencingtrauma.

Inthislesson,GlenBloomstromdiscussestheareaoftraumainthemilitaryfromhisownstudy

andknowledge,aswellashisownexperienceasamilitarychaplain.Beginningwithathorough

introduction to military culture and trauma, the presentation continues by discussing how

treatments have or have not aided in healthier minds post-trauma. Finally, Bloomstrom

presentsHogue’smodelofhelping traumavictims ingreatdetail, aswell asdiscussingother

successfulhelpingresourcesforthosestrugglingwithtrauma.

LearningObjectives

1. Participantswillexploreingreatdetailtheareaoftraumawithinthemilitaryculture.

2. Participantswillidentifydifferenttypesoftrauma,howtheyoccur,symptoms,andwhat

treatmentsmightbebest.

3. Participantswilldiscussstrategiesforhelpingindividualsstrugglingaftertrauma.


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I. Introduction

A. LearningObjectives

1. Describethecontextofmilitarytrauma

2. Identifytypesofmilitarytraumaresponsesbydefinition,symptomsandinteractions

3. Illustratecomponentsforhelpingandotherhelpingstrategies

B. MilitaryContext

1. Statistics/Recruitment

• ActiveMilitary–1.37M

• Reserve&NationalGuard–874K

• FamilyMembers–1.9M

• Retirees–2M

• Veterans–23M

• AnnualRecruitment

o 180,000recruitedasenlistedpersonnel

o 20,000arecommissionedasofficers

2. TransitionsintoCulture

3. TheContemporaryContextofWar

• Since1989continuousdeployments

• 2001-present:OIF/OEFCharacteristics

o No front line, demanding climate, sleep deprivation 24/7 operations,

multiple roles, confusing enemy appearance, tactics (often using civilian

shields),IEDs,rocket,mortarattacks,changingRulesofEngagement,

o Casualties,collateralcasualties


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• Stoploss,In-theaterextensions

• MultipleDeployments

• Shortdwell/resettimebetweendeployments

4. LifestyleChallenges

• DeploymentAffectsEveryone

• Transitionsafterdeployment

o Change

o Guilt

o Loss

o Finances

o CombatStress

o Identityloss

• ReserveComponent(RC)Challenges

o Changingexpectations

o LifeInterrupted

o CommunityUnaware

o MilitaryCommunityInfrastructuremissingforRC

II. MilitaryTraumaResponse

A. TermsofHistoryofWarRelatedTrauma

B. Statistics

1. PTSDVietnam(NVVRS)

• NationalVietnamVeteransReadjustmentStudy(NVVRS)

o Indicated30.9%who served inVietnamexperienced combat relatedPTSD

duringtheirlifetime


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o 15.2%hadcurrentPTSD(1990)

o Other commonly reported disorders: depression, alcoholism, generalized

anxietydisorder

• Lifeadjustmentissues:maritalandwork

2. PTSDVietnam(NVVLS)

• In2013-14afollowupstudy:theNationalVietnamVeteransLongitudinalStudy

(NVVLS)examinedhealthandmentalhealthovertime

• 11% rate (male) and 7% female had warzone PTSD and another 3% for

“subthresholdPTSD”

• Equatingto283Kmale400femaleveterans

• 50xhigherratesofdepressionforthosewithPTSD

• ThosewithwarzonePTSDat firstassessmentwere twiceas likely tohavedied

beforesecondassessmentthanthosewithoutPTSD.

3. GWOTPTSDRatesandHealthConcerns

• Studiesshow5-20%ofveteransinOIFOEFmeetcriteriaforPTSD

o Higherforthosewhoparticipateindirectcombat

o ComparabletothoseofVietnamveterans

• Otherhealthconcernstakeatoll

o Depression,substanceuse,suicide

o Other symptoms related to PTS include sleep problems, concentration,

memoryproblemsheadaches,backpain,hypertension

C. Treatment

1. ReserveComponentsvs.ActiveComponents


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2. Reluctancetoseekhelp

• Limitedappointments

• Workorchildreninterfering

• Stigma

• Hesitanttodiscussmemories

• MentalHealthCaretermsandlabels

3. TypicalTreatmentsandRecoveryRates

• TalkTherapies

• Medication

• RecoveryRates

o 50%seektreatment

o 20-40%dropoutbeforecompleting

o 60-80%ofcompletersrecover

• Elementsofbest“A-leveltherapiesforPTSD”

o Narration

o CognitiveRestructuring

o GradualExposure

o Stressinoculationskills

o Psychoeducation

III. Trauma

A. TraumaticEvents-ThreeGroups:

1. ActsofGod

2. UnintentionalthroughHumanInvolvement

3. HumanCaused


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B. WarTrauma

1. Constantthreatofattack

2. Witnessingcombat/accidentalinjuryordeath

3. Handlingbodyparts

4. Impactofkillingtheenemyorinnocentpersons

5. SexualAssault

6. Cumulativeeffects

C. PTS(CombatOperationalStress)

1. A common, normal, adaptive response to experiencing a traumatic or stressful

event;“fight-or-flight”

2. Symptoms

• Racingheart, shaking, nervous, drained, leeryof similar situations,maydream

about,mayhaveintrusivethoughts

• Symptomssubsideoverashortertime

3. PostTraumaticStressDisorder

• ResponsetoaTrauma

• Referstoasetof3criteria

o Re-experiencingtrauma

o Withdrawal/Detachment/Avoidance/Numbing

o Hyper-arousal(Hypervigilance)


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• Symptomspresentatleastonemonth

• What distinguishes PTSD from PTS is the degree to which these reactions

interferewith

o Makingasuccessfultransitionhome

o Interfere on an an ongoing basis with life, relationships, work, studies,

hobbies

• Similarparallelstopolice,firstresponders,firefighters

• “Reactions” called “symptoms” are also “survival skills” for Law Enforcement

officers&warriors

o Hypervigilance=situationalawareness,awarenesstolifesavingclues

o Numbing = channeling anger, emotions in the face of danger, casualties in

ordertolead

o Re-experiencing=rehearsalofimmediateactiondrillsinresponsetodanger

o Functioningonlittlesleepisanadaptivebehavior

4. TraumaticBrainInjury(TBI)

• TBIistheresultofasudden,violentbloworjolttotheheadresultinginpossible

bruisingofthebrain,tearingofnervefibersandbleeding

• TBIcanrangefrommild(mTBI)/concussiontomoderateorsevereTBI

• Symptoms

o Difficultywithconcentrationwhendistractionspresent

o Slowtotakeinnew,fast,complicatedinformation

o Problemswithrecentmemory,newlearning

o Executivefunctionissues,startingtasks,settinggoals,planning,organizing

5. mTBIandPTSD

• Arewar-related reactions such as cognitive problems, rage, sleep disturbance,

fatigue,headachesandothersymptomspsychological(PTSD)orphysical(mTBI)?


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• Research from New England Journal ofMedicine in 2008-9 showed that these

symptoms are “more likely to be associated with PTSD than with concussion

mTBI.”

6. MilitarySexualTrauma

• VAtermforsexualassaultorrepeated,threateningsexualharassment

• Againstone’swillwhileinthemilitary.

o Notadiagnosis

o MayresultinPTSDsymptomsforsome

o Pressured, without consent, unwanted touching, grabbing, remarks or

advances-Betrayal

o Victimoftenmadetofeeltobetheguiltyparty

o ViolationofWarriorEthos,BandofBrothersbond

7. MoralDistress

• Ethicsandmoralsrelatedtorightandwrongconduct

• Ethicsarerulesprovidedtoanindividualbyanexternalsource

• Moralsrefertoanindividual’sownprinciplesregardingrightandwrong

• MoralDistressoccurswhenoneknows theethicallyorprofessionalprescribed

actiontotakebutindoingsoviolatestheirmoralcode

8. MoralInjury

• “anactofserioustransgressionthat leadstoserious innerconflictbecausethe

experienceisatoddswithcoreethicalandmoralbeliefsiscalledmoralinjury”

• “perpetrating,failingtoprevent,bearingwitnessto,orlearningaboutactsthat

transgressdeeplyhelpmoralbeliefsandexpectations”(Litzetal.,2009)

• “SoulWound”–EdTickWarandtheSoul

• “Violation of the Geneva Convention of the Soul” – Larry Dewey War and

Redemption


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IV. HelpingA. Hogue’sLANDNAV

1. Elements

• Aboutwarriorsnavigatingfindingawayintransitions

• Commoneverydaywarriorlanguage

• Explanationsofwhattoexpectintheprocess

• Specificstepsforwarriorsandfamilymembers

2. LANDNAV–LifeSurvivalSkills–UnderstandingyourwarriorreflexesandImproving

Sleep

• Becomemoreawareofyourreactionsbykeepingajournal

• Learntoacceptreactionswithoutjudgmentoranger

• Improvephysicalconditioningandrelaxmuscletension

• Improvesleep

• Learnhowalcoholordrugsaffectyourreactions

3. LANDNAV – Attend – learn to pay attention to and modulate your reactions,

emotionsandwaysofthinking

• Payattentiontoyourphysiologicalreactionsandanxietylevel

• Learntopayattentiontoyourfeelingsandemotions

• Createspacebetweenyourreactionstostressfuleventsandbehaviors

• Learntomonitorandeliminate“should”andrelatedwordsorphrases

• Noticeyourbreathing

• Improveyourfocusandattentionthroughmeditationandmindfulness

4. LANDNAV–Narrate–learntonarrateyourstory

• “Imaginalexposuretherapy”

o Leadstothebodyandmindlearningthereisn’taneedtoreacttothestory

likeit’stheactualtraumaticevent


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o “Habituation”

5. LANDNAV–LearningtoDealwithstressfulsituations,stupidstuff,peopleandanger

• Resiliency“inoculationtraining

• Dealingwiththe“stupidstuff”peopledo

• Dealingwithmoreserioussituationsinvolvingpeople

• Dealingwithanger,rageandrelatedemotions

6. LANDNAV–Navigatingthemedicalandmentalhealthcaresystems

• Reasonstoseekmentalhealthtreatment

• Understandingandovercomingstigmaandotherbarrierstocare

• Whattoexpect-aroadmapforgettinghelp

• Typesoftreatment

• TreatmentandDisability

7. LANDNAV–Acceptance:LivingandCopingwithMajorLosses

• Understandingtheemotionsofloss

• Exploringtheconnectionsbetweencomplexandprimaryemotions

• Lettinggoofunanswerablequestions

• Copingwithgriefandsurvivor’sguilt

• Acceptingotherdifficultthingsthathappenedincombat

8. LANDNAV–Fivequalitiesofdiscoveringmeaningandpurposeinyourjourney

• Vision–beingpresentinthemoment

• Voice–howtheWarriorandfamilyexpressesthemselvesintheworld

• Village(Community)–connectingandfunctioninginalargereffort

• Joiedevivre(joyofliving)–joy&happinesscanbediscoveredthroughsuffering

bygrace

• Victory–applyinggracetocreateabetterworld


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B. BasicsofHelping

1. SMisaperson,notadiagnosis

2. Understandmilitaryculture

3. Learntolistenwellandpatiently

4. Berealandempathetic

5. Beinformedandaware

6. SharetheloveofamercifulandforgivingGodthroughyourfaithcommunity

C. HelperSelfCare

1. Thehelpermustbealertforvicarioustrauma

2. TrainingandEducationareessential

3. Monitoryourself

4. Selfcareisessentialforthehelper

V. ConclusionA. OtherHelpingStrategies

1. VetCrisisLineintegratedwithNSPL800-273-8255,press1forVeterans

• www.veteranscrisisline.net(havelivechat)

• Textto838255

http://www.veteranscrisisline.net


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2. VAOEF/OIFTeamsatVAMedicalCenters

• OutreachandEducation877-927-8387

3. VAVeteranCenters

• http://www2.va.gov/directory/guide/vetcenter_flsh.asp

• Call 877-WAR-VETS (927-8387) to speak with counselor or get

info.

4. MilitaryOneSourcewww.militaryonesource.com

B. FaithBasedStrategies

1. MoralInjury(FaithBased)BriteDivinitySchoolSoulRepair

• http://brite.edu/academics/programs/soul-repair/resources/#ministers

2. WebsiteforPTSD/Suicide/MoralInjury(FaithBased):

• www.militaryoutreachusa.org

3. SaddlebackChurch“TheGatheringforMentalHealthandtheChurch”

• HowtostartaMentalHealthMinistry(Includingveterans)

C. OtherHelps

1. GetHelp–FollowupwithMentalHealthCare

2. GetConnected–WiththeFaithCommunity,orwithVeteranServiceOrganizations

(VSOs),VeteranPeerGroupscanhelpreduceisolation

http://www2.va.gov/directory/guide/vetcenter_flsh.asp

http://www.militaryonesource.com

http://brite.edu/academics/programs/soul-repair/resources/

http://www.militaryoutreachusa.org


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3. GetActive–someVSOsgatherforfitness,naturalmentalhealthbenefitscanresult

4. GiveBack–Serve–Intimebyservingotherswithpurposeishealing

5. SpiritualRituals – traditions, study, prayer groups, retreats (formenandwomen)

arerestorative

6. Remember – celebrate life on anniversaries of loss, civic holidays, go to unit

reunions,gatherings


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MSIP105:

MentalIllnessandtheEpidemiologyofSuicide

LindaMintle,Ph.D.


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AbstractSuicideisacomplexissuewithmultiplecontributinggeneticandenvironmentalfactors.Mental

illness isakey factor in identifyingsomeoneashavingapredisposition for suicide.Thereare

riskfactorssurroundingsuicide,suchasgender,age,race/ethnicity,maritalstatus,geography,

professions/occupations,economics, timeofyear, illness,andothers.Methodsarediscussed,

along with common triggers and general warning signs. Protective factors and prevention

strategiesareimportantindealingwithpeopleinsuicidalcrisis.

LearningObjectives

1. Participantswillexplorevariousmythssurroundingsuicide.

2. Participants will define risk factors for suicide, such as gender, age, race/ethnicity,

marital status, geography, professions/occupations, economics, time of year, and

medicalconditions/illness.

3. Participants will identify common methods and triggers of suicide, general warning

signs,protectivefactors,andpreventivestrategies.


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I. Introduction

A. StoryAboutProminentLawyer’sSuicide

1. SuicideisatragedyandJesussaysitisalossnotagain.

2. Proverbs23:18

“Surelythereisafuture,andyourhopewillnotbecutoff.”

B. Definitions

1. Epidemiology is the study and control of disease or injury patterns in human

populations.

2. Suicideisthepurposefulacttoendone’slife.

3. Suicideattempt isanactofself-harmincludingwhatwaspreviouslyreferredtoas

“para-suicidalbehavior”-theattempttohurtoneselfwithoutkilling.

• Thisisnowcallednonsuicidalself-injury.

C. CommonMythsAssociatedwithSuicide

1. Peoplewhotalkaboutsuicidewon’treallydoit.

2. Anyonewhotriestokillhimself/herselfmustbecrazy.

3. Ifapersonisdeterminedtokillhimself/herself,nothingisgoingtostophim/her.

4. Peoplewhocommitsuicidearepeoplewhoareunwillingtoseekhelp.

5. Talkingaboutsuicidemaygivesomeonetheideatocommitsuicide,andthenthey

couldactonit.


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D. KeyFacts

1. Globally,over800,000peopledieduetosuicideeveryyear.AccordingtotheWorld

HealthOrganization,suicideisthefifthleadingcauseofdeath(2012).

2. Suicideisthe10thhighestcauseofdeathforallages,sexes,andethnicities.

3. IntheU.S.alone,40,600suicideswerereported.Thisequatestoonesuicideevery

12.9minutes.

4. Foreverysuicide,therearemanymorepeoplewhoattemptsuicideeveryyear.

5. A prior suicide attempt is the singlemost important risk factor for suicide in the

generalpopulation.

II. TheRoleofGenetics,EpigeneticsandEnvironment

A. FamilyandTwinStudies

1. There is a higher rate of suicidal behavior in relatives of suicide victims and

attempterscomparedtorelativesofnon-suicidalcontrols.

2. Most suicide attempters/completers have underlying neuropsychiatric diagnoses,

butfamilytransmissionmaybeindependentofthosepsychiatricdisorders.

B. AdoptionStudies

1. Showthatsuicideinvolvestheinheritedtraitoftemperamentofimpulsivityandthe

regulationofimpulsivityisinvolved.

2. Suicidecanhappenimpulsivelyinmomentsofcrisis,unrelatedtopsychiatricillness.


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C. TheFieldofEpigenetics

1. Looksatthepossibilitythatpartofthestronggeneticcomponentisdeterminedby

DNAmodification.

2. Epigeneticsignaturesareheritable,butcanbemodifiedbytheenvironment.

3. Thisisagrowingfield.

4. A number of recent studies have shown epigenetic alterations associated with

suicidalbehavior.

D. EnvironmentInteractingwithGenes

1. Apersonalhistoryofchildhoodabusehasbeenrepeatedlyimplicatedasariskfactor

forsuicidalbehavior.

2. Someepidemiologicalstudieshaveestimatedthatsexualabusemayexplain20%of

theriskvarianceinsuicide.

III. TheRoleofMentalIllnessinSuicide

A. PsychiatricDiagnoses

1. Majordepressivedisorder

2. Conductdisorder

3. Anxietydisorder

4. Substanceuse

5. PTSD


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B. Statistics

1. Ninetypercentofpeoplewhocommitsuicidehaveoneormorediagnosablemental

illnesses.

2. Sixtypercentofallsuicidesarecommittedbypeoplewithmooddisorders.

3. Approximately 30% of suicides are committed by people who have psychiatric

disordersotherthanmooddisorders.

4. Thirty percent of all clinically depressed individuals attempt suicide. About half

aresuccessful.

5. Persons discharged from mental hospitals are 34 times more likely to commit

suicidethanthegeneralpopulation.

6. Menwithasubstanceusedisorderareapproximately2.3timesmorelikelytodieby

suicidethanthosewhoarenotsubstanceabusers.Amongwomen,asubstanceuse

disorderincreasestheriskofsuicideby6.5times.Morethanone-fourthofsuicides

arealcoholrelated.

7. Bipolarwith comorbid substanceusehasalmosta40% rateof lifetimeattempted

suicidecomparedtothosewithasubstanceuseonly.

8. The majority of suicidal behavior occurs in depressed patients, but the role of

antidepressantsiscontroversial.

IV. WhoisatRisk?

A. Gender

1. Menarefourtimesmorelikelytocommitsuicidethanwomen.


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2. Womenattemptsuicidethreetimesmoreoftenthanmen.

B. Age(WorldHealthOrganization–2012)

1. Generally,suicideratesincreasewithage.

2. Thehighestsuicideratewasamongpeople45-59yearsold.

3. Thesecondhighestrateoccurredinthose75andolder.

• Untreateddepression

• Physicalcauses

• Medication

• Healthcaresystem

4. Suicideisthesecondleadingcauseofdeathamong15-19yearolds.

C. Race/Ethnicity

1. Whitemalesaccountfor65%ofallsuicides.

2. ThesecondhighestrateisamongAmericanIndiansandAlaskanatives.

3. Much lower and similar rates were found among Asians and Pacific Islanders,

Hispanics,andblacks.

D. MaritalStatus

1. Marriage is associated with lower rates of suicide (heterosexual data only).

2. Divorcedpeoplearethreetimesmorelikelytocommitsuicidethanpeoplewhoare

married.Thisisthenumberonefactorinurbancenters.


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3. Divorcedandwidowedmenaremorelikelythandivorcedandwidowedwomento

commitsuicide.

4. Livingaloneandbeingsingleincreasetheriskofsuicide.

5. Beingaparentdecreasestheriskofsuicide,especiallyformothers.

E. Geography

1. Mountainstateshavethehighestsuicidecompletionrates.

2. Peoplelivinginruralareasareathigherriskforsuicidethanthosewholiveinurban

areas.

3. ThelowestrateswereinNewJersey,NewYork,RhodeIsland,andMassachusetts.

F. ProfessionsandOccupations

1. Physicians

2. Dentists

3. Financeworkers

4. Lawyers

5. Policeofficers

6. Militaryveterans


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G. Economics

1. Extremesinwealthorpovertyareassociatedwithhighersuiciderates.

2. Timesofeconomicdepressionshavebeencorrelatedtoincreasedsuiciderates.

3. Unemployment or being in debt increases an individual’s feeling of hopelessness

makinghim/hermoresusceptibletosuicide.

H. TimeofYear

1. Despitepopularbeliefs,suicideratesdonot increaseduringthewinterholidaysor

on an individual’s birthday. December is the lowest month related to completed

suicides.

2. Mostsuicidesoccurinthespring.

3. Statistically,therearemoresuicidesonMonday.

4. Norelationshipexistsbetweensuicidesandthephaseofthemoon.

I. MedicalandIllness

1. Terminallyill

2. Serious/chronicillnesses

3. Chronicpain

J. OtherFactors

1. Previousattempt(#1)


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2. Feelingsofhopelessness

3. ProtestantsmorethanCatholics

4. Culturalandreligiousbeliefsinwhichsuicideisglorified

5. Localepidemicsofsuicide

6. Isolation

7. Barrierstoaccessingmentalhealth

8. Loss

9. Easyaccesstolethalmethods

10. Unwillingnesstoseekhelpduetothestigmainvolved

11. Peoplewhohavelostafamilymemberorfriendtosuicide

12. Copycat

13. Sexualorientation(LGBT)

14. Peopleinvolvedinorarrestedforcommittingcrimes

15. Victimsofdomesticviolence


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V. MethodsofSuicide

A. Firearms

1. #1method

2. Accountsforover50%ofallsuicidedeaths

B. Suffocation

1. Includeshanging

2. Almost25%rate

C. Poisoning

1. Overdosing

2. 16.6%rate

VI. CommonTriggers

A. Loss

1. Romanticrelationship

2. JoborEducationalOpportunity

B. Grief

C. Changes

1. Healthofalovedone

2. Socialoreconomicstatus


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D. LegalProblems

VII. GeneralWarningSigns

A. TalkingAboutSuicide

B. SeekingLethalMeans

C. PreoccupationwithDeath

D. NoHopefortheFuture

E. GettingAffairsinOrder

F. SayingGoodbye

G. WithdrawingfromOtherPeople

H. Self-destructiveBehavior

I. SuddenSenseofCalm

J. Caseexample


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VIII. ProtectiveFactors

A. EffectiveClinicalCare

B. EasyAccesstoClinicalInterventions,SupportandHelp

C. FamilyandCommunityConnectedness

D. SupportfromOngoingMedicalandMentalHealthcareRelationships

E. Skills in Problem Solving, Conflict Resolution, and Nonviolent Ways of Handling

Disputes

F. CulturalandReligiousBeliefsthatDiscourageSuicideandSupportSelf-preservation

IX. Screening

A. Definitions

1. Suicide screening refers to a procedure in which a standardized instrument or

protocolisusedtoidentifyindividualswhomaybeatriskforsuicide.

2. Suicide assessment usually refers to amore comprehensive evaluation done by a

clinician to confirm suspected suicide risk, estimate the immediate danger to the

patient,anddecideonacourseofaction.


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3. DetectionTools

• BeckDepressionInventory

• The19-itemScaleforSuicidalIdeation

• TheColumbia-SuicideSeverityRatingScale(C-SSRS)

X. PreventionStrategiesA. RecognizeEarlyWarningSignsandIntervene

B. ReduceAccesstoLethalMethods

C. Follow-upSupport

D. BetterTrainingforPrimaryCareWorkers

E. Community-basedInterventions

F. SeniorPeer-counselingPrograms

G. ImprovementsinMentalHealthServicesThroughSuicidePreventionCenters

H. NationalHotline–(1-800-273-TALK)


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MSIP106:

TheEthicsofSuicideIntervention

MiriamParent,Ph.D.


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AbstractWorkingwithpeopleinsuicidalcrisisisaverystressfulandethicallycomplicatedscenario.The

ethicalprinciplesofbeneficence,non-maleficence,autonomy,justice,fidelity,andveracityare

importantwhendealingwithclientsinregardtosuicide.Itisimportanttonotethatlawsdiffer

ineachstatewhenitcomestodutytowarn/dutytoprotectandendoflifelegislation.There

are several questions a mental health provider should ask when deciding to break

confidentiality in suicidal crisis. During ethical decision making, the mental health provider

should identify theproblemandpotential issues involved, knowand reviewall ethics codes,

laws, regulations and policies, obtain consultation, consider all possible courses of action,

choosewhatappearstobethebestcourseandfollowthrough,anddocumenttheprocessand

outcomes.

LearningObjectives

1. Participantswillidentifytheethicalprinciplesinvolvedindealingwithclientsinsuicidal

crisis.

2. Participants will understand important questions which need to be addressed when

decidingtobreakconfidentialityinsuicidalcrisis.

3. Participantswillexplorethestepsneededduringethicaldecisionmaking.


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I. Introduction

A. Ethics

1. Noteveryone’spassionbutitdoesneedtobeourconcern.

2. WemustprovidequalityeducationandinterventionsinawaythathonorsGod.

3. Wemustmeetthecivilandprofessionalresponsibilitiesthatwehaveagreedto.

B. WorkingwithPeopleinSuicidalCrisis

1. Consistentlyranksasoneofthemoststressfulandethicallycomplicatedscenarios.

2. Self-careindealingwithsuicidalcrisisisamajorethicalresponsibility.

3. Burnoutishighandcanleadtohurtingyourselfandothers.

4. Daniel6:5

Thenthesemensaid,“WewillnotfindanygroundofaccusationagainstDaniel

unlesswefinditagainsthimwithregardtothelawofhisGod.”

5. GodwillprovideuswiththewisdomanddiscernmentweneedifweseekHim.

II. EthicalPrinciplesA. Hippocrates

1. Beneficence–dogood

2. Non-maleficence–donotharm


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B. Justice

1. Equalaccess

2. Fairness

3. Equality

C. Veracity

1. Integrity

2. Truthfulness

D. Autonomy

1. Self-determination–myrighttochoose.

2. Bedrockofinformedconsent.

3. In suicidal crisis, we are often faced with the dilemma of overriding someone’s

autonomy.

E. Fidelity

1. Trustandconfidentiality.

2. Bedrockofamentalhealthpractice.

3. Allowspeoplethesafetytotalkabouttheirpain.


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III. CompetingEthicalIssues

A. Confidentiality

1. Tiedtotheissueoftrustandfidelity.

2. Essentialtoanycounselingrelationship.

3. Clientsneedtoknowandhaveinwritingtheconditionswhenconfidentialitymaybe

waivedorlimited.

4. Harmtoselforothersneedstobeoneofthoseclearlimits.

5. When dealing with suicidal crisis, we are constantly balancing confidentiality and

keepingourclient’strustwithpreservinglife.

B. PreservingLife

1. Interveninginsuicidalcrisis

2. Weshouldintervenetherapeuticallyinwaysthathonortheclinicalrelationship.

3. When clinical interventions are insufficient, we may have to override

confidentiality.

4. Example–AACCCodeofEthics

IV. CompetingLegalIssues

A. Privilege/Confidentiality

1. Privilege is therightoftheclienttodeterminehowandwithwhominformation is

shared.


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2. Protectedformentalhealthprofessionalsbystateandfederallaw.

3. Fewunderstandthedifferencesbetweenthelegalrequirementofprivilegeandthe

ethicsofconfidentiality.

B. VariableStateLegislation

1. Inregardtoharmtoselforothers,statelawsvary.

2. Tarasofflaws–dutytoprotect/dutytowarn.

3. Map– states vary. Some statesmandatewhileother statespermitmental health

professionalstoreport.

C. IntenttoHarmCriteria

1. Thethreatisserious.

2. Thethreatisimminent.

3. Thethreatisdoable.

4. Thethreatisagainstselforanidentifiableperson(s).

D. FutureTrends

1. Statelawsarechangingtoreflectthedebateoverfirearms.

• NYSAFEAct(2013)

• ILFOIDMentalHealthReporting(2014)

2. DeathwithDignitydebates


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V. BreakingConfidentialityinSuicidalCrisis

A. WhoHoldstheLegalPrivilege?

1. Inmostcases,aminordoesnothold legalprivilege. Theparentor legalguardian

does.

2. Ifanadultchoosesnottohavethementalhealthprofessionaldisclose,theirrightto

privilegeisbeingoverridden.

B. IsThereanAppropriateInformedConsentAgreement?

1. Isthereawritten,signeddocument?

2. Hasthisbeenreiteratedinverbaldiscussion?

C. WhatInformationisNeededtoPreserveLife?

1. Limitdisclosuretoessentials.

2. Therestofthementalhealthrecordcanremainconfidential.

D. WhoisintheBestPositiontoIntervene?

1. Sometimesitisfamily.

2. Sometimesitislegalormedicalauthorities.

3. Custodialissuesmayneedtobeconsidered.

4. Beverycarefulwithinstitutionalinvolvement.

E. IsthisaMandatedorPermissiveReportingSituation?


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VI. EthicalDecisionMaking

A. IdentifytheProblemorDilemma

1. Articulatethedilemma.

2. Isitanethical,legal,professional,clinical,orspiritualissue?

B. IdentifythePotentialIssuesInvolved

C. KnowandReviewallRelevantEthicsCodes,Laws,Regulations,andPolicies

D. ObtainConsultation

1. ConsultGodthroughprayer.

2. Consultotherprofessionalstogetasecondsetofeyesonthesituation.

E. ConsiderallPossibleCoursesofActionandtheirConsequences

F. ChoosewhatAppearstobetheBestCourseandFollowThrough

G. DocumenttheProcessandOutcomes

VII. Conclusion

A. Ethically

1. Be proactive.

2. Haveclear,written,informedconsentregardingconfidentialityforeveryclient.


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B. Spiritually

1. Seekwisdom.

2. Knowledgeplusdiscernmentequalswisdom.

3. Proverbs9:10

“ThefearoftheLordisthebeginningofwisdom,andtheknowledgeoftheHoly

Oneisunderstanding.”

C. Professionally

1. Haveestablishedpolicies.

2. Knowthegeneralpoliciesthatarerequiredorexpectedinyourarea.

D. Clinically

1. Carefortheclient.

2. Seektodogood.Donotdoharm.


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MSIP107:

MilitarySuicide,PreventionandIntervention:

WhatYouNeedtoKnow

GlenBloomstrom,M.Div.


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Abstract

Withatopicasburdensomeandimportanttodiscussassuicidewithinthemilitary,itishighly

beneficialtohaveawell-experiencedchaplaindiscussthebestwaystopreventsuicide inthe

lives of military service members and veterans. Glen Bloomstrom begins by presenting the

statistics and rates related to military suicide and what this means for prevention and

intervention.Mr.Bloomstromalsopresentsmanyhelpfulsuicidepreventionand intervention

programs,programorigination,whattheprogramshouldconsistof,andhowtheprogramsare

proven most beneficial. This presentation is highly educational and resourceful through a

discussion of the facts surrounding suicide prevention and intervention, alongwith practical

application.

LearningObjectives

1. Participantswillidentifythecontext,statisticsandratesrelatedtomilitaryandveteran

suicides.

2. Participantswilldiscussvariousmilitaryandveteransuicidepreventionprograms.

3. Participantswillanalyzecomponentsforeffectivesuicideintervention.


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I. Introduction


1. Reviewthecontext,statisticsandratesrelatedtomilitaryandveteransuicides

2. Overviewmilitaryandveteransuicidepreventionprograms

3. Overview types of military and veteran suicide intervention training and analyze

componentsforeffectiveintervention

B. MilitaryandVeteranContext,StatisticsandRates

1. MilitaryStatisticsandRecruitment

• ActiveMilitaryServiceMembers(SM)–1.37Million

• ReserveandNationalGuard–874,000

• FamilyMembers–1.9Million

• Retirees–2Million

• Veterans–23Million

• AnnualRecruitment

o 180,000recruitedasenlistedpersonnel

o 20,000arecommissionedasofficers

o Attritionrate(1stterm)=20%orhigher


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2. DoDSuicideNumbersandRates

3. DoDSuicideExtendedImpact


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4. VeteranRate

• 22veteransuicidesperday

• Averageveteranageis59.6

5. DeploymentConnectiontoSuicide

• Nostudyhasdefinitivelyconfirmedanindependentassociateswithdeployment

• Greaterexposureincreasescapacityforsuicide

6. PTSDVietnamStatistics

• National Vietnam Veterans Readjustment Study (NVVRS) indicated 30.9%who

servedexperiencedcombatrelatedPTSDduringtheirlifetime

• Australian Study: the Retrospective Cohort Study found a 21% increase in

veteransuicidesfrom1982-1994

• NewEnglandJournalofMedicine1986studynoteda65%greaterlikelihoodof

suicidethancivilians

7. OIFandOEFVeteranSuicideRates

• 1.28millionactivedutyveteransservingfrom2001-2007

• 1,868suicides(29.5per100,000rate)

• Ratesarehighestthefirstthreeyearsafterdischarge

• Rateswere16%higherforthosewhodidnotdeploytoOIF/OEF

• Femaleveteransare6timeshigherratethancivilianrate

8. Summary

• Veteransare22%ofallUSsuicides,butonly7%oftheUSpopulation


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II. MilitarySuicidePreventionConsiderations

A. Schneidman–10Commonalities(TheSuicidalMind)

1. Purposeofsuicideistoseekasolution

2. Stimulusofsuicideispsychologicalpain

3. Stressorinsuicideisfrustratedpsychologicalneeds

4. Cognitivestateofsuicideisambivalence

5. Perceptualstateinsuicideisconstriction

6. Interpersonalactinsuicideiscommunicationofintention

B. Joiner


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C. Stigma

1. Stigma=“abrandasonacriminal;amarkofdisgraceordisrepute

2. ServiceandVeteranIndividualStigmaPerceptions

• Seekinghelpwouldbeembarrassing

• Seekinghelpwouldhurtone’sreputation

• Seekinghelpwouldnotbekeptconfidential

• Seekinghelpwouldresultinbeingtreateddifferently

3. CulturalStigmaandConsequences

• SupervisorsmaybelievetheSMisexaggeratingornotreallysuffering

• Servicemembercanbelabeled

• Consequence:miss,dismissoravoidthetopicofsuicide

4. Stigma’sInfluence

• Perceived or stated Community or Cultural Shame is communicated to SM or

Veteran

• LeadstoasenseofnotbelongingandIsolation

• Resultsinlossofhope

D. ChoosingSuicide

1. WhySMandVetsKillThemselves

• Priorsuicideattemps

• Substanceabuse

• Mentalillnessdiagnosis

• Accesstolethalmeans

• Combatexposure

• PTSDincombinationwithdepression

• MultipleTraumaticBrainInjuries


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• Physical/sexualassaultasanadult

• ChildhoodTrauma

• Triggeringevents:financial,legal,orrelational

2. ProtectiveFactors

• EffectiveMHcare

• Connectedness

• Problem-SolvingSkills

• ContactswithCaregivers

• UnitCohesion

• Post-deploymentsocialsupport

• Post-deploymentsenseofpurposeandcontrol

• CommunitywithVSO,Communitycanhelptomakeasmoothtransition

• GuardandUSARLackBaseInfrastructureofADmustlocal/availableresources

3. WarningSignsofSuicide

• Talkingaboutwantingtodieorkillself

• Lookingforwaystokillself,onlinesearch,buyingaweapon

• Talkabouthopelessness,noreasontolive

• Talkaboutfeelingtrappedorinunbearablepain

• Talkaboutbeingaburdentoothers

• Increasinguseofalcoholordrugs

• Lackofconcernforhygiene

• Actinganxiousoragitated;behavingrecklessly

• Sleepingtoolittleortoomuch

• Withdrawingorisolatingthemselves

• Showingrageortalkingaboutseekingrevenge

• Displayingextrememoodswings


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4. SuicideTriggers

• Relationships

• FinancialIssues

• Legal

• SubstanceAbuse

• BehavioralHealth/MedicalIssues

• Emotional/SocialIssues

III. MilitaryandVeteranSuicidePreventionProgramsandStructure

A. DoD(DefenseSuicidePreventionOffice)

1. Allservicesoffersuicidepreventiontraining

• Militarychaplains

• Militarybehavioralhealth

• Operationalstresscontrol

• Mandatoryannualprevention

• Suicidepreventionprogrammanagers

• Sexualassaultresponseprogramsandcoordinators

1. Programs

• GeneralMilitaryPreventionandAwareness:

o ArmyACE

o NavyACT

o USMCRACE

o USAF

• HolisticApproaches

o ComprehensiveSoldierFitness

o USMC


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2. SafeTALK

• AlertnessTraining(3.5-4hours)

• NestswithASISTprogram

• UsedmostwidelyinUSNavyandAirForce

• Skillsorientedwithpractice

3. NationalGuard

• StateSPCoordinators–largest,Armylead

• ManytrainedChaplainsandChaplainAssistants(inASIST)

• DirectorsofPsychologicalHealthineachstate

4. VeteransAdministration1

• VetCrisisLineintegratedwithNSPL

o 800-273-8255,press1forVets

o www.veteranscrisisline.net

o textto838255

• VeteranCenters

o www2.va.gov/directory/guide/vetcenter_flash.asp

o call877-WAR-VETS(927-8387)

• MaketheConnectioncampaign

• RuralClergyInitiative

5. VeteransAdministration2

• VASuicidePreventionCoordinators(SPC)

o Link to SPC/Crisis Centers:

www.veteranscrisisline.net/gethelp/resourcelocator.aspx

o TakecallsandlinkatriskVetstoMHscreeningNLT72hoursaftercall

o ProvideOutreachTraining

http://www.veteranscrisisline.net

http://www.veteranscrisisline.net/gethelp/resourcelocator.aspx


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6. OtherResources

• MilitaryOneSource:www.militaryonesource.com

• Real Warriors Campaign:

www.realwarriors.net/family/support/preventsuicide/php

• StopSoldierSuicide:www.stopsoldiersuicide.org

• Webinar:SuicideinMilitaryandVeteranPopulations:ImplicationsforChaplains,

Health Care Providers and Leaders – www.

Dcoe.mil/Training/Monthly_Webinars/Archive.aspx

IV. SuicideInterventionA. Intervention

1. Thenextlevelofsuicidefirstaidthatcollaborativelyworkswithapersonatriskwith

agoalofkeepingthemsafe

2. NotlimitedtoBehavioralHealthProfessionals

3. “Gatekeeper”focus

B. VA/DoDInterventionTools

1. VAandUSNavy

• ColumbiaSuicideSeverityRatingScale

• VASafetyPlan

2. USArmyandNavy

• AskCareEscort

• AppliedSuicideInterventionSkillsTraining(ASIST)

http://www.militaryonesource.com

http://www.realwarriors.net/family/support/preventsuicide/php

http://www.stopsoldiersuicide.org


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C. InterventionChallenges

1. Interventionisfrightening

2. Suicideiscomplexandunique

3. FirstAidCaregivermustknowtheirownattitudesandstigma

4. Respectandsafetymustinformprotocol

D. InterventionProgramEssentials

1. TrainingFocus–NotEducation

2. FoundedonSuicidologyresearchandlearningmethodology

3. Reflectshelperattitudes

4. Validatedevidenceofeffectiveness, feedback fromhelpersandpersonswith lived

experience

5. Conceptualmodelsandpracticeforskilldevelopment

6. Commoncomponents

• Establishacaringcollaborativerelationship

• TellyourSMorVetchangesyounotice

• Askclearlyanddirectlyaboutsuicide

• Listentotheirstory

• KeepsafeplanandConfirmActionsSafetysteps

• Partnerwithpersonatrisk’sresources


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7. LivingWorksASISTandsafeTALK

• 3,000DoDtrainers

• Trained32,000personnelin2014

• TwoDayGatekeeperskillbasedtraining

• Regularlyupdatedover30years

• Highresearchvalidity,highsatisfaction

• 7,000+USCanada,InternationalTrainers

• StandardforNationalSuicidePreventionLifeline

V. Conclusion


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MSIP108:

ConductingaSuicideAssessment:

UsingtheSafe-TModel

GarySibcy,Psy.D.


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AbstractInthissession,Dr.GarySibcyreviewsandunpackstheSafe-T5StepEvaluation&TriageSystem

for Suicide Assessment developed by the Substance Abuse and Mental Health Services

Administration(SAMHSA)oftheAmericanPsychologicalAssociation(APA).Throughthreerole

plays,Dr.Sibcydemonstrateshowtousethismethodwithclientsofvaryingsuiciderisklevel.

Cliniciansareencouragednotonly togetasuicideassessmentright,but todemonstrateand

document how they have thought through the factors competently and documented the

process.

LearningObjectives

1. Participants will name and describe the five steps of using the Safe-T method with

clientswhoneedsuicideintervention.

2. Participantswillbeexposedtothreedifferentroleplaysshowingappropriateclinician

responsetodifferinglevelsofsuicidalideation.

3. Participants will understand how the client’s risk and protective factors informed

decision-makingineachofthethreescenarios.


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I. Introduction

A. ThreeRolePlays

B. Safe-TMethod

1. Safe-T5StepEvaluation&TriageSystemforSuicideAssessment

2. Developed by the Substance Abuse and Mental Health Services Administration

(SAMHSA)oftheAmericanPsychologicalAssociation(APA)

II. TheFiveSteps

A. Step1:RecognizeSuicideRiskFactors1. Thekindofthingsthatputpeopleatrisk.

2. Triggerscombinedwithmentalhealthriskfactors.

B. Step2:CompareRiskFactorswithExistingProtectiveFactors

1. Religiousbeliefs

2. Senseofobligation

3. Otherreasonsforliving

C. Step 3: Inquiry and Assess the Client’s State of Mind with Respect to Attachment,

History,andIdeation1. Dotheyhaveaplan?


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2. Dotheyhaveintention?

3. Howmuchdotheywanttodiecomparedwithhowmuchtheywanttolive?

D. Step4:DetermineaHigh,MediumorLowLevelofRisk

E. Step5:DocumentandImplementaTreatmentPlan

F. FollowingtheSafe-TMethod

1. Itisnotonlyimportanttogetasuicideassessmentright,butitisalsoimportantthat

you have thought through the factors competently and documented the process.

2. Whenapersonisreferredbysomeoneelseasopposedtocomingbecausetheyfeel

liketheyneedhelp,thisitselfispartofariskprofile.

III. RolePlay1:Jessica

A. Background

1. 22yearoldcollegesenior

2. Referredbyparents

3. Beingreferredasopposedtocomingwillinglyispartoftheriskprofile.

B. RolePlay


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C. Summary

1. Thiswasamorecomplicatedandseriouscase.

2. Jessicahasanumberofriskfactors.

3. Jessica’smostnotableriskfactor isherpreviousattemptaswellasherreactionto

theattempt.

4. Jessicadidnotregretherchoiceafterhersuicideattemptwasthwarted.

5. Triggers included the breakup, a desire for revenge, and hopelessness combined

withveryfewprotectivefactors.

6. AcontractwouldnothavebeenappropriateasJessicawasnot likelytohonorthe

contract.

IV. RolePlay2:AngiePartOne

A. Background

1. Self-Referred

2. Angiehasrunintoanumberofstressors.

3. Angieisfeelinghopelesswithsuicidethoughts.

4. PayattentiontoAngie’slevelofthinking,amountofplanning,andhowthecontract

ismade.

B. RolePlay


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C. Summary

1. Angieisself-referred.

2. Sheisfeelingquitebadly,butwantshelp.

3. Non-suicidalself-injury(tensionreductionbehavior)isrevealed.

4. Angiedoesnothaveasignificanthistoryofsuicidalbehavior.

5. Angie’slevelofhopelessnessisinamoderaterange.

6. Angieisopentocontractingforsafetyandfollowingthesafetyplan.

7. Angiehasalowtomediumrisk.

8. Angiedoeshavehope.

9. Itisimportanttodocumentreasoningaswellasclient’sopennesstocontracting.

V. RolePlay2:AngiePartTwo

A. Background

1. ThisisacontinuationofthefirstroleplaywithAngie.

2. Angiehasbeenintherapybutherlevelofriskhaschanged.

3. YouwillseeanewplanbasedonAngie’slevelofrisk.

B. RolePlay


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C. Summary

1. CircumstanceshadgottenworseforAngie.

2. Angiefollowedtheplanshehadmadewithherclinician.

3. Theriskfactorshaveincreasedduetothestressorsandherlevelofhopelessness.

4. Protectivefactorsarestillinplace.

5. Angie’ssenseofnotbeingsafeisimportant.

6. Ifyoukeepaclientintheoutpatientsetting,makesureyouaredocumentingyour

decisionmakingprocessandthestepsyouaretaking.


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MSIP109:

FamiliesinCrisis:

TheFirst48HoursFollowingaSuicide


withKevinEllers,D.Min.


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AbstractSuicide typically comes as a deep shock to surviving loved ones. Discovering the body of

someonewhohascommittedsuicideorreceivingadeathnotificationcanbetraumatictothe

pointthatthechemistryofthebrainchangesintheimmediateaftermath.Thisbrainchemistry

change can cause decision making to become overwhelmingly difficult. Throughout this

tumultuoustime,caregiverscanprovideemotionalandpracticalsupportthatminimizesfurther

secondarywoundstosurvivors.

LearningObjectives

1. Participantswillidentifywhatcanbedoneinthefirst48hourstotwoweeksfollowinga

suicidetohelpminimizefurthersecondarywoundstothesuicidesurvivors.

2. Participantswillunderstandhowtoprovidebothemotionalandpracticalsupportinthe

immediateaftermathofasuicide.

3. Participantswillexplorecommonissuesandwhatnottodoorsaytosuicidesurvivors.


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I. Introduction

A. GearedTowardCrisisIntervention

1. Firsttwoweeksoruntilthefuneral

2. Thefirstcrisisstageforfriendsandfamilymembers

3. Everything thathappens in thiswindow-positive andnegative- impacts long term

recovery.

B. FirstRespondersandOthers

1. Crisis responders, chaplains, law enforcement, medical professionals, clergy, and

others.

2. Allwhointeractwithsurvivorsinthefirst48hoursto2weeksfollowingthedeath.

II. DiscoveringthebodyorreceivingadeathnotificationA. Traumaticandunexpected.

1. Even if the loved one had chronic mental illness or previous attempts.

2. “FightorFlight”response

3. Thechemistryofthebrainchanges.

• Activityinthefrontallobedecreases.

• Theamygdalaor“fearcenter”firesup.

• Thinkingiscompromisedandemotionsexplode.


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4. Maybechaotictimeandverydifficultforlovedones/family.

5. ThosewhodiscoverthebodymayexperiencesPostTraumaticStresssymptoms.

B. TheDeathScene

1. Thelocationofdeathlikelytobeacrimescene.

2. Thiscancomplicatesituationandbeverychaotic.

3. Themoregruesomethedeathscene,themoretraumacanoccur.

4. Logistics

• Lovedonesoftencan’tvieworbewithbody.

• Theremaybequestioningbypolice.

• Cleanupofscenewillneedtotakeplace.

5. NotifyingothersoftheDeath

• Difficultdecisionsregardingwhattosay/whatnottosay.

• Tellingchildrenpresentsadifficultchallenge.

• Notifyingimportantgroupsmusttakeplace–employers/co-workers,church,

friendsandpastrelationships.

VideowithDr.KevinEllers-HowCrisisRespondersCanAdvocateforFamiliesOn-Scene

6. Caregiverscanadvocateforsomeoneelsetocleanupthedeathscene.


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7. IfCauseofDeathisUndetermined

• Nosuicidenote

• Maynothavedeterminationforsometime

• Mayneverhavedefinitedetermination

• Each person must be allowed their own timetable for coming to

conclusions/answers.

• Some people may be very resistant to accepting the idea of a loved one

committingsuicide.

8. SuicideNotes

• Familymembersshouldhaveaccesstothisnote,particularlyifpositivesare

shared.

VideowithDr.KevinEllers-SuicideNotes

VideowithDennisMinns:SuicideAftermath

III. ImmediateIssues

A. NotificationofDeath

1. Thinkingclearlyandrememberingthegroupstotell.

2. Dowetellthetruth?

B. Emotions

1. Shock/denial

2. Guilt/Self-Blame


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3. Blameofothers

4. Inabilitytothinkclearly

5. Difficultymakingdecisions

C. ProblemswiththeTerm“CommittedSuicide”

VideowithDr.KevinEllers:SuicideTerms

IV. ContagionEffectA. SuicideRiskIncreasedforCommunity

B. At-RiskPopulationandCloseFamilyMembers

C. Windowof48Hours-2Weeks

V. PracticalAssistanceA. DecisionMaking

B. BasicNeeds

1. Shelter–ifhomeiscompromised

2. Food


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3. SocialSupport

4. SpiritualSupport

5. Helpinginmakingplans/decisions

6. Helpingettinginformation

C. Funeral/MemorialArrangements

1. Practicalfuneraldecisions

2. FinancialAssistance

D. EmotionalProtection

1. Protectionfromignoranceandthehurtfulorpainfulthingspeoplesayanddooutof

thatignorance.

2. Workasabuffer.

E. LookingintoLifeInsurance

VI. Conclusion:SelfCareforFirstResponders


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MSIP110:

TheImpactofSuicideon

MilitaryMarriagesandFamilies

DavidMikkelson,Ph.D.

andSuzanneMikkelson,Ph.D.


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Abstract

Theissueofsuicidewithinmilitaryservicemembersandveteranshasbeenandcontinuestobe

a topic thatmust be further researched and discussed. As important as this is, it is equally

importantforresearchers,counselors,chaplains,andcivilianstobecomeawareoftheimpact

suicidehasonthefamilyoftheservicemember.Losingaservicemembertosuicidehasmany

notabledifferencesandimpactsonthefamilythanifacivilianlosesafamilymembertosuicide.

Dr.’s David and SuzanneMikkelson present the specific impact suicide has on the family of

militarypersonnelandhowthoseinthehelpingfieldcanbestinterveneintheirlivesafterthe

suicidehastakenplace.Themostimportantthingahelpercandoistofirstunderstandmilitary

cultureandhowmovingfromthisculturewillaffectthefamilymost.

LearningObjectives

1. Participantswillgainanunderstandingforhowsuicideandthemilitaryculture impact

militaryfamilies.

2. Participants will identify ways the military will directly affect a family following the

suicideoftheservicememberandwhattheseactionswillrequireofthefamily.

3. Participantswilldiscussthebestmethodsandinterventionswhenworkingwithafamily

afterthesuicideoftheservicemember.


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I. Introduction


1. Exploresuicidesuniqueimpactonfamilies

2. Understandmilitaryculture

3. Discussdynamicssurroundingmilitarysuicides

4. Learnhowtohelpmilitaryfamiliesafterasuicide

5. Discusswhathappenswhenaservicememberisactivelysuicidal

6. Learnhowtohelpmilitaryfamilieswithasuicidalfamilymember

C. Suicide’sImpactonFamily

1. FamilyNarrativeisdifferentbecausethefamilyidentityisaltered

2. Spouseissuddenlynolongerpartofacouple

3. Socialstigmaandoftenspiritualstigma

4. Discordance of grief reactions causes disruption in communication, empathy and

support

5. Witnessingthedeath,thebodyorthesceneaddstothetrauma

6. Childrenoftenfeelresponsible(magicalthinking)


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7. Childrenmaybeleftwithatraumatizedpossiblydysfunctionalcaregiver

8. Childrenmaybecomeveryanxiousaboutlosingtheremainingparent

9. Unspokenfamilyrulesaroundhowtotalkaboutthelostperson;oftenincludeswhat

totellchildrenandwhen

10. Dying by suicide can put family members at risk for contagion of maladaptive

behaviors

11. Survivorsloseconfidenceintheirownrelationalinstincts

D. MilitaryCulture

1. ConceptslikeDuty,Honor,Country,andSacrificearenotjustasloganbutawayof

life.

2. Themilitaryplacesahighfocusonhowonedieswhileinuniform.

• Thephrase,“he/shemadetheultimatesacrifice”isanimportantone.

3. The military honors their fallen warriors, and that respect and legacy is a great

sourceofcomfortforsurvivingfamilymembers.

4. Themilitaryplacesgreatvalueonloyaltyandteamwork.

• “You’reonlyasstrongasyourweakestlink”isacommonstatement,andnoone

wantstobethatweakestlink.

5. Disciplineandself-sacrificearealsoimportantvaluesinthemilitaryculture.


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6. Being in themilitary ismuchmore than justaplaceof steadyemployment; it isa

lifestyleforthewholefamily.

7. Partofthemilitarycultureistheimportanceofgenerationalmilitaryservice.

TolearnmoreaboutmilitaryculturecheckouttheCommunityProviderToolkitat

www.mentalhealth.va.gov

II. WhenSuicideHappens

A. MilitaryProtocol

1. Militaryfamilymembersareoften livingfarfromtheirtraditionalsupportnetwork

suchasextendedfamily,long-termfriends,andahomechurch.

2. An official “15-6” investigation is conducted to determine if the servicemember’s

deathwasinthelineofdutyorinvolvedcriminalactivity.

• This can take a long time and create an atmosphere of suspicion,

embarrassment,andshame.

3. Familymustoftenrelocatewithinafewmonthsoftheservicemember’sdeath.

4. Command involvement can highly influence the family’s experience of feeling

supportedorrejected.

5. Familymaynothavenormalsupportfromunitduetothenatureofthedeath


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6. Theservicemembermaynotbeincludedonamemorialwallsorplaquethathonors

thefallenfromthatunit.

• AsofNov6,2014,Armyregulationdirectsthateverysoldierwhodiesonactive

duty, including suicides, be honored with a ceremony, unless the soldier was

guiltyofseriouscriminalactivity.

• Prior toNov 2014, this decisionwas often left to local commanders and their

policymayhavebeendifferent.

7. Familiesmay fear that thedeathby suicidewillovershadowhowtheperson lived

andthememoryofwhotheywere,includingtheirhonorableservicetothecountry.

8. Following death of the servicemember, the family is separated from the military

community,causingthemtofeel“cut-off”fromthemilitaryfamily

9. Civiliansmay be less judgmental about the suicide andmore open to accept the

narrativethattheservicememberhaddeployedtocombatorhadPTSD.

• Thiscancauseleavingthemilitaryfamilytofeellikeapositivelifechange

B. HowtoHelptheFamilyAfterASuicide

1. Geteducatedaboutmilitaryculturefromthefamilyandfromothersources; learn

fromyourclientwhatmilitarylifewaslikeforthem

2. Connectthemwithresources:TAPS,SOS(Army),GriefShare,Chaplains

3. Helpwithtransitionsfrommilitarytocivilianlife

4. Legacymanagement


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5. Addressthespiritualimplicationsofdeathbysuicide

6. Instillhopeforfuture

7. Monitorcontagionofsuicidalideation

8. Recognizeandaddressmaladaptivegrief

9. Helpadultsremainappropriatelytruthfulwithchildren

10. Helpsurvivorscreateanewfamilynarrativethatincludesthesuicide

11. Helpthemhaveawaytospeakaboutthedeceasedwithrespectandhonor

12. Helpfamilyunderstandthesuicidalmind

13. Helpsurvivorslearntotrusttheirowninstinctsagain

14. Tailoryourhelpingtosuicidesurvivors likeusing“suicided”ratherthancommitted

suicide

15. Rememberthatthefamilymayseeitasanaccidentormurder

16. Firstyearisaboutthe“why”

17. Secondyearisoftenharderthanfirst

• Thisisnotregressionbutpartofthejourney

• Nowitisrealaftertheangerandthewhygiveswaytogrief


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C. Grief

1. Trackgriefresponsesintermsofadaptiveandmaladaptive

• Source:Kaplow, J.B., Layne,C.M., Saltzman,W.R.,Cozza, S .J., Pynoos,R. S.,

(2013).

2. Encouragemovementtowardsadaptiveresponses

3. Adaptive

• Missingthedeceased

• Heartacheoverthelovedone’sfailuretoreturn

• Longingtobereunitedwithyourlovedone

• Searchingfornewidentity,meaning,purpose,orfulfillment

• Strugglingwithnewrolesorfunctions

• Sadness,anger,horror

4. Maladaptive

• Identifyingwithunhealthybehaviorsorvaluesofthedeceased

• Developmentalregressionorarrest

• Inabilitytoprovidecareforchildren

• Suicidalideationorbehaviors

• Severeorunresolvableidentitycrisis:“Ishould’vediedwithhim/her”

• Hopelessness,risk-taking,apathy,survivorguilt

• Persistentrage,shame,numbing,retaliatoryfantasies,vengefulbehavior

III. Resources

A. TAPS:TragedyAssistanceProgramforSurvivors1. Forallbranchesofservice


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2. Provideshope,connectedness,support,andmeaningfollowingthedeath

3. Provide professional therapy, trauma care, help with memorial services, legal and

financialhelp

B. VAWebsite–CommunityProviderToolkit

C. CourageAfterFirebyArmstrong,Best,andDomenici

D. WhyPeopleDieBySuicidebyThomasJoiner1. Theoryfocusedoninterpersonalconnectedness

• ThreeElements:o Perceived burdensomeness to others and the conviction that others will

benefitmorefrommydeaththanfrommylife.Thisisarobustpredictorof

suicidality

o Lowbelongingness,asensethatoneisnotanintegralpartofavaluedgroup

o Capacityforlethalitythatinvolvesbothacognitivedecisionacquiredthrough

repeated exposure to painful, fearsome, or lethal experiences that can

habituate the person to death, and the ability to access and use lethal

means.

IV. WhenAServicememberisActivelySuicidal

A. BarrierstoSeekingHelp

1. Limitedappointmentsandlongwaitingtimes


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2. Stigma-howtheywillbeviewedbyothers

3. Concernsaboutsecurityclearanceandimpactoncareer

4. Concernsaboutonlybeinggivenmedications

5. Denialthattheyhaveaseriousproblemorneedhelp

6. UnitresponsestosuicidalSMscanbeopenlyshaming

7. Catch 22: suicide risk increases without help, but the help they receive can be

intrusiveordismissive

B. EncouragingHelp-SeekingBehaviors

1. Helpservicememberconsider the risksofnot seekinghelp; “howbadwould things

needtoget…?”

2. Appeal to their sense of courage to seek help and to protect their family. See the

bookCourageAfterFire

3. Increase suicidal person’s senseof belongingbyhelping them reconnectwithGod,

theirfamily,thechurch,theircalling

4. Askthehardquestionsandbewillingtoactonsuicidalthreats

5. Providepersonalreferralstohelpingagenciesorpersons

6. Chaplainsprovideconfidentiality,evenincasesofsuicideideationsandintentions


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C. HowtoHelptheFamily

1. Beavailabletoseethefamilyorsuicidalfamilymemberregularly

2. Family members are at risk for burnout, compassion fatigue, numbing,

hypervigilence,orexhaustion

3. Incorporate asmany resources as available: church family, neighbors,medications,

extendedfamily,friends

4. Confrontperceivedburdensomeness

5. Offerhope:thisisatemporaryproblem,notapermanentsituation

6. Offertopraywiththefamilyandincorporatescripturalreassuranceduringsession

V. Conclusion

A. DisplayChristinYou

B. OfferHope

Notonlyso,butwealsogloryinoursufferings,becauseweknowthatsuffering

producesperseverance;perseverance,character;andcharacter,hope.Andhopedoes

notputustoshame,becauseGod’slovehasbeenpouredoutintoourheartsthrough

theHolySpirit,whohasbeengiventous.-Romans5:3-5


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MSIP111:

GrievingaSuicide:

Long-termSupportforSurvivors

andLovedOnes


andEricScalise,Ph.D.


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AbstractInthissession,JenniferCisneyEllersandDr.EricScalisewilldescribethecomplicatedgriefthat

followsasuicideandtheexperienceofsurvivors. Strategiestofacilitatehealthygrievingand

healingareoutlined.Viewerswillalsolearnwhatisunhelpfulandhowtoavoidresponsesthat

cause furtheralienationand shame for survivors.Anemphasis isplacedonhelping survivors

stayconnectedtosupportsystemsandsafespiritualenvironments.

LearningObjectives

1. Participants will identify the causes and impact of complicated grief as it relates to

survivingalovedone’ssuicide.

2. Participantswill understand the challenges ofworking through the suicide of a loved

one,includingthecommonlackofsocialsupport.

3. Participantswilllearnwhyconnectednessandcommunityareofutmostimportancefor

suicidesurvivorsworkingthroughthegriefprocessandtowardshealing.


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I. Introduction

A. SupportingSurvivorsIsPrevention

1. Supportingsurvivorsintheaftermathofasuicideisalsopreventingsuicideinfuture

generations.

2. Survivors of suicide get less support and havemore complicated grief than other

typesofdeath.

B. ConnectednessofClinician

C. AwarenessisNeeded

II. TheUniqueGriefProducedbySuicide

A. WeGrieveBecauseWeLove

Godwhispersinourpleasures,speaksinourconsciousness,butshoutsinourpain.Itis

hismegaphonetoadeafworld.–C.S.Lewis

B. ResearchShows:

1. Similartolossbysuddenorviolentdeath.

2. Shock/numbness

3. Denial


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C. Recovery

1. Expecta4-7yearrecoveryperiod.

2. Maynotbe“pathological”griefbutcomplicatedbythefactorssurroundingsuicide.

D. Unhelpful“Helpers”

1. Donotgivepatanswers

2. Donotofferclichés

3. Survivorstendtohearcommentsthatcomeoutofignorance,andthiscanresultin

secondarywounding.

VideowithDr.KevinEllers:SecondaryWoundingvs.Grace

4. Suicide survivors receive less social support than survivorsofother typesof loved

ones’deaths

5. Theyexperiencegreatershameandguilt.

6. Maystrugglewithmore“whatifs”and“whys.”

7. Experiencemorecomplicatedandlong-termgriefissues.

8. ClinicianResponse:

• Helpthesurvivorchangethe“why”questionstothe“what”questions.

• Heartheheartofthecry.

• Don’tunderestimatethepowerofapersonshowingup.


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III. ComplicatedGrief

A. Differsfrom“Typical”Grief

1. Forasuicide,workingthroughgrieftakestwiceasmuchtime,andsometimesfrom

4-7years.

2. Theaveragepersonhasneverpreparedthemselvesforalossofthisnature.

B. ExperienceofComplicatedGriefafterSuicide

1. Guiltcanbecomeimmobilizing.

• Thiscanbeanindicationthatapersonis“stuck”

• Self-blameanddebilitatingguilt

2. Shameforasurvivorcancomefrominternalandexternalmessages.

• Study by Calhoun, Selby, and Faulstich, 1980, showed that respondents

viewedparentsofachildwhocommittedsuicidetobe:

Ø Lesslikeable

Ø Moretoblame

Ø Moreashamed

Ø Moreabletopreventdeath

3. Themodeofdeathcancomplicatetheexperienceofthesurvivor.

4. Dependencyorunhealthyattachmentcancomplicatethegriefprocess.

5. Inadditiontopainandgrief,survivorsoftenfeelanger.

• Theymayfeelthesuicidewasaselfishact.

• Thepersonisnolongertheretoworkthroughtheemotionswith.


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6. Survivorsmayfeelasenseofrelief.

• Thiscanhappenatthesametimeasfeelingsadthepersonisgone.

• Survivorscanbeveryashamedofthisfeeling.

7. Religiousandspiritualissues

• Caregiversshouldworkthroughtheseissuesintheirownheartsandminds.

• Theyshouldnotdothistogiveanswers,asassurancesshouldbelefttoGod

alone.

VideowithDr.KevinEllers:HelpingGrievingPeoplePrepare

IV. WhatDoesandDoesNotHelp

A. Unhelpful

1. Ignoring/Avoidance

2. Denial

3. Pressuringthemto“getoverit”

4. NegativeReligiousjudgments

5. Anyjudgment

6. Keepingitsecret

7. Encouragingornotconfrontingself-medication


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B. Helpful

1. Bewillingtotalkabouteverything-eventheuncomfortableanddifficultparts.

2. Encouragetheemotionalprocessing.

3. Practicalandtangiblesupport.

4. Encouragegrievingrituals.

• Sayinggoodbyeinaletter

• Sendingwishes

• Emptychairdiscussion

5. Rememberrealistically.

6. Allowsurvivorstoworkthroughguiltissuesattheirownpace.

7. Help them get information from other sources (mental health professionals, law

enforcement,medicalprofessionals,co-workers,friends.)

8. Help families grieve together – different grieving styles, ways of coping and

timetables.

9. Helpthemfindsafespiritualenvironmentandcomfortinfaith.

10. Facilitateprocessingwiththedeceasedthroughexperientialtechniques.

11. Helpthemprocessthetraumaofdiscovery.

12. Referraltomentalhealthprofessionalifneeded.

13. Helpthemwithlong-termsupport.


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14. Prepareforanniversariesandothertriggerevents.

15. Supportgroupsforgriefandifpossiblesurvivorsofsuicide.

VideowithDr.KevinEllers:HelpingGrievingPeopleRememberLovedOnes

V. Conclusion:

A. HelpingSurvivorsfindClosure

B. HelpingSurvivorsfindSafeSpiritualHomes

1. Pastors

2. Churches

3. SurvivorSupportGroups

C. Revelation21:1-5

“Then I saw a new heaven and a new earth; for the first heaven and the first earth

passedaway,and there is no longerany sea.And I saw theholy city, new Jerusalem,

comingdownoutofheavenfromGod,madereadyasabrideadornedforherhusband.

And I heard a loud voice from the throne, saying, “Behold, the tabernacle of God is

among men, and He will dwell among them, and they shall be His people, and God

Himselfwillbeamongthem,andHewillwipeawayeverytearfromtheireyes;andthere

willnolongerbeanydeath;therewillnolongerbeanymourning,orcrying,orpain;the

firstthingshavepassedaway.’AndHewhositsonthethronesaid,‘Behold,Iammaking

allthingsnew.’AndHesaid,‘Write,forthesewordsarefaithfulandtrue.’“Revelation

21:1-5


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MSIP112:

CaregiversinCrisis:

WhenClientsTakeTheirLives

EricScalise,Ph.D.

andJenniferCisneyEllers,M.A.


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AbstractCaregiverswhoexperiencethesuicidaldeathofaclientorparishionerexperienceamultitude

ofemotionsrangingfromguilt,shame,sadness,griefandlosstoangerandanxiety.Inaddition

totheprofoundpersonalimpact,theseprofessionalsfeeladeepprofessionallossastheyoften

strugglewithfearofblameandquestioningthemselves.Counselorswhohavelostaclientto

suicide oftendescribe the event as oneof themost profoundly difficult experiences of their

professionalcareers. In this session,youwill learnhowtoprepareorcare foryourself in the

event of a client’s suicide, and you will learn how to care for other clinicians who have

experiencedthisdevastatingevent.

LearningObjectives

1. Participantswillidentifyhowcounselorscanprepareforthepossibilityofthetragedyof

losingaclient to suicide throughkeeping themselvesaccountable,healthyandhaving

theirownsupportsysteminplace.

2. Participantswillnameanddescribethecommonemotionalandprofessionalresultsof

losingaclientorparishionertosuicide.

3. Participantswilldiscoverhowtohelpacaregiver intheaftermathof losingaclientto

suicide.


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I. Introduction

A. SurvivorsofSuicide

1. Any and all people who experience the pain of a suicidal death and who

acknowledgethatthe losshasaffectedtheminpainandprofoundways(Jobes,et

al.,2000)

2. MentalHealthProfessionals inalldisciplinesarenot recognizedas survivorswhen

thoseundertheircarefortreatmentcommitsuicide.

• Emotionsaresimilartothosereportedbyfamilymembersandlovedones.

• Professionals may also experience reactions related to their professional

position.

B. ARelationshipisTraumatized

1. Thereisadepthofrelationshipbetweenclinicians/clients

2. Manycounselorstrulylovetheirclients.

II. CommonExperiencesforClinicianSurvivors

A. Emotions

1. Guiltandshame

2. Sadness,grief,loss

3. Anger

4. Emotionalnumbness

5. Intensedistress


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6. Anxiety/fearofblame

7. Lossofself-esteem

8. Intrusivethoughtsofthesuicide

B. FeltExpectations

C. Dr.Scalise’Testimony

1. Sometimestheclientdoesnotgivehonestfeedbackordivulgeallinformation.

2. Therecanbeashockvalueinthistypeofsituation.

D. ProfessionalSymptoms

1. Lossofcontrol

2. Compassionfatigue

• Compat-tosufferwith

3. Stress

• Theneurobiologyofstress

• Adrenaline

• Cortisol

• Longtermseriouseffects

• Theamygdala-trafficcop

Ø Newpathways

Ø Cortexis“skipped”


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Ø Reactionsandemotionalexperience

Ø Thenewpathbecomeseasierandeasiertowalk

4. Doubtaboutone’sskillsandclinicalcompetence

5. Heightenedfocusonsuicidecues

6. Increaseduseofpeer/colleagueconsultation

7. Hospitalizationoflowriskoutpatients

8. Refusaltoacceptreferralsofanypatientsknowntohavesuicidaltendencies

III. Preparation

A. Support

B. Accountability

C. VariedAtmosphere&ChallengesbySetting

1. Hospital/ResidentialSetting

2. Students/Residents/Interns

3. Therapyorsupportgroups

4. PrivatePractice

5. Church/Pastors


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D. PreparingforGreyAreas

E. PreparingforConfidentialityIssues

VideowithDr.KevinEllers:CaregiverSurvivors

IV. HowtoHelpAClinician-Survivor

A. CounselorsShouldBeCounseled

B. AllowCliniciantoProcessandVentilateConcerns/Feelings

C. NormalizePTSandGrief

D. DiscussMeetingswithFamilyMembersandAttendanceatFuneral

E. DiscussLiability/LegalIssues

F. RecommendSessionswithaTherapist

V. ResourcestoHelpClinician-Survivors

A. Organizations/Supervisors/Colleagues

1. InstituteforCompassionCare-http://institute4compassionatecare.com

2. AmericanAssociationofChristianCounselors–www.aacc.net


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B. PsychologicalAutopsy/Debriefing

1. Nottodetermineblamebutexploretheissueandallowforprocessing

2. Prepareforthefuture

C. OnlineSupport

1. AmericanAssociationofSuicidology–Clinician-SurvivorTaskForce–

http://www.suicidology.org/suicide-survivors/clinician-survivors

2. AmericanFoundationforSuicidePreventionwww.afsp.org


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MSIPBonusSessionOne:

TheEthicsofSuicideIntervention

forEducatorsand

ChurchandCommunityLeaders

MiriamParent,Ph.D.


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AbstractWorkingwithpeopleinsuicidalcrisisisaverystressfulandethicallycomplicatedscenario.The

ethicalprinciplesofbeneficence,non-maleficence,autonomy,justice,fidelity,andveracityare

importantwhendealingwithindividuals inregardtosuicide. It is importanttonotethat laws

differ ineachstatewhenitcomestodutytowarn/dutytoprotectandendof life legislation.

Thereareseveralquestionsapeople-helpershouldaskwhendecidingtobreakconfidentiality

insuicidalcrisis.Duringethicaldecisionmaking,thepeople-helpershouldidentifytheproblem

andpotentialissuesinvolved,knowandreviewallethicscodes,laws,regulationsandpolicies,

obtainconsultation,considerallpossiblecoursesofaction,choosewhatappearstobethebest

courseandfollowthrough,anddocumenttheprocessandoutcomes.

LearningObjectives

1. Participants will identify the ethical principles involved in dealing with individuals in

suicidalcrisis.

2. Participants will understand important questions that need to be addressed when

decidingtobreakconfidentialityinsuicidalcrisis.

3. Participantswillexplorethestepsneededduringethicaldecision-making.


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I. Introduction

A. Ethics

1. Noteveryone’spassionbutitdoesneedtobeourconcern.

2. Wemustprovidequalitypeople-helpinginawaythathonorsGod.

3. Wemustmeet the civil and societal responsibilities that arepartof the setting in

whichGodhascalledustominister.

B. WorkingwithPeopleinSuicidalCrisis

1. Consistentlyranksasoneofthemoststressfulandethicallycomplicatedscenarios.

2. Self-careindealingwithsuicidalcrisisisamajorethicalresponsibility.

3. Burnoutandcompassionfatiguearefartoooftentheendresultforthehelper.

4. Daniel6:5

Thenthesemensaid,“WewillnotfindanygroundofaccusationagainstDaniel

unlesswefinditagainsthimwithregardtothelawofhisGod.”

5. GodwillprovideuswiththewisdomanddiscernmentweneedifweseekHim.

II. GeneralPrinciplesRegardingMoralandEthicalParameters

A. CompetingMoralIssues

1. Sometimeswe are caught between our call to serve others and issues of our own

competence.

2. Lovingothersasourselves.


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3. TheParableoftheGoodSamaritan(Luke10:25-37).

B. Compassion

1. Compassion,althoughessential,maynotbeenough.

2. Compassioncausesustostop,tosee,andtodesiretoactonsomeone’sbehalf.

3. Compassioncallsusforward.

C. Care

1. Alongwithcompassion,wealsoneedtobeabletoprovidethecarethatisneeded.

2. Thisincludesthephysicalabilitiesrequiredandthefinancialresourcesnecessary.

D. Commitment

1. Thisispartofourserviceanddemonstratedlovetoothers.

2. Commitmentinvolvesfollow-up.

E. Competency

1. Ifwelackthenecessarycompetency,wemaydomoreharmthangood.

2. Competency,whichcomesfromthehead,maynecessitatesteppingback.

3. Mydesiretoservemaycompetewithmyownassessmentofcompetency.


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F. Gifts,AbilitiesandTalents

1. Romans12:4-6a

“For just aswe havemanymembers in one body and all themembers do not

have the same function, so we, who are many, are one body in Christ, and

individuallymembersoneofanother.Sincewehavegiftsthatdifferaccordingto

thegracegiventous,eachofusistoexercisethemaccordingly….”

2. EachmemberinthebodyofChristhasbeenequippeddifferentlyforHisservice.

3. Understandingmygifts,talents,andabilitiesisanethicalandmoralresponsibility.

4. TrainingandexperiencecanhoneourgiftsandabilitiesforGod’sservice.

G. PracticalConcerns

1. Family issues suchas young childrenathomemaykeepus fromservingothers in

crucialmoments.

2. SometimesourservicemaybebringingtheindividualbeforetheLordinprayerand

askingtheLordtoprovidetherightpersonwhohastheskillstohelpthatindividual

incrisis.

3. Perhapswecannotcommittotheindividuallong-term,butcanconnecthim/herto

someonewhocan.

III. EthicalandMoralConsiderations

A. NoExemptionfromEthicalandLegalResponsibilities

1. AACC2014CodeofEthics.

2. People-helpers are still expected to attend to certain ethical and legal

considerations.


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3. People-helpersneedtounderstandthe foundationalprinciplesonwhichcodesof

ethicsarebuilt.

B. SixPrinciplesthatGuideProfessionalCodesofEthics

1. Beneficence–dogood.

2. Non-maleficence–donotharm.

3. Justice–fairnessandequality.

4. Veracity–integrityandtruthfulness.

5. Autonomy–self-determination.

6. Fidelity–trustandconfidentiality.

C. SocietalViews

1. Societalviewsonsuicidearechanging.

2. Fivestatesnowallowforphysician-assistedsuicide.

IV. CompetingEthicalIssues

A. Confidentiality

1. Confidentialityisessential.

2. Confidentialityprovidessafety.

3. Breakingtrustdemandsexplicitconsentorveryclearjustification.


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4. Thelimitationsofconfidentialityneedtobeveryclearlyarticulated.

• Writtenandverbalized

• Harmtoselforothers

B. MoralValueforPreservingLife

1. Confidentiality is the expectation but codes of ethics provide an exception in the

caseofharmorseriousthreattolife.

2. Ministry workers should be aware of the greater expectation to access violent

behaviorandtotakesomeaction.

3. Lackofcivilliabilitydoesnotprecludeourresponsibilitytotakeappropriateaction.

4. Statelawsvary.

C. IntenttoHarmCriteria

1. Thethreatisserious.

2. Thethreatisimminent.

3. Thethreatisdoable.

4. Thethreatisagainstselforanidentifiableperson(s).

V. BreakingConfidentialityinSuicidalCrisisA. WhoisatRiskforWhat?

1. Ifthepersonatriskisaminor,theparentsmayneedtobeinvolved.


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2. Determineifthepersonatriskisconsideringonlyharminghimorherselforharming

othersaswell.

B. HaveExpectationsaboutConfidentialitybeenDiscussed?

1. Talkaboutthelimitsofconfidentiality.

2. Thereshouldbewritten,signeddocumentation.

C. WhatInformationisNeededtoPreserveLife?

1. Limitdisclosuretoessentials.

2. Therestofthementalhealthrecordcanremainconfidential.

D. WhoisintheBestPositiontoIntervene?

1. Sometimesitisfamily.

2. Sometimesitislegalormedicalauthorities.

3. Custodialissuesmayneedtobeconsidered.

4. Beverycarefulwithinstitutionalinvolvement.

E. IsthereanEstablishedPolicytoFollowinRegardstoReporting?

F. WhataretheLikelyRepercussions?


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VI. EthicalDecisionMakingModel

A. IdentifytheProblemorDilemma

1. Ifaminorisinvolved,talktotheparents.

2. Don’tgetcaughtupinemotionwhendeterminingifthereisadilemma.

B. IdentifythePotentialIssuesInvolved

1. Aretherelegalissues?

2. Aretherespiritualconsiderations?

3. Aretherefamilydynamics?

C. KnowandReviewallRelevantEthicsCodes,Laws,RegulationsandPolicies

1. Knowthepoliciesrelevantinyourministry’ssetting.

2. Knowthebodyofknowledgethatisavailableandhowitwillhelp.

D. ObtainConsultation

1. ConsultGodthroughprayer.

2. Limittheinformationwhenconsultingothers.

E. ConsiderallPossibleCoursesofActionandtheirConsequences

F. ChoosewhatAppearstobetheBestCourseandFollowThrough


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G. DocumenttheProcessandOutcomes

VII. Conclusion

A. Ethically

1. Beproactive.Don’twaitforthecrisis.

2. Setclearexpectationsaboutconfidentiality.

3. Knowthegeneralproceduresexpectedinmysituation.

B. Spiritually

1. Seekwisdom.

2. Proverbs9:10

“ThefearoftheLordisthebeginningofwisdom,andtheknowledgeoftheHoly

Oneisunderstanding.”-Proverbs9:10

C. CaringfortheIndividualGodhasPlacedBeforeMe

1. IwanttodogoodforthoseGodhascalledmetoserve.

2. Havetheintenttoserve.


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MSIPBonusSessionTwo:

ConductingaSuicideIntervention:TheRoleof

MinistryLeadersandCaregivers(with

demonstrations)

GarySibcy,Ph.D.


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AbstractInthissession,Dr.SibcyagainutilizestheSafe-Tmethod,butthistimewithanemphasisonthe

role of pastors andother lay caregivers in conducting a suicide intervention. It is of utmost

importancethatwhenasuiciderisk isclearlypresent,referralsystemsareinplacetogetthe

at-riskparishionertoatrainedclinicianwhocanhelp.

LearningObjectives

1. ParticipantswillnameanddescribeeachstepofthefivestepSafe-Tsuicideintervention

model.

2. Participantswillunderstandimportantconsiderationsforlaycaregiverswhoencountersuiciderisk.

3. Participantswillviewanexampleofreferringtoappropriateresources.


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I. Introduction

A. SuicideCrisis

1. Theriskisprevalent.

2. Ifyouworkwithpeopleinacaregivingrole,youwilllikelyencountersomeonewith

suicidalthoughtsandideationwhomaybeatriskforsuicidecompletion.

3. Thisistrueevenifyouarenotworkingasacounselor.

4. Preparing for the instance of suicide threat is absolutely crucial to intervention

outcome.

B. TheSafe-TMethod

1. Safe-TFive-StepEvaluation&TriageSystemforSuicideAssessment

2. Developed by the Substance Abuse and Mental Health Services Administration

(SAMHSA)oftheAmericanPsychologicalAssociation(APA).

3. Payattentiontosignificantstressorsinyourparishioners’lives.

II. TheSafe-TMethod

A. Step1:RecognizeanIndividual’sRiskFactors

B. Step2:CompareRiskFactorswithExistingProtectiveFactors


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C. Step3:Inquiry

1. Assess the client’s state of mind with respect to attachment, history, ideation.

2. Thethreefactorstobalancearerisk,protectivefactors,andsuicidestateofmind.

3. Asalayclinician,itisimportanttobereadytorecognizewhensomeoneneedshelp,

andbepreparedtoplugthemintohelp.

D. Step4:DetermineaHigh,Medium,OrLowLevelofRisk

E. Step5:DocumentanImplementaTreatmentPlan:WhatYouDid,WhyYouDidIt,and

HowYouDidIt.

1. Trytounderstandaperson’sstateofmindbeforetryingtointervene.

2. Ifsomeone’slevelofriskishighormoderate,gettingthemconnectedtosomeone

whocaninterveneataprofessionallevelistheimmediateconcern.

3. It is importanttohavearicharrayofpeoplewhoyoucanrefertoandunderstand

theirprocesses.

• Youwillwant toknowwhohasa longwaiting listandwho leavesspace in

theirscheduleforemergencyclients.

• Getcontactinformationandhaveitreadilyavailable.

• Understand how to access the local Emergency Room and what their

proceduresare.


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III. RolePlay1

A. Background

B. RolePlay

C. Review

IV. RolePlay2

A. Background

B. RolePlay

C. Review

V. RolePlay3

A. Background

B. RolePlay

C. Review


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Appendix1:

ASystematicProcessforAssessing

SuicideRisk:TheSAFE-TMethod

GarySibcy,Ph.D.


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ASystematicProcessforAssessingSuicideRisk:

TheSAFE-TMethod

GarySibcy,Ph.D.

Thelastcenturyhaswitnessedanexplosionofeffectivetreatmentsforavastarrayofillnesses

anddeathrateshavedroppeddramatically.Paradoxically,though,suiciderateshaveincreased

by60%overthelast45years.1Every20minutes,thereisacompletedsuicide.Suicide—aself-

inflictedactofviolence—representstheninthmostcommoncauseofdeathamongadults; in

youthages15to24,itisthethirdmostcommoncauseofdeath,andfor25to34-year-olds,itis

the second leadingcauseofdeath.2Therearemany,manymore suicideattempts—10 to40

timesmorethancompletedsuicide.WithintheU.S.alone,therearenearly650,000attempted

suicidesperyear,3whichtranslatesintoonesuicideattempteveryminute.Nearlyonequarter

ofallmentalhealthprofessionalshaveworkedwithaclientwhohascompletedasuicide.Given

theexpandingmagnitudeofthepotentialrisk,assessingsuicideisoftenadailytaskformental

healthcounselors.4

Currently, there are no singlemeasures that accurately and effectively assess suicide

risk. Proper assessment requires amultidimensional approach that balances awide array of

relevant factors. One of the most accepted examples is the Suicide Assessment Five-step

Evaluation and Triage (SAFE-T) system. The protocolwas developed by the SubstanceAbuse

and Mental Health Services Administration (SAMHSA), and based on data and

recommendationsprovidedbytheAmericanPsychiatricAssociationPracticeGuidelines.These

steps are used at all initial evaluationswith clients throughout the course of treatment and

wheneverthecliniciansuspectsthatsuicideriskmayincrease.

SAFE-T5 is a process measure that involves balancing three aspects: risk factors,

protective factors, and an assessment of the client’s current state of mind with respect to

suicide. The process begins with an assessment of risk for key factors through a clinical

interviewandfrompreviousrecords.Theseinclude:


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§ Theclient’ssuicidehistoryintermsofanypastattemptsorahistoryofself-injurious

behavior.Apastattemptisthenumberonepredictorofcompletingasuicideinthe

future. This is especially true for individuals who have utilized a highly lethal

method,butsomehowsurvivedagainsttheirwill.Themoreserioustheintent,the

greaterthefuturerisk.

§ Theclient’scurrentandpastpsychiatrichistory,aswellas their familyhistory that

requiredhospitalization.Highrisk individualsare likelytopresentwithahistoryof

mooddisorders suchasmajordepressionandbipolardisorder.Otherdisordersof

risk are psychotic disorders, alcohol and substance abuse problems, ADHD (when

combined with another disorder like depression), PTSD, traumatic brain injuries

(TBI),antisocialbehavior,impulsivity,andaggression.

§ Varioustypesofprecipitantsandstressorsthatmaytriggerasuicidalcrisis.Manyof

these are interpersonal in nature, especially those that produce a sense of

humiliation,shameordespair.Chronicpainandongoingmedicalillnessesthataffect

the central nervous system (such as Multiple Sclerosis, Parkinson’s, ALC, and

Huntington’s) are also considered risk factors. Other relevant triggers include

changesintreatmentandmedicationregimensorchangesintreatmentproviders.

§ Current psychological and emotional symptoms such as a significant loss in the

clientsabilitytoexperiencepleasure(anhedonia),feelingsofhopelessness, intense

anxiety and panic symptoms, pervasive insomnia, impulsivity, substance

intoxication,andcommandhallucinations.

The SAFE-T balances the above-mentioned risk factors with protective factors, which

canbeacombinationofbothinternalandexternalresources.

§ Internal resourcesmay include a capacity fordistress/frustration tolerance, coping

skills,andstronglyheldreligiousbeliefs.

§ External factors may include a sense of responsibility to children, a positive

therapeuticrelationship,andaccesstotrustedsocialsupportnetworks.


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Withbothriskandprotectivefactorsinmind,aclinicianshouldconductamoreformal

suicideinquiry.Thisentailsasetofsensitivelydeliveredquestionsassessingtheclient’scurrent

stateofmindwithrespecttosuicideandincludethefollowingareas:

§ Suicide ideation,which involves the frequency, duration, and intensity of suicide

thoughtsoverthelast48hours.

§ Anassessmentoftheclient’ssuicideplansandbehaviorsandwhethertheclienthas

determined the locationand time inwhichheor shewouldwant tocarryout the

act.Thepotentiallethalityoftheplan,realisticaccesstoitemsneededtocarryout

theplan,andpreparatoryacts(suchasrehearsingtheactmentallyorbehaviorally)

are also important. Thismay include non-suicidal, self-injurious behaviors such as

cuttingandburning.

§ Assessing client intent—the degree of motivation and extent to which the client

believestheplanwillbe life-endingversusself-injurious.Withminors,theclinician

shouldalsoaskparentsandguardiansaboutevidenceofsuicidethoughts,plansand

behaviors.

TheSAFE-Tprovidesguidelines fordeterminingrisk levelandcorrespondingclassesof

interventions.Theseinclude:

§ HighRiskStatus involvessignificantrisk factorsthatoutweighprotective factors in

combinationwithpersistentsuicideideation,aplanand/orintention.Interventions

would includehospitalization,preferablyvoluntaryadmission incollaborationwith

theclient,butinvoluntaryifnecessary.

§ Moderate Risk Status involves a number of risk factors with very few protective

factors. However, unlike the high risk category, such individualsmay have suicide

ideationandaplan,butno intentandnoovertbehaviororrehearsals.Thetrigger

may be relatively transient and modifiable and the client has some internal

resources for coping. Interventions may include hospital admission or a detailed

crisis plan with a commitment from the client to call should his or her condition

changefortheworse.


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§ LowRiskStatusinvolvesriskfactorsthatarelessintense,transientandmodifiableto

problem-solving and other types of interventions. The client also possesses a

numberofprotectivefactors,suchasstrongreligiousbeliefsagainstsuicideand/ora

sense of obligation or commitment to the care of others.Moreover,while clients

may report persistent thoughts of death, they do not report any suicide plans,

intentions, behaviors or rehearsals. In such cases, interventions are focused on

outpatient symptom reduction with phone numbers available in case of crisis or

emergencysituations.

ThefifthandfinalstepoftheSAFE-Tprocessisdocumentation.Thisisaveryimportant

stepbecause it creates a permanent and legal record about themeasures taken to properly

assessandevaluateaclient’ssuicidalrisk.Thekeyhereistodemonstraterationaleformaking

clinicaldecisionsandfollowingasystematic,best-practicesapproachregardingriskfactorsand

clinicalintervention.Thetreatmentplanshouldbedocumentedonhowitisdesignedtotarget

currentandfutureriskfactors.Forminors,documentationshouldreflecttherolesofparents

andguardians.

Itiscrucialthatcliniciansworkdiligentlyatmaintainingasolidtherapeuticrelationship

and be mindful of how suicide assessment can sometimes challenge the quality of the

therapeutic alliance. This is particularly challenging with clients who may present with a

moderatetohighdegreeofrisk,butwhoarenotopentomoreintenseinterventions,especially

hospital admission. Even for seasoned therapists who are treating difficult cases, effective

clinical decision-making often requires ongoing consultation and collaboration with other

professionalshavingexpertiseinsuicideriskassessment.

A helpful resource can be found atwww.SPRC.orgwhere a pocket card that outlines

thesefivestepsandhelpsmanagesuicideriskinyourclinicalpracticecanbedownloaded.


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Endnotes1WorldHealthOrganization(2005).WorldHealthOrganization:SuicidePrevention.RetrievedOctober26,2005,fromhttp://www.who.int/mental_health/prevention/suicide/suicideprevent/en/2 Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query andReporting System (WISQARS) [Online]. (2007). National Center for Injury Prevention andControl,CDC(producer).Availablefromwww.cdc.gov/injury/wisqars/index.html3 Goldsmith, S.K., Pellmar, T.C., Kleinman, A.M. & Bunney,W.E. (2002). Reducing Suicide: ANationalImperative.Washington:InstituteofMedicine,NationalAcademiesPress.4Ibid.5SAFE-T Drew Upon the American Psychiatric Association Practice Guidelines for theAssessmentandTreatmentofPatientswithSuicidalBehaviors.http://www.psychiatryonline.com/pracGuide/pracGuideTopic_14.aspxDerived from: American Psychiatric Association (2003). American Psychiatric AssociationPracticeGuideline


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