Slide 1

1

Slide 2

Learning Objectives: Have a general understanding of the scope of suicide within the United States Know how to identify a Veteran that may be at risk for suicide Know what to do when you identify a Veteran at risk Learning Objectives: Have a general understanding of the scope of suicide within the United States Know how to identify a Veteran that may be at risk for suicide Know what to do when you identify a Veteran at risk 2

Slide 3

3 16,799 U.S. deaths from homicide per year, a pproximately 1/2 the number of annual suicides Homicide is the 15 th leading cause of death in the U.S. 16,799 U.S. deaths from homicide per year, a pproximately 1/2 the number of annual suicides Homicide is the 15 th leading cause of death in the U.S.

Slide 4

Ethnicity Of every 100,000 people in each of the following ethnic/racial groups below, the following number died by suicide in 2009 Highest rates: White Male 21.6 per 100,000 Native Americans 12.3 per 100,000 Non-White Males 9.2 per 100,000 Black Males 8.6 per 100,00 Lowest rates: Hispanics 5.3 per 100,000 Asian and Pacific Islanders 6.3 per 100,000

Slide 5

20 percent of U.S. deaths from suicide are Veterans Veterans are more likely than the general population to use firearms as a means for suicide 950 suicide attempts per month among Veterans receiving VA health care services Decreased suicide rates in Veterans aged 18-29 who use VA health care services 33 percent of recent Veteran suicides have a history of previous attempts 20 percent of U.S. deaths from suicide are Veterans Veterans are more likely than the general population to use firearms as a means for suicide 950 suicide attempts per month among Veterans receiving VA health care services Decreased suicide rates in Veterans aged 18-29 who use VA health care services 33 percent of recent Veteran suicides have a history of previous attempts 5

Slide 6

Myth: Asking about suicide may lead a Veteran to commit suicide Reality: Asking a veteran about suicide does not create suicidal thoughts any more than asking about chest pain causes angina. The act of asking the question simply gives the Veteran permission to talk about his or her thoughts and feelings. Myth: Asking about suicide may lead a Veteran to commit suicide Reality: Asking a veteran about suicide does not create suicidal thoughts any more than asking about chest pain causes angina. The act of asking the question simply gives the Veteran permission to talk about his or her thoughts and feelings. Myth: There are talkers and there are doers. Reality: People who talk about suicide must be taken seriously. Talking about suicide is an important warning sign that further mental health evaluation is necessary. Myth: There are talkers and there are doers. Reality: People who talk about suicide must be taken seriously. Talking about suicide is an important warning sign that further mental health evaluation is necessary. 6

Slide 7

Myth: If somebody really wants to die by suicide, there is nothing you can do about it. Reality: Individuals who have survived serious suicide attempts have clearly stated that they wished someone had shown an interest. By supporting the Veteran to get help, youve gone a long way toward saving a life Myth: If somebody really wants to die by suicide, there is nothing you can do about it. Reality: Individuals who have survived serious suicide attempts have clearly stated that they wished someone had shown an interest. By supporting the Veteran to get help, youve gone a long way toward saving a life Myth: A Veteran wont commit suicide because he just made plans for a vacation she has young children at home he made a verbal or written promise she knows how dearly her family loves her Reality: The intent to die can override any rational thinking. A suicidal Veteran must be taken seriously and referred for evaluation and treatment Myth: A Veteran wont commit suicide because he just made plans for a vacation she has young children at home he made a verbal or written promise she knows how dearly her family loves her Reality: The intent to die can override any rational thinking. A suicidal Veteran must be taken seriously and referred for evaluation and treatment 7

Slide 8

Operation S. A. V. E. will help you act with care and compassion if you encounter a Veteran who is suicidal. Follow these steps: Signs of suicidal thinking Ask questions Validate the Veterans experience Encourage treatment and Expedite getting help Operation S. A. V. E. will help you act with care and compassion if you encounter a Veteran who is suicidal. Follow these steps: Signs of suicidal thinking Ask questions Validate the Veterans experience Encourage treatment and Expedite getting help 8

Slide 9

Important Warning Signs: Hopelessness Rage, anger, seeking revenge Feeling trapped Increasing drug or alcohol abuse Withdrawing from friends, family and society Anxiety, agitation Dramatic changes in mood Feeling there is no reason for living, no sense of purpose in life Difficulty sleeping or sleeping all the time Giving away possessions NOTE: Many Veterans may not show any signs of intent to harm themselves before doing so 9

Slide 10

Acute Warning Signs and Symptoms: Thinking about hurting or killing themselves Looking for ways to die Talking about death, dying, or suicide Self-destructive or risk-taking behavior, esp. when it involves alcohol, drugs, or weapons 10

Slide 11

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

Slide 12

Inpatient suicides in the U.S. 1500 per year 5-80 of every 100,000 psychiatric admissions end in inpatient suicide Physical environment root cause in 84% of inpatient suicides. Hanging is the most common method reported in JC (75%) literature and in the VA (30.8%). 50% of suicide by hanging were NOT fully suspended using anchor points below the head. Inpatient suicides in the U.S. 1500 per year 5-80 of every 100,000 psychiatric admissions end in inpatient suicide Physical environment root cause in 84% of inpatient suicides. Hanging is the most common method reported in JC (75%) literature and in the VA (30.8%). 50% of suicide by hanging were NOT fully suspended using anchor points below the head. 12

Slide 13

Eliminate structures capable of supporting a hanging object Plumbing, ductwork, fire sprinkler heads, curtain or clothing rods, hooks, shower heads and controls, doors, hinges, door handles, light fixtures Include structures close to the floor Towel bars, grab bars, toilet/sink plumbing & faucets, projections and side-rails on beds Eliminate structures capable of supporting a hanging object Plumbing, ductwork, fire sprinkler heads, curtain or clothing rods, hooks, shower heads and controls, doors, hinges, door handles, light fixtures Include structures close to the floor Towel bars, grab bars, toilet/sink plumbing & faucets, projections and side-rails on beds Reduce Strangulation devices: drapery cords, belts, shoe laces, ties, kerchiefs, bathrobe sashes, drawstring pants, coat hangers, call cords, privacy curtains, trash can liners. Access to dangerous objects: contraband check, medications, objects provided by roommates and visitors, cleaning supplies, electrical outlets, stoves, breakable furniture Access to sharps: any breakable glass or tiles, razors, flatware, light bulbs, wires or springs, dishes, scissors Opportunities to jump: windows, balconies, walkways, roofs Reduce Strangulation devices: drapery cords, belts, shoe laces, ties, kerchiefs, bathrobe sashes, drawstring pants, coat hangers, call cords, privacy curtains, trash can liners. Access to dangerous objects: contraband check, medications, objects provided by roommates and visitors, cleaning supplies, electrical outlets, stoves, breakable furniture Access to sharps: any breakable glass or tiles, razors, flatware, light bulbs, wires or springs, dishes, scissors Opportunities to jump: windows, balconies, walkways, roofs 13

Slide 14

DO ask the question if youve identified warning signs or symptoms DO ask the question in a natural way that flows with the conversation DONT ask the question as though you are looking for a no answer You arent thinking of killing yourself are you? DONT wait to ask the question when he/she is halfway out the door DO ask the question if youve identified warning signs or symptoms DO ask the question in a natural way that flows with the conversation DONT ask the question as though you are looking for a no answer You arent thinking of killing yourself are you? DONT wait to ask the question when he/she is halfway out the door

Slide 15

When asking the Veteran about suicide: Remain calm Listen more than you speak Maintain eye contact Act with confidence Dont argue Use body language that is open Limit questions to casual information gathering Use supportive and encouraging comments Stay non-judgmental Be as honest as possible Know how to ask the BIG QUESTION: Have you thought about killing yourself?? 15

Slide 16

Talk openly about suicide. Be willing to listen and allow the Veteran to express his or her feelings Recognize that the situation is serious Do not pass judgment Reassure the Veteran that help is available 16

Slide 17

What should I do if I think someone is suicidal? Dont keep the Veterans suicidal behavior a secret Do not leave him or her alone Try to get the person to seek immediate help from his or her doctor or the nearest hospital emergency room Call 911 Reassure the Veteran that help is available. Call the Veterans Crisis Line at 1-800-273- 8255, Press 1 Safety Issues: Never negotiate with someone who has a gun. Get to safety and call VA police or security If the Veteran has taken pills, cut himself or herself or done harm to himself or herself in some way, call VA police or security 17

Slide 18

18

Slide 19

Available to all CTVHCS employees. An anonymous self referral may be made by contacting the Employee Health Department at 40745 or 53088. Common Workplace Stressors Include: high/insufficient workloads a lack of control over work activities poor working relationships leading to a sense of isolation people being asked to do a job for which they have insufficient experience/training difficulty settling into a new position bullying or harassment weak/ineffective or over-management multiple reporting lines for employees a failure to keep employees informed poor physical working environment. 19

Slide 20

1. Operation S.A.V.E. Guide Training VA Edition 2. http://www.cdc.gov/violenceprevention/suicide/statistics/ http://www.cdc.gov/violenceprevention/suicide/statistics/ 3. http://vaww.mentalhealth.va.gov/suicide.asp http://vaww.mentalhealth.va.gov/suicide.asp 4. http://mentalhealth.samhsa.gov/suicideprevention/elderly.asp http://mentalhealth.samhsa.gov/suicideprevention/elderly.asp 5. National Center for Injury and Prevention Control. WISQARS (Web-based Injury Statistics Query and Reporting System). http://www.cdc.gov/ncipc/wisqars/ accessed Jan 2009. 6. American Psychiatric Association. Practice guideline for the assessment and treatment of patients with suicidal behaviors. Am J of Psychiatry 160:1-60, Nov. 2003. 7. Shapiro S and Waltzer H. Successful suicides and serious attempts in a general hospital over a 15-year period. Gen Hosp Psych,2, 118-126, 1980. 8. Lieberman DZ and Resnik, HLP. Environmental Risk Factors in Hospital Suicide. Suicide and Life-Threatening Behavior. 2004; 34(4): 448-453. 9. Mills PD, DeRosier J, Ballot B, Shepherd M. and Bagian JP. Inpatient Suicide and Suicide Attempts in Veteran's Affairs Hospitals. The Joint Commission Journal on Quality and Patient Safety, 34(8), 482-488, August, 2008. 10. Gunnell D, Bennewith O, Hawton K, Simkin S and Kapur N. The epidemiology and prevention of suicide by hanging: A systematic review. International J. of Epidemilogy. 2005; 34: 433-442. 11. Mills, PD, Watts, BV, Miller S, Kemp J, Knox K, DeRosier J, and Bagian JP. A checklist to identify inpatient suicide hazards in Veterans Affairs hospitals. The Joint Commission Journal on Quality and Patient Safety, 36 (2): 87-93, Feb. 2010. 12. The Joint Commission: Sentinel Event Alert. A follow-up report of preventing suicide: Focus on medical/surgical units and the emergency department. Issue 46, November 17, 2010. 13. Tischler CL, Reiss NS. Inpatient Suicide: Prevention a Common Sentinel Event. General Hospital Psychiatry, 2009: 31: 103- 109. 20

Slide 21

Suicide is everyones business General facts about suicide in the U.S. Facts about Veteran suicide How to identify a Veteran who may be at risk for suicide How to help a Veteran at risk for suicide How to address a crisis situation What resources are available and how to access them