1Suicide Prevention Janet Kemp RN, Ph.D. VA National Suicide Prevention CoordinatorAssociate Director Education and TrainingKerry L. Knox, Ph.D., M.S.DirectorDeborah A. King, Ph.D.Clinical Training CoordinatorJane Wood, R.N., M.S.N.Clinical TrainerRevised 10/2009 by:Education, Training, and Dissemination core of the VISN 2 Center of Excellence at CanandaiguaCanandaigua VA Medical CenterCenter of Excellence, Bldg. 3400 Fort Hill AvenueCanandaigua, NY 14424
2Suicide Prevention Introduction Objectives:By participating in this training you will learn:The scope and importance of suicide preventionThe negative impact of myths and misinformationHow to identify a Veteran at riskHow to effectively communicate with a suicidal VeteranHow to gain information to help the VeteranHow to refer a Veteran for evaluation and treatment
3Suicide Prevention Brief Overview Suicide in the U.S. (2006 CDC data)Suicide is the eleventh leading cause of death for all ages:33,000 suicides occur each year in the U.S.91 suicides occur each dayOne suicide occurs every 16 minutes
4The Face of Suicide in the U.S.(SAMHSA, 2009) Suicide Prevention Brief OverviewThe Face of Suicide in the U.S.(SAMHSA, 2009)Gender -Men take their lives at nearly four times the rate of womenAge - Suicide is the second leading cause of death among25-34 year olds and the third leading cause among15-24 year oldsPersons aged 65 years and older have the highestsuicide rate of any age groupOne older adult commits suicide every 90 minutesVeteran Status-Veterans may be at even greater risk than those in the general population
5Suicide Prevention Brief Overview What do the statistics mean?Veterans are at risk for suicide.We need to do more to reduce their risk.
6VA National Initiatives Suicide Prevention Brief OverviewVA National InitiativesResearch in suicide preventionBest practices in identification and treatmentEducating employees at every levelPartnering with community-based organizations and the armed forcesVeterans Suicide Hotline/Chat LineLOCAL InitiativesCommunity Education/Awareness
7Suicide Prevention Myths and Misinformation Myth: Asking about suicide may lead a Veteran to commit suicide
8Reality: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.
9Suicide Prevention Myths and Misinformation Myth: There are ‘talkers’ and there are ‘doers’.Myth:There are talkers and there are doersReality:Most people who die by suicide have communicated some intent. Someone who talks about suicide gives the guide and/or clinician an opportunity to intervene before suicidal behaviors occur.
10Reality: People who talk about suicide must be taken seriously. Talking about suicide is an important warning sign that further mental health evaluation is necessary.
11Suicide Prevention Myths and Misinformation Myth: If somebody really wants to die by suicide, there is nothing you can do about it.
12Reality: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, you’ve gone a long way toward saving a life.
13Suicide Prevention Myths and Misinformation Myth: A Veteran won’t commit suicide because…she has young children at homehe has made a verbal or written promise
14Reality: The intent to die can override any rational thinking. A suicidal Veteran must be taken seriously and referred for evaluation and treatment.
15Suicide Prevention Operation S.A.V.E. Operation S. A. V. E. will help you act with care andcompassion if you encounter a Veteran who is suicidal.The acronym “SAVE” helps you to remember theimportant steps involved in suicide preventionSigns of suicidal thinkingAsk questionsValidate the veteran’s experienceEncourage treatment and Expedite getting help
16Suicide Prevention Operation S.A.V.E. Importance of identificationThere are a number of warning signs and symptoms.Some of the signs are obvious but others are not.When you recognize one of these signs, it’s critically important to ask the Veteran if he or she is thinking of suicide.
17Suicide Prevention Signs of suicidal thinking Acute Warning Signs and Symptoms:Threatening to hurt or kill selfLooking for ways to kill selfSeeking access to pills, weapons or other meansTalking or writing about death, dying or suicide
18Suicide Prevention Signs of suicidal thinking Additional Important Warning Signs:HopelessnessRage, anger, seeking revengeActing reckless or engaging in risky activitiesFeeling trappedIncreasing drug or alcohol abuse
19Suicide Prevention Signs of suicidal thinking Additional Important Warning Signs:Withdrawing from friends, family and societyAnxiety, agitationDramatic changes in moodFeeling there is no reason for living, no sense of purpose in lifeDifficulty sleeping or sleeping all the timeGiving away possessions
20Suicide Prevention Asking the question Know how to ask the most important question of all:“Are you thinking of killing yourself.”
21Suicide Prevention Asking the question DO ask the question if you’ve identified warning signsor symptomsDO ask the question in such a way that is natural andflows with the conversation
22Suicide Prevention Asking the question DON’T ask the question as though you are looking for a“no” answer. “You aren’t thinking of killing yourself are you?”DON’T wait to ask the question when the Veteran is halfwayout the door
23Suicide Prevention Ask the question Things to consider when you talk with the Veteran:Remain calmListen more than you speakMaintain eye contactAct with confidenceDo not argueUse open body languageLimit questions-let the Veteran do the talkingUse supportive - encouraging commentsBe honest –there are no quick solutions buthelp is available
24Suicide Prevention Validate the Veteran’s experience Validation means:Acknowledging the Veteran’s feelingsRecognizing that the situation is seriousNot passing judgmentReassuring him or her that you are here to help
25Suicide Prevention Encourage treatment and Expedite getting help Reassure the Veteran that:Treatment is availableGetting help for suicide is like getting help for any medical problemEvery Veteran has the right to careEven if they have had treatment before, it’s worth it to try again
26Suicide Prevention Tips for expediting a referral: Get to know the referral process in your facilityKnow barriers in your facility, i.e., no acute psychiatry available in this facilityIf you don’t know the answer to a question the Veteran asks, let them know that you will help find the answer
27Suicide Prevention Encourage treatment and Expedite getting help Safety IssuesNever try to negotiate with a Veteran who has a gun-call securityIf a Veteran has taken pills or cut him or herself-call securityIf a Veteran runs away-call securityIf you are speaking with a suicidal Veteran located at your facility call security. If they are located outside your facility call 911.Know your facility process for referring Veterans for treatment
28Suicide Prevention Operation S. A.V. E. Operation S. A. V. E. can save lives by helping you recognize: Signs of suicidal behaviorAsking the question, “Are you thinking of killing yourself?”Validating the veteran’s experience andEncouraging treatment and Expediting referral
29Suicide Prevention By participating in this training you have learned: The scope of the problem of suicides in the Veteran populationThe importance of suicide preventionThe negative impact of myths and misinformationHow to identify a Veteran who may be at riskSome of the signs and symptoms of suicidal thinkingHow to effectively ask the most important question of allHow to gain information to help the VeteranHow to refer a Veteran for evaluation and treatment
30Thank You References Operation S.A.V.E. Guide Training VA Edition