1. Brookhaven Hospital Seminar May 2, Suicide Prevention: Clinical Tools and Resources in the US Department of Veterans Affairs
Juli McNeil, MSSW, LCSW
Program Manager, Suicide Prevention
Jack C. Montgomery VA Medical Center

2. 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

3. Initiation -Suicide Prevention Program
2007 Joshua Omvig Veterans Suicide Prevention Act

4. 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: (1st highest)

5. Jack C. Montgomery VAMC (Tulsa, Vinita, Hartshorne Clinics) Suicide Prevention Team
Juli McNeil, LCSW
Program Manager, Suicide Prevention
/4144
Tina Bevans, LCSW
Tulsa VA Clinics (41st and 11th)
Suicide Prevention Coordinator

6. Suicide Prevention Team Cont’d
Alexa Youngblood, LCSW
Suicide Prevention Case Manager
Tawnya Wilson
Suicide Prevention Program &
SUD Intensive Outpatient Program
Administrative Assistant
/3439

7. Oklahoma is 12th in the Nation.
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 year olds
Suicide is the 3rd leading cause of death among 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.

8. 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 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.

9. VA Screenings and Suicide Risk Assessments
VA Clinical Reminders: Screening for Depression, PTSD, Alcohol, etc.
Suicide Risk Assessments
Completed on those who present with risk factors (depression, anxiety, etc.)
Initial MH Visit
During Inpatient Psychiatric Stay
Treatment Plan Updates
During times of significant changes/stress/crisis

10. 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

11. 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

12. PROTECTIVE FACTORS Positive social support (#1)
History of adaptive coping skills
Participating in treatment and/or good relationship w/their provider.
Veteran acknowledges hopefulness
Religious/Spirituals beliefs
Life satisfaction (e.g., rating 1 to 10)
Fear of suicide or death
Family or friends that act as barrier to self-harm

13. 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

14. Other Theory/Interventions
T. Joiner’s Interpersonal-Psychological Theory:
3 variables must be present for one to die by suicide
Sense of thwarted belongingness (lacks meaningful connections to others, previous rel, strained or lost
Perceived burdensomeness (burden to others, fails to make meaningful contributions, liability-These two together produce the desire
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

15. Interventions Caring letters
Collaborative Assessment & Mgmt of Suicidality (CAMS)-David Jobes
DBT-M. Linehan
CBT
Safe Vet
Addressing Suicide vs. Diagnosis, VISN 19 MIRECC

16. 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):
Suicide prevention programs
Suicide prevention research
Suicide prevention education

17. 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

18. Resources www.mirecc.va.gov/visn19 www.suicidology.org
Refer to VA Resource Guide
PTSD COACH APP
SAFETY PLAN APP, COMING SOON

19. (918)
Questions…