1st SERGEANT’S BRIEFING Airmen in Distress Neysa Etienne Clinical Psychologist Maxwell Air Force Base Mental Health Clinic 42nd MDG

Learning objectives Describe Phenomenon of Suicide Model Mind Manage your reactions to Airmen in distress Take a collaborative, non-adversarial stance Manage Suicide Risk in Airmen Helpful Language and Approach Reconcile conflicting goals Plan for how to assist Awareness of helping agencies Identify and Manage Airman in Crisis Manage your reactions Reconcile Conflicting Goals: You desire to keep them safe, VS their desire to engage in self injurious behavior.

Why The 1st Sgt? Spends time w/ personnel almost every day Is most likely familiar w/ typical behavior One of the first to see problems develop You are the first line of defense Being proactive with wellness & safety benefits people as well as the AF’s mission Rationale… WHAT ARE YOU DEFENDING AGAINST? Lets take a look. This came out just last week… Stats update… HOW BIG OF A PROBLEM IS THIS? AND WHY IS IT RELEVANT TO YOU? Every single one of those completed AD suicides had a 1st Sergeant, a dormmate, a Commander

COMPARISON BETWEEN: Air Education & Training Command and AIR FORCE AIR FORCE LETS SEE WHAT WE BELIEVE ABOUT THESE NUMBERS…

SNAPSHOT: MILITARY FAMILIES 2005-2009: > 1,100 members of the Armed Forces took their own lives 2010: ARMY suicide rate among active-duty soldiers decreased slightly 2009: 162 2010: 156 2010: Number of suicides in the Guard and Reserve increased by 55% 2009: 80 2010: 145 2010: More than half of the National Guard members who died by suicide had not deployed. * Suicide among veterans accounts for as many as 1 in 5 suicides in U.S. * No greater risk for service members compared to general population… AVERAGE OF 1 SUICIDE EVERY 36 hours & 3 These numbers may reflect differences in deployment tempos and percentages between AD vs Guard vs Reserves 4. Interesting Stat, and encouraging

“Mostly, I have been impressed by how little value our society puts on saving the lives of those who are in such despair as to want to end them. It is a societal illusion that suicide is rare. It is not.” --Kay Redfield Jamison HOW RARE IS IT?

SNAPSHOT: UNITED STATES - 11th leading cause of death in the US - 2nd leading cause of death among college students - 3rd leading cause of death for young people aged 15-24 - 4th leading cause of death among people aged 25-44 - For every suicide event, 6 survivors are left behind - More than 30,000 Americans Commit suicide every year - 1 Suicide in the US approximately every 17 minutes - 650,000 attempted suicides per year - 2:3 Ratio (HOMICIDE TO SUICIDE) in the U.S. Startling to think that over the course of these three + hours we will spend together, approximately 12 people would have taken their life somewhere in the US.

MYTH OR FACT 1. Suicide Usually Happens with no warning 2. More than 70% of people who kill themselves have previously considered it seriously? 3. There is most often a note left behind when someone commits suicide. 4. People who are suicidal are intent on dying and feel there is no turning back? 5. Someone who survives a suicide attempt is really not serious about it. Discussing suicide openly with someone who seems really depressed does more harm than good. People who attempt suicide once, are unlikely to try it again. MYTH: Fact is 8/10 people who kill themselves give some sort of warning or clue to others, even if it is subtle. FACT: Myth is Someone who talks about suicide a lot is just trying to gain attention MYTH: Fact is, in most cases there is NO NOTE, or explanation. MYTH: Fact is… most people who are suicidal are of two minds about it. Part wants to die, but part of them does not. The main thing is they want is to stop their pain. MYTH: Fact is: Any suicide attempt should be treated as though the person intended to die, and not simply dismissed as an attention seeking device. MYTH: Fact is discussing it openly can actually help not hurt. MYTH: 80% of people who die from suicide have made at least one other attempt already. MYTH OR FACT: SHOUT OUT WHAT YOU THINK! Perhaps because suicide is rarely talked about openly,there are a lot of mis- conceptions surrounding the issue,including who is at risk,why and under what circumstances it occurs,and how to get help.Knowing the facts is critical to taking action and essential in saving lives. recommendation to “maintain continuity of care across transitions” for service members and veterans. The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) man- ages the program and its support coaches. Family members are also encouraged to call the program to find out how their service member can get started with inTransition. Coaches are available 24/7 via toll-free call. All inTransitioncoaches are skilled counselors who understand today’s military culture and issues. They understand and respect the importance of your privacy. They are with you every step of the way. When you contact inTransition, you will be assigned your own coach who will: Coachyou one-on-one as you go through your transition Connectyou with your new provider Empoweryou with tools to continue making healthy life choices Simply call the toll-free numbers: 800-424-7877Inside the United States 800-424-4685(DSN) Outside the United States toll-free 314-387-4700 (collect) Outside the United States www.health.mil/inTransition Join our listserv!

EXPERIENTIAL EXERCISE FIND A PARTNER FACE OFF RELATE DEBRIEF WHY? Let’s pause here for a moment for a fun little interactive exercise… EVERYONE Get a Partner… Someone in close proximity. And I want you to face off, as best as you can. EYE to EYE. So be sure you are looking each other square in the face. Now one of you please volunteer to go first. Let me see? Who are my brave souls. Okay, now for the next 4 minutes, I want you to look at your partner and share your most AMAZING sexual experience… Spare no detail! Just jump right in and tell them the who what when where how… and why it was SOOOOO FANTASTIC! Hmmm… a bit quiet. Anyone feel a bit uncomfortable? Can someone tell me why? Okay, so here is the thing, that I hope you can take away from that experience. I was asking you to share a HIGHLIGHT EXPERIENCE, and it was not easy... For a number of reasons… People do not come in for tx to share their life highlights. Usually PTSD equates to the worst experience in their life. I hope you can remember that sense of discomfort you felt sharing a + experience, bc it is magnified 100 fold when your airman are coming to share something so – and painful, so we need to make it easier for them to share.

MIND & MODEL Theoretical Framework BIOPSYCHOSOCIAL MODEL THE SUICIDE MODE (Rudd, 2009) Predispositions to Suicide Triggers Interaction between: Perceptions (thoughts) Emotions (feelings) Behaviors Physiology

This diagram illustrates THE SUICIDE MODE (FRAME OF MIND) model of suicide. Attempts to provide a foundation to understand how an individual arrives at the point of wanting to end life by taking into account: Any contributing biological and genetic factors such as: Genetic Predisposition towards impulsive behavior, family history of suicidal behavior, family history of psychiatric disorders. Any contributing psychological factors: mood state, impaired problem solving, hopelessness, despair. Any contributing social factors: lack of adequate support network, lack of adequate access to helping resources. TAKEN ALL TOGETHER… the biological/psychological/ and social factors create a profile of PREDISPOSING FACTORS. OR A PERSON’S BASELINE RISK FOR SUICIDE… This model is known as the suicidal mode (Rudd, 2006) According to theory, in the combination of predisposing factors and an acute stressor (SUCH AS) can trigger or activate a suicidal episode. The suicidal mode consists of cognitive, affective, behavioral, physiological, and motivational systems that interact with each other and sustain the suicidal state.

BASELINE RISK Predispositions Previous suicide attempts Impulsivity Male Same sex orientation Recent discharge from inpatient unit Family history of suicide History of physical, emotional, or sexual abuse Previous suicide attempts Impulsivity Subjective or Objective

ADDITIONAL RISK Additional Risk Factors Older Caucasian Isolated Medical issues Alcohol use Depression Panic attacks The following basic risk factors have remained relatively consistent over the years… The theoretical models identified cognitions, emotional processing, and associated behavioral responses as critical to understanding motivation to die, associated distress (and symptoms) and ultimately changing the suicidal process. Patients found the models easy to understand, distilling them down to thoughts, feelings and behaviors that are associated with suicide risk and hopelessness. In short, these treatments made it easy to sit down with a patient and explain in understandable language why they have tried or are thinking about killing themselves. This was an important consistency across effective treatments.

PROTECTIVE FACTORS Optimism about the future Strong social support life has purpose and meaning Feeling a sense of belonging Willingness to seek help Willingness to talk about problems Effective coping and problem solving skills Cultural norms that encourage Optimistic… This will pass Social support: from family, friends, and co-workers Belief that your life… One individual told: Message of childhood…Mom and Dad never believed you would amount to much. You were not wanted, you were an accident… The In Group and the Out Group (even in the AF) Cultural Norms ENCOURAGE PEOPLE TO SEEK HELP… It is part of your job to create that cultural norm. Is that a norm you are familiar and comfortable with? If not… it will be hard for you to create… Need to work through your own reasons and examine your own beliefs…

KNOW YOURSELF Questions to ask self: Self-Awareness of personal reactions How to Manage Your Reactions Unhelpful Attitudes Recognize Difference in Goals Conflict of interest in accomplishment Reconcile differences Collaborative approach

Questions to ask self Why do people die by suicide? What are your beliefs about suicide? What have you learned about suicide during your life? What type of person kills themselves? Who do you know that has died by suicide? (Rudd, 2006) What is your core belief? How do you feel about the act? spiritual and/or moral What is your personal experience, and how might past experiences you have had taint, inform and influence how you view this topic…

BE MINDFUL OF REACTIONS Fear Helplessness: “I can’t do anything to help” Hopelessness: “Nothing I do matters” Anxiety Over-protectiveness: Reduce autonomy Under-protectiveness: Casual avoidance Anger Lack of compassion: Inability to care Criticism: Blaming

YOUR REACTION Accept that we will have emotional reactions to the problems our Airmen bring to us Take some time to explore our beliefs about the issues we will commonly face Keep in mind that it is not our problem or perspective that matters, but the Airman’s Recognize that you do not have to agree with an Airman’s beliefs, perspectives, or behavior in order to help them

ATTITUDES & BELIEFS Avoiding or denying that the Airman has a problem Doing the bare minimum to help the Airman Over-reliance on one’s own opinions and experiences Defensiveness Believing the Airman is being manipulative Undervaluing or overvaluing helping agencies Managing your reactions to Airmen in distress What are your ATTITUDES and BELIEFS Here are some A & B that are unhelpfu, or might get in the way?l

GOAL CONFLICT 1st Sergeant Goals: 1. Keep Airman safe 2. Keep others safe 3. Mission effectiveness 4. Protect unit morale 5. Stay out of trouble Airman’s goals: 1. Reduce distress 2. Reduce pain 3. Alleviate suffering 4. Be understood 5. Stay out of trouble

APPROACH CONFLICT 1st Sergeant: Talk with others Increase healthy behaviors Access professional help Distressed Airman: Alleviate the pain Drinking Drugs Reckless behaviors Violence / aggression Suicidal ideation Approach to accomplishing the goal… Important to recognize, so you are prepared for the struggle. Not caught off guard.

Reconciling Differences Understand that the Airman engages in harmful behaviors because they “make sense” and they work Recognize the functional purpose of the behaviors View the Airman as individual with unique set of issues and circumstances Listen to the Airman’s “story” Part of the work of Reconciling these differences has to do with maintaining a COLLABORATIVE/NON-ADVERSARIAL STANCE (reserch to support this). Based off of the work of David A Jobes (authored Managing Suicide Risk) Emphasizes a CAMS approach which stands for: Collaborative Assessment and Management of Suicidality

"I got very angry when they kept asking me if I would do it again "I got very angry when they kept asking me if I would do it again. They were not interested in my feelings. Life is not such a matter-of-fact thing and, if I was honest, I could not say if I would do it again or not. What was clear to me was that I could not trust any of these doctors enough to really talk openly about myself."

Collaborative approach Managing risk vs “telling” the Airmen what is best for him/her. Airmen is the “expert” on his or her behavior Airmen feels safe discussing sensitive issues. Increase the Airmen’s openness for discussion Increase the patient’s help-seeking behaviors in the future Improve the effectiveness of the risk assessment 1st Sgt is the “coach” 1st Sgt can reinforce any help-seeking behaviors and/or any already existing coping resources Willing to do whatever it takes, however long, at whatever time Decreases the 1st Sgt’s emotions (i.e. lessen the unrealistic sense of responsibility) Can’t work harder than they are willing How you communicate matters… (Jobes, 2006) Create environment where Airman feels SAFE discussing…

HELPFUL APPROACHES LISTEN first before giving advice Ask directly about thoughts of suicide Take reports of suicidal ideation seriously Don’t be judgmental Don’t promise anything Express genuine caring and hope Don’t promise secrecy or what will or will not happen… Regarding Military career, impact, hospitalization, secrecy… ETC…

HELPFUL LANGUAGE I've noticed you're feeling upset. What's going on in your life? Are you thinking about suicide? What do you think might help? Where would you like to go for help? Why don't we make the call together? I'm not going to feel comfortable without being sure you're going to get some help. Accurate, Direct, & Precise: Enhances Communication w/ Providers Enhances Communication w/ Airmen Characteristics: Intent to die Evidence of self-infliction Outcome

Direct Communication HARD communication H Good Ex: “you look down” Bad Ex: avoidance A Good Ex: “Sometimes people are down” Bad Ex: “Airmen don’t kill themselves” R Good Ex: “Would it be ok if we talk” Bad Ex: “get in my office” D Good Ex: “Are you thinking about killing yourself” Bad Ex: “ambiguity”

REDUCING ANXIETY Be direct Notice hesitancy and body language “Are you thinking about suicide?” “Do you know how you might do it?” Notice hesitancy and body language “It looks like this is difficult to talk about.” Do not accept the first “no” Ask in slightly different ways Remain relaxed and unhurried “I know this can be tough, so take your time.”

Raising the issue… Make behavioral observations Express concern “I’ve noticed…” technique Express concern Avoid judgmental language Stick to the facts

NORMALIZE DISTRESS Normalize the Airman’s feelings through gradual sequencing of questions “When people are extremely upset, they often feel like things will never get any better. Do you feel that way?” “When people feel things will never get any better, they often think about death. Have you been thinking about death or not being around?” “When people think about death, then sometimes think about killing themselves. Have you had any thoughts about suicide?”

ATTENUATE SHAME Phrase questions so that positive response do not feel self-incriminating or accusatory “With all this going on, have you been drinking more often?” “You said you were opposed to suicide, but I’m wondering, with all this stress you’ve been experiencing, did you have some thoughts about suicide, even if only a little bit?”

WHAT ARE SOME SIGNS? Preoccupation with Death and Dying Drastic changes in behavior or personality Recent severe loss or threat of loss Unexpected preparations for death Giving away prized possessions Previous attempts Uncharacteristic impulsiveness Loss of interest in personal appearance Increased use or abuse of alcohol Sense of hopelessness about the future Morbid fascinations… (Music Choices, How room is decorated, clothing choices) Person just seems off, “Not themselves” Major Losses (reputation, loved one, relationship) Making out a will, giving stuff away History of self-injurious behavior, hx of attempts, statements recklessness, risk taking (Drunk and playing with a tomahawk…) Reckless driving, flagrant violation of rules (uncharacteristic) Poor hygiene, lack of military bearing Comments about bleak future…

SEEK HELP WHEN… Persistent stress interfering w/ daily life Difficulty coping Difficulty functioning Accumulating signs of distress Multiple risk factors Thoughts about suicide Encourage people to seek help if you notice…

ACCESS TO LETHAL MEANS Suicidal crises are short-term peaks in distress Among survivors of life-threatening attempts: 24% decided within 5 minutes preceding attempt 70% decided within 60 minutes preceding attempt Suicide rates by firearm: 57x higher in week following purchase 30x higher in month following purchase 7x higher in year following purchase Routinely ask about methods and access to means multiple times (Simon et al, 2001): IN VIEW OF RESEARCH ON ATTEMPT SURVIVORS: The crisis response plan is very strategic in that it is designed to cover a 60 minute period of time, because if we can move a person through the first 60 minutes of a strong suicidal mindset, we are ACTUALLY addressing close to 94% of the people who would have actually made an ATTEMPT! (Wintemute et al, 1999):

IMPORTANT TERMS Suicide Suicide Attempt with injury Suicide Attempt without injury Instrumental suicide-related behavior Suicide threat Suicidal ideation Morbid ideation Instrumental suicide-related behavior… RISKY BEHAVIORS MORBID IDEATIONS- MORE PASSIVE

Consult Your suspicions are substantiated Contact The Mental Health Clinic When to Contact Them DOCUMENT Your Interaction You feel as if you have adequate evidence to support your concern. Confirmed by Airman verbally, collateral information Your observation Warm hand off to Mental Health… AVAILABLE AT ANY POINT IN YOUR PROCESS OF MANAGING INITIAL CRISIS, but Clinical Risk Assessment of individual is officially conducted by a mental health provider… Documentation of your interactions, observations, concerns, is very important… (NEXT SLIDE)

Document Improve Continued Risk Assessment Improve Management Interventions Help Develop Long Term Treatment Plans Expedite the Transferring of Care Very Important Function in the Case of Morbidity/mortality Reviews Important in the case of CDE Important in the case of Admin Separation

MH RISK ASSESSMENT Suicide Status Informed Consent Commitment to Treatment Crisis Response Plan Suicide Tracking Stabilization Consent to treatment… CDE and exceptions to consent EMERGENT CDE G-Series Commander

Suicide Status Form: Filled out sitting next to the PT Suicide Status Form: Filled out sitting next to the PT. Coming along side them… Break Down of our risk assessment…

Item 1: Psychological Pain “Psych-ache”: unbearable suffering unique to the individual Suicide risk reduction occurs through 2 processes: Increasing tolerance for psychological pain Removing / ameliorating root of psychological pain

Item 2: Stress Largely external (sometimes internal) pressures or demands that psychologically affect the individual Relationship conflicts Job loss Command hallucinations Ruminations Intimately linked to overwhelming feelings

Item 3: Agitation State of being emotionally upset, disturbed, and disquieted Cognitive constriction Predisposition for self-harm Impulsive desire to do something to change or alter his or her unbearable state Psychological energy / driving force behind suicidal behaviors

Item 4: Hopelessness One’s expectation that a negative situation will not get better no matter what one does Intimately linked to future thinking Based largely on work of Aaron Beck

Item 5: Self-hate Suicide as escape from unacceptable perceptions of self Suicidal individuals are fundamentally preoccupied with their unhappiness 2 essential components of suicidal struggle (Baumeister, 1990): Need for escape Core importance of self

Item 6: Self-assessment Behavioral self-report of risk We have the tendency to overestimate suicide risk when compared to patient self-report (Joiner, Rudd, & Rajab, 1999)

CONFIDENTIALITY Harm to Self Harm to Others Abuse Child Spousal Elder UCMJ LPSP (Limited Privilege Suicide Prevention) 1st Sgt & Commander Profile Line of Duty Duty Impact/Restrictions Mobility Restrictions Informed Consent outlines expectations regarding the relatinship between the individual and the clinic, their protected health information, and what goes on in treatment. EXCEPTIONS TO Confidentiality… RELEASE OF INFORMATION: Normal procedure Continued interaction Treatment updates Setbacks Progress

Commitment to Treatment I, ________________, agree to make a commitment to the treatment process. I understand that this means that I have agreed to be actively involved in all aspects of treatment including: (1) attending sessions (or letting my therapist know when I can’t make it) (2) setting treatment goals with my therapist (3) voicing my opinions, thoughts, and feelings honestly and openly with my therapist (whether they are negative or positive, but most importantly my negative feelings) (4) being actively involved during sessions (5) completing homework assignments in between sessions (6) taking my medications as prescribed (7) trying new behaviors and new ways of doings things (8) implementing my crisis response plan when needed I also understand and acknowledge that, to a large degree, a successful treatment outcome depends on the amount of energy and effort I make. If I feel like treatment is not working, I agree to discuss it with my therapist and attempt to come to a shared understanding as to what the problems are, and to identify potential solutions together. In short, I agree to make a commitment to treatment, and to living. This agreement will apply for the next ____ months, at which time it will be reviewed with my therapist and modified as needed.

Crisis Response Plan When thinking about suicide, I agree to do the following; Use relaxation skills Go for a walk or play a video game Call a friend; (Earl; XXX-XXX-XXXX) REPEAT ALL OF THE ABOVE Call provider at Clinic X (Dr.; XXX-XXX-XXXX) If unavailable, call Clinic (XXX-XXX-XXXX) Call crisis hotline; 1800-273-TALK Go to the emergency department Call 911 PERCENTAGES: LIMIT ACCESS TO LETHAL WEAPONS…

TRACKING Levels: Stabilization Back to baseline Self-management Mastered and uses skills Utilization 1st Sgt’s Role What we are working towards. Monitored at varying levels of intensity until we see the following…

ROLE OF LEADERSHIP · Good leadership promotes suicide prevention · Build a supportive work environment · Know Your Airman · Know the warning signs · Know the helping resources · Ask the tough questions · Encourage help seeking behaviors · Stay involved until problem is resolved · Recognize when help is needed and get it · Apply Suicide Intervention Skills THE TOUGH QUESTIONS…(i.e., about life problems, distress, suicidal ideation, alcohol use, etc.)

ASK CARE ESCORT A - Ask your wingman Have the courage to ask the question, but stay calm Ask the question directly: "Are you thinking of killing yourself?" C - Care for your wingman Calmly control the situation, do not use force, be safe Actively listen to show understanding and produce relief Remove any means that could be used for self-injury E - Escort your wingman Never leave alone Escort to chain of command, behavioral health professional, Chaplain, or primary care provider Call the National Suicide Prevention Lifeline: 1-800-273-8255(TALK) I am sure you are all familiar with this… I throw it in to reinforce what you already know, for the other AIRMAN, who are additional sets of eyes and ears… Empower them and lead by example.

URGENT HELP Escort the person to the ER or the Mental Health Clinic Mental Health Clinic is on call 24/7 Notify your supervisor or call 911 for help Don’t leave the person alone Remove means of self harm Suicide Prevention Hotlines: 1-800-273-TALK or 1-800-SUICIDE 1-800-273-TALK can connect you to a counselor who understands military issues By law, only commanders can order Airmen to receive a mental health evaluation, and only when following appropriate procedures EMERGENT CDE Commander who can give G-Series ORDERS

Research Direction Current Research in the Maxwell Clinic  Guilt & Shame w/ Suicide Risk Aim of this Research study The proposed basic research attempt to advance our knowledge of the relationships between two specific cognitive/emotional processes, guilt and shame, with suicide risk. guilt and shame often considered to be important psychological contributors to suicide risk, very little research… AND Because guilt and shame are often associated with trauma, they could be particularly relevant among military populations, especially those with combat-related trauma. Shame involves negative attributions about one’s worth and goodness, while guilt involves feelings of sadness, and remorse over specific actions. In general, shame demonstrates a stronger relationship with depression than guilt (Kim et al., 2011), consistent with shame’s association with core identity. Because shame involves a sense of loss of one’s identity as a person of goodness, integrity, and virtue (Wilson, 2005), individuals experiencing shame may fear humiliation and reproach by others, and may feel unable to restore their value, integrity, and self-esteem. It has been suggested that this may lead to fantasizing about, or resorting to, suicide as a means of self-obliteration.

Tips for managing crises Understand your own triggers or hot buttons Be consistent in how you help Airmen Avoid coercion Encourage and model openness and honesty Recognize positive change might be slow Pay attention to positive changes (not just negative changes)

Tips for after the crisis Protect privacy Normalize stress reactions “Who wouldn’t feel this way?” Foster a culture of help-seeking “Who wouldn’t get help in this situation?” Maintain Airman’s level of responsibility Avoid stigmatization Provide support on group level Don’t single out Airmen in distress

Connecting Airmen to helping agencies

Be prepared Keep a list of helping agencies nearby Familiarize yourself with AF policy Discuss with leadership how problems and issues will be handled in the unit Be Wingmen – don’t let your Airmen go alone

Question If someone came to you with a problem, would you know the agencies and resources available to help them? All of us, and especially those of us who are supervisors, have a sacred responsibility to know how to match people’s needs with community resources. IDS and Community Sources of Support Each installation has an Integrated Delivery System (IDS) consisting of all the helping agencies on a base. As individual agencies and as a collaborative agency the IDS exists to assess and respond to community needs. Types of Help List those services (classes, support groups, workshops) available at your base: Financial counseling, employment assistance, couples classes/support groups (PREP Fighting for your Marriage), parenting classes/support groups (Boys Town Commonsense Parenting), respite care, Infant and Toddler University play groups, conflict resolution workshops, dealing with difficult people workshops, life skills workshops, depression management classes/support groups, anxiety management classes/support groups, etc. IDS Handout Ask your IDS to put together a handout that lists each of the services above, the POC, and their telephone number.

Helping Agencies Airman & Family Readiness Center: 953-2353 Transition Assistance, Employment Assistance, Volunteer Resources, Information & Referral, Financial Readiness, Relocation Assistance, Air Force Aid, Personal & Work Life, Family Readiness, Family Ser-vices Family Advocacy: 953-5055 Family Maltreatment assessment & intervention, Outreach & Prevention Programs, New Parent Support Program, Family Resource Library Sexual Assault Response Coordinator: 953-4416 24 hr assault report hotline 953-8676 Education, Awareness & Protection, Confidential Consultation, Victim Advocacy & Support

Helping Agencies Family Member Support Flight: 953-3524 Full time child care, School Age Program, Hourly Care, Part Time Enrichment, Give Parents A Break Chaplain Service: 953-2109 Counseling services for: Premarital/Marriage, Family/ Parenting, Religious Issues, Work Related Issues, and Grief Catholic/Protestant Worship & Religious Education Mental Health Clinic: 953-5430 Group Therapy, Individual Therapy, Marriage Counseling, Personal Problem Assistance, Command Consultation, Evaluations, Psychological Testing, Relaxation Program, Healthy Thinking, Substance Abuse Evaluation & Treatment, Special Needs Coordination (SNIAC) Health & Wellness Center (HAWC): 953-7117 Nutrition Assessment & Counseling, Weight, Cholesterol, Hypertension & Diabetes Management, Exercise Assessment, Body Composition Assessment, Tobacco Cessation, Relaxation Room, Wellness Library

Helping Agencies Educational & Developmental Intervention Services (EDIS): 953-4415 Early intervention services for children under three years of age who have developmental delays of certain medical conditions Behavioral Health Consultant: 953-5430 Behavioral Health appointments in primary care setting Military Family Life Consultant: 334-430-4409 Free confidential counseling, up to 4 appointments Military One Source: 1-800-342-9647 Free confidential counseling, up to 12 appointments

Final thoughts "Suicide, I have learned, is not a bizarre and incomprehensible act of self destruction. Rather, suicidal people use a particular logic, style of thinking that brings them to the conclusion that death is the only solution to their problems. This style can be readily seen, and there are steps we can take to stop suicide, if we know where to look". -- Edwin Shneidman

Final Thoughts