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Veterans and Suicide: Know the Facts, Save a Life Maryland Veterans Commission Meeting January 20 th, 2014 10:30am Nikole S. Jones, LCSW-C Suicide Prevention.

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Presentation on theme: "Veterans and Suicide: Know the Facts, Save a Life Maryland Veterans Commission Meeting January 20 th, 2014 10:30am Nikole S. Jones, LCSW-C Suicide Prevention."— Presentation transcript:

1 Veterans and Suicide: Know the Facts, Save a Life Maryland Veterans Commission Meeting January 20 th, 2014 10:30am Nikole S. Jones, LCSW-C Suicide Prevention Coordinator VA Maryland Health Care System

2 About Me  Social Worker  Survivor of Suicide Loss – Cousin Tony Harrison died by suicide in 2006  VA Suicide Prevention Coordinator in 2007.  Helped create a Maryland Chapter of the American Foundation for Suicide Prevention in 2011.  Served as the President and later the Chairman of the Board of Directors of the Maryland Chapter.  Currently writing a book, “The Compulsion to Die”  “Stand Up & Speak Out” Button Awareness Campaign

3 Suicide: A National Crisis  In the United States, more than 40,000 people die by suicide a year.  10 th leading cause of death in U.S.  One person dies from suicide every 14 minutes.  8-25 attempted suicides per suicide death.  90% of people who die by suicide have a diagnosable mental illness and/or substance abuse disorder.  40-60% of individuals that committed suicide were seen by their Health Care Provider in the month prior to suicide. 3 * Statistics from

4 Suicide in the General Population  13.5% of all Americans report a history of suicidal ideation or suicidal thinking  3.9% have actually making a suicide plan  4.6% have made an attempt  Any suicide attempt should be considered “serious” * Statistics from

5 Risk Factors: 5  History of suicide attempt  Family history of suicide or suicide attempts  Pain, particularly unremitting  Loneliness/Isolation  Presence of firearm in home or vehicle  History of sexual abuse  Lack of social support  Changes in financial status  Cancer  HIV/AIDS  Chronic diseases  Head injury  Disappointed/regretful that a prior suicide attempt failed

6 Why people enter the military? (National Survey conducted with 100 veterans*)  Patriotism  Career/Opportunities  Escape Family/Legal  Family Tradition  Pride/Achievement  Full-Time Employment  Test Courage/Thrill “Happiness equals reality minus expectations” * National On-line Survey by the Washington Post in May 2009

7 Suicide Statistics Unique to Veterans  1/5 suicides in this country are Veterans  An estimated 22 Veterans die by suicide everyday  Male veterans are twice as likely as civilians to commit suicide  1000 suicides occur per year among veterans receiving care at a VA Facility  5000 suicides among all veterans * Statistic from the and

8 Risk Factors:  History of suicide attempt  Hopelessness  Family history of suicide or suicide attempts  Pain, particularly unremitting  Presence of firearm in home or vehicle  History of sexual abuse  Homelessness  Illicit Drug Use/Dependence  Alcohol Abuse/Dependence  Fearlessness  Lack of social support  Changes in financial status  Unemployment  Disability (Medical/MH Issues)  Cancer  HIV/AIDS  Chronic diseases  Head injury (TBI)  Impulsivity  Legal Issues  Family Dysfunction  Lack of Coping Skills 8

9 Veteran Specific Risks for Suicide:  Frequent deployments  Deployments to hostile environments  Exposure to extreme stress  Physical/sexual assault while in the service  Length of deployments  Service related injury 9

10 Pre-War/Post War Statistic on MH Issues  Military service comes with special challenges, and the 1999 Veterans Health Study found that nearly a third (31%)- of veterans were suffering depressive symptoms, a rate that's two to five times higher than observed in the general public.  Imagine the number of veterans after 11 years of war post 9/11 (5,714 service members killed in the line of duty while serving in the Iraq and Afghanistan with 36,757 injured). * Statistic from the Iraq and Afghanistan Veterans of America Organization 2012 Annual Report

11 Reactions to War Positive Reactions Sense of Honor Sense of Self- Respect Improve Interpersonal Relations Accomplishment Courage and Strength under Pressure

12 Reactions to War Negative Reactions Anxiety PTSD Panic Attacks Anger Substance Abuse Depression Isolation Suicide

13 Post-Deployment Issues Welcome Home – Exciting Time Family Disconnect (Role Confusion) Financial Stress (Economic Stress) On-set of Symptoms (difficulty coping & functioning) Applying for Benefits (SC pension) Chronic Pain Issues Substance Use/Abuse (self medicating)

14 Risks of Veterans in the 20’s and 30’s  Afghanistan and Iraq Veterans (OEF/OIF)  Age of normal onset of Mental Illness  Transitional Veterans (Military Lifestyle to a Civilian Lifestyle)  Fearlessness, Recklessness and Impulsivity  Increase risk for substance abuse/dependence

15 Risks of Veterans in the 30’s and 40’s  Afghanistan and Iraq Veterans (OEF/OIF)  Persian Gulf Veterans  Career and Unemployment Issues (“searching for purpose”)  Transitional Veterans (Military to Civilian)  Marital and Family Issues  Increase risk for substance abuse/dependence

16 Risks of Veterans in the 50’s – 70’s  Mandatory Military Draft  Vietnam War Veterans (1964-1975)  Anti-War Movements  Grief & Loss Issues (Retirement/Death)  Disability/Increase of Medical Issues  Loss of Independence  Retrospectively Thinking Back on Life  Increased Risk for Substance Abuse Issues

17 Risks of Veterans 70 Years and Older  Korean War Veterans  WWII Veterans  Financial Issues/Cost of Living Increases  Increase in Medical Problems  Life Threatening Health Concerns  Loss of Independence  End of Life Issues

18 Warning Signs of Suicide:  Communication of Intent  Concrete Suicide Plan  Access to Means  Irritable or Aggressive Outbursts  Withdrawn/Isolated  Increased Alcohol/Substance Use  Giving away Personal Items  Deliberate Self Injury  Saying “Goodbye” Orally or Written  Loss of Interest in Hobbies 18

19 Protective Factors  Positive social supports  Spirituality  Sense of responsibility to family  Children/Pregnancy  Life satisfaction  Reality testing ability  Positive coping skills  Positive problem solving skills  Positive therapeutic relationship

20 It only takes one……. ……to make a change!

21 VA Initiatives for Suicide Prevention  VA National Suicide Hotline  Increased Mental Health Resources  Medical Center-wide Training/Education  Suicide Prevention Awareness Month  Funding for Suicide Prevention Coordinators at every Medical Center 21

22 VA Suicide Prevention Programs

23 VA’s integrated approach to suicide prevention v_1.26.13

24 Veterans Crisis Line: more than five years of saving lives

25 Role of Suicide Prevention Team  Screening and Assessment  Referrals  Tracking and Reporting  Monitoring and Support  Consultation  Training and Education  Outreach

26 Suicide Prevention Coordinators serving Maryland: 26 Nikole Jones, LCSW-C VA Maryland Health Care System (410) 642-2411 Ext. 5020 Please contact the Suicide Prevention Coordinators for further questions! * To get more information and find a suicide prevention coordinator in another state- go to Yvette Gibson, LICSW Washington D.C. VA Medical Center (202) 745-8000 Ext. April Hamilton, R.N. Martinsburg VA Medical Center (304) 263-0811 Ext. 3624

27 Assessing for Suicide Risk  Current Ideation  Intent  Plan  Access to means  History of Mental Illness or Substance Abuse  Hopelessness  History of Physical or Sexual Abuse  Co-morbid Diagnosis  Age, Gender, Race

28 Responding to Suicide Risk  Refer to mental health treatment and ensure follow-up appointment is made.  Increase contacts with veteran until crisis is resolved  Inform someone close to the veteran (address access to lethal means)  Give the number to 24 hour hotline (1-800-273- TALK)  Develop a safety plan  Refer to an immediate evaluation (ER/Mobile Crisis)

29 Suicide Safety Planning  Step 1: List warning signs (thought process, images, experiences, mood and or behaviors)  Step 2: Internal Coping Skills (identify alternative coping skills)  Step 3: Social Contacts that may distract from the crisis)  Step 4: Family Members or Friends who can offer help  Step 5: Professionals and Agencies to Contact for help (Doctors, MH providers, Mobile Crisis, Crisis Lines)  Step 6: Making the environment safe (assessing means and reducing/restricting access) VA endorses a Six Step Suicide Safety Plan the addresses warning signs, coping strategies, social and professional resources to assist when in crisis

30 Interview with a Vietnam War Veteran “And now I have even got to the point that I keep a weapon near. At first it was just by my bed, but lately I have been carrying it in my car. This is dangerous, and I know it’s wrong and eventually I will get in some kind of trouble. But I feel better when it is near”

31 Methods of Suicide Firearms are the most lethal method of suicide In 2005, 55% of handgun deaths were self-inflicted (compared to 40% used in homicides) Veterans are trained to handle/use weapons Veterans usually have access to firearms, some have a collection of firearms

32 VA Gun Safety Program  VA began giving out gun locks in 2008 modeling the program after the national gun safety campaign Project ChildSafe.  Focus on gun safety not ownership.  Awareness of gun laws and guidelines for providers and veterans.  Educate providers about the importance of assessing for guns in the home.  Assessing for guns in the homes of at risk veterans (How to ask about guns?).  Discuss safety risk with veterans and their families.  Distribute FREE gun locks to veterans.

33 VA Maryland Health Care system Specialty Services Physical Rehabilitation Inpatient /Residential Services Pain Management Trauma Recovery Program Residential Services (Domiciliary, Psychiatric Rehabilitation, and Substance Abuse Rehabilitation) Outpatient Mental Health Services (MHICM-R, Recovery Center) Outpatient Substance Abuse Treatment Program (Buprenorphine/Methadone Maintenance) Recovery Mall – Psycho-educational Classes and Groups Incarcerated Veterans/Veteran’s Justice Programs Heath Care for Homeless Veterans

34 Outreach Individual/Groups Martial and family counseling Bereavement counseling, Medical referrals, VA benefits assistance Employment counseling Alcohol & Drug assessment and referral Information and referral to community resources and community education Vet Centers

35 Community Resources for Veterans and their families  Maryland Commitment to Veterans (DHMH)  Maryland Center for Veteran Education & Training (MCVETS)  Maryland Work Force Promise  Wounded Warrior Project  Military One Source  Tragedy Assistance Program for Survivors (TAPS)

36 Any Questions

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