JULI MCNEIL, MSSW, LCSWPROGRAM MANAGER, SUICIDE PREVENTIONJACK C. MONTGOMERY VA MEDICAL CENTER
Brookhaven Hospital Seminar May 2, 2012
Suicide Prevention: Clinical Tools and Resources in the US Department of Veterans Affairs
Objectives
Suicide Prevention Program
Suicide Facts and Statistics
Suicide Risk Assessment
National VA Safety Planning Intervention/Tool
The Self-Directed Violence Classification System (SDVCS): What is it and why it matters
VA Programs, Services, other helpful tools, websites
Initiation -Suicide Prevention Program
2007 Joshua Omvig Veterans Suicide Prevention Act
National Level, Suicide Prevention
Suicide Prevention efforts, such as the Suicide Hotline and hiring of Suicide Prevention Coordinators began in FY2007 with full implementation in FY2008
A 24/7 Veterans Crisis Line Over 417,000 callers have called the Crisis line Over 259,000 of those callers have identified themselves as
Veterans or family members/friends of Veterans Over 15,000 rescues of actively suicidal Veterans
Online Chat Service Initiated in July 2009 Over 17,000 chatters; over 3761 mentioned suicide
VISN 16 Total Calls YTD 2010 –9742 (2nd highest) VISN 22: 12365 (1st highest)
Jack C. Montgomery VAMC (Tulsa, Vinita, Hartshorne Clinics)
Suicide Prevention Team
Juli McNeil, LCSW Program Manager, Suicide Prevention 918-577-3087/4144 [email protected]
Tina Bevans, LCSW Tulsa VA Clinics (41st and 11th) Suicide Prevention Coordinator 918-628-2659
Suicide Prevention Team Cont’d
Alexa Youngblood, LCSWSuicide Prevention Case Manager [email protected]
Tawnya WilsonSuicide Prevention Program & SUD Intensive Outpatient Program Administrative Assistant918-577-4111/3439
Suicide Statistics 36, 909 US deaths from suicide/year; nearly 100 lives/day
One Suicide every 15 minutes
Suicide is the 10th leading cause of death in the US
Suicide is the 2nd leading cause of death among 25-34 year olds
Suicide is the 3rd leading cause of death among 15-24 year olds
4 times as many men kill themselves compared to women, yet 3 times as many women attempt suicide as compared to men.
Oklahoma is 12th in the Nation.
Suicide Statistics Continued
~20% are Veterans
~18 deaths from suicide per day are Veterans
~About 5 deaths from suicide per day among Veterans receiving care in VHA
Veterans are more likely to use firearms as a means for suicide
~1000 attempts/month among Veterans receiving care in VHA as
reported by suicide prevention coordinators.
Preliminary data since 2006 show decreased suicide rates in Veterans aged 18-29 who use VA health care relative to Veterans in the same age group who do not. This decrease in rates translates to about 250 lives per year.
VA Screenings and Suicide Risk Assessments
VA Clinical Reminders: Screening for Depression, PTSD, Alcohol, etc.
Suicide Risk AssessmentsCompleted on those who present with risk
factors (depression, anxiety, etc.)Initial MH VisitDuring Inpatient Psychiatric StayTreatment Plan UpdatesDuring times of significant changes/stress/crisis
RISK FACTORS
Thoughts about harming self that include plan & method Previous suicide attempts Alcohol or substance abuse History of mental illness Poor self-control Hopelessness Recent loss (e.g., loved one, job, relationship) Family history of suicide History of abuse Serious health problems Non Suicidal injury Rehearsal behavior Recent discharge from hospital, group home etc. Recent diagnosis of an illness Demographic factors: White men over 70 years of age
are at increased risk Burdensomeness, Isolation, Thwarted belongingness Chronic Pain , PTSD, TBI
VETERAN SPECIFIC RISKS
Multiple deployments; Length of deployments
Deployments to hostile environments
Exposure to extreme stress/death/combat
Physical/sexual assault while in the service (not limited to women)
Service related injuries (TBI, PTSD, other medical and mental health diagnoses)
Familiarity with weapons
Survivor Guilt
PROTECTIVE FACTORS
Positive social support (#1) History of adaptive coping skillsParticipating in treatment and/or good
relationship w/their provider.Veteran acknowledges hopefulnessReligious/Spirituals beliefsLife satisfaction (e.g., rating 1 to 10)Fear of suicide or deathFamily or friends that act as barrier to self-
harm
Safety Planning
STEP 1: Warning Signs
STEP 2: Internal Coping Strategies
STEP 3: Social Contacts Who May Distract from the Crisis
STEP 4: Family or Friends Who May Offer Help
STEP 5: Professionals and Agencies to Contact for Help
STEP 6: Making the Environment Safe
Other Theory/Interventions
T. Joiner’s Interpersonal-Psychological Theory: 3 variables must be present for one to die by suicide
1. Sense of thwarted belongingness (lacks meaningful connections to others, previous rel, strained or lost
2. Perceived burdensomeness (burden to others, fails to make meaningful contributions, liability-These two together produce the desire
3. Acquired capability for suicide (degree to which one can enact a lethal suicide attempt-lethal or near lethal attempt is fearsome and often pain-inducing, habituation to the fear and pain is prerequisite for serious suicidal behavior.
Address: employment, education/re-education, volunteering; use cognitive restructuring techniques, family/couples therapy, CBT, DBT
Interventions
Caring lettersCollaborative Assessment & Mgmt of
Suicidality (CAMS)-David JobesDBT-M. LinehanCBTSafe VetAddressing Suicide vs. Diagnosis, VISN 19
MIRECC
Nomenclature: Self-Directed Violence Classification System (SDVCS)
In 2008, former Secretary of Veterans Affairs, Dr. James B. Peake, recommended a standard
nomenclature for “suicide” and “suicide attempts” to improve Veterans Affairs’ (VA):
1. Suicide prevention programs2. Suicide prevention research3. Suicide prevention education
SDVCS Overview
• To learn and begin to using the new nomenclature for self-directed violence.
• Review of the language of suicidology
• Rationale for a self-directed violence classification system
• Implementation of a new classification system
Resources
Refer to VA Resource Guide
www.veteranscrisisline.netwww.suicidepreventionlifeline.org www.mirecc.va.gov/visn19www.suicidology.org
PTSD COACH APPSAFETY PLAN APP, COMING SOON
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