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Captain Kurt Scott, USN
Director, Behavioral Health Programs
25 September 2012
NAVY BEHAVIORAL HEALTH
20 Sep 2012 Source: OPNAV N135
SUICIDES SNAPSHOT
NOTE: Data for SELRES not on AD in parentheses All other data reflect AC + RC on AD
Average of 4.8 suicides per month on AD last 12 months
44 40 37 38 40 39 46
39 52 48
7 9
6 6 3 9 6
4
7 3
0
5
10
15
20
25
0
10
20
30
40
50
60
70
80
90
100
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Raa
tes
pe
r 1
00
K
Nu
mb
er o
f D
eat
hs
Navy Suicides
AC (incl RC on AD) RC Navy Suicide Rate Civilian Crude Rate
FACTORS SEEN IN NAVY SUICIDES
4
Distorted Thinking + Lethal Action
Stressors
Disrupted Social Network
Judgment Factors
Access to Lethal Means
Compressed Intervention
Window
Relationship problem >60%
Work-related problems 27-50%
Discipline/legal action 21-39%
Physical health problems 10-35%
Financial problems 16%
• Relationship breakups
• Transitions (pending separation / PCS)
• First 6 months after deployment
• Anger - argument or confrontation within 24 hours of death
• Alcohol – about 1/3 likely used alcohol near the time of death
• Sleep Deprivation - sleep problems linked to suicide
• >80% suicides on liberty or leave
(only 4% on deployment)
• About half of suicides deaths used firearms
• About half of non-fatal attempts used drug ingestion (>60% did not have firearms around)
• From case reviews - there can be a short time between suicide thoughts and action
• Overt warning signs may not be shown or are seen too late to intervene
• A family member or significant other were most likely to know the Sailor was having problems or was suicidal
• Almost 2/3 of non fatal attempters had not planned in advance to attempt suicide – they just acted on a thought.
• Feeling ineffective, burdensome, not belonging
• Acquired capacity to inflict lethal harm
• About 1/5 had treatment or counseling ongoing or historic
• Suicide Exposure via family or recent workplace:
• 10%Death of significant other: 9%
History
Reference DODSER and case review by OPNAV N135
NAVY SUICIDE PREVENTION APPROACH
Fostering Resilience
Vigilance
&
Early Intervention
Crisis Response
Post-
Vention
Warning Signs
Suicide Behaviors
Comprehensive Prevention and Family Support
Address Risk Factors •Depression/Anxiety •Sleep Disturbance •Health Problems
Coordinated Response •Coordinated Assessment of Suicide Risk, Treatment, and Follow-up
Reporting •DoDSER for Suicide Attempts
Operational Stress Control-Life Skills-Strengthen Families-Awareness
Referrals & Counseling
Reporting-Survivor Assistance-ACT
Risk Factors
Build Resilience
Navigate Stress
Bystander Intervention
Reduce Barriers to
Seeking Help
6
STRESS CONTINUUM
• Conduct and integrate suicide risk assessments into routine office visits
• Reinforce skills and confidence in working with individuals at risk for suicide
• Recognize co-occurring physical and mental health issues that impact suicide risk
• Manage at-risk individuals through changes in practice patterns
• Work collaboratively with patients to create treatment plans based on level of risk
• Identify the elements to be included in documentation of assessments, treatment plans, and communications to the Commanding Officer
6
SUICIDE PREVENTION PROGRAM COMMUNICATIONS
Program communications
facilitate the Public Health
Approach to suicide
prevention
– Integrate Health Communication theory into message development and dissemination
PERCEIVED BURDENSOMENESS
FAILED BELONGINGNESS
HABITUATION (ACQUIRED
CAPACITY FOR SUICIDE)
PERSON MAY DESIRE DEATH
RISK FOR SUICIDE ATTEMPT
THOMAS JOINER’S THEORETICAL MODEL OF
SUICIDE
NAVY SUICIDE PREVENTION AWARENESS MONTH
• Sustainable ways to effectively navigate stress year-round while continuing to instill awareness on suicide warning signs/resources
• Includes communications products that aim to facilitate meaningful and responsible discussion of suicide/seeking-help – What’s in a Word? How we Talk About
Suicide • One version for PA/media, one for general
audience
– Stress Navigation Plans • Template for self identification of practices for
navigating stress while in an emotionally healthy state
SUICIDE PREVENTION AWARENESS RESOURCES
SUICIDE PREVENTION AWARENESS CAMPAIGNS
It’s Okay to Speak Up When You’re Down Campaign aimed at reducing social barriers to help-seeking behavior (stigma)
Cartoon produced by Mike Jones (“Ricky’s Tour”) for Suicide Prevention Awareness Month,
illustrating the message while integrating concepts of bystander intervention and identifying resources
11
STRATEGIC FOCUS – NAVY SUICIDE PREVENTION
FOCUS
Sailors reporting more work stress and performance impact
RESPONSE
Operational Stress Control, Personal and Family Readiness, and Health Promotion Programs
FOCUS
Strong relationships and communities are key protectors
RESPONSE
Family outreach, community education, leadership skills, prevention network
FOCUS
Provider and responder competence for suicide risk cases varies
RESPONSE
AMSR Provider Training, Command Response Plans, and Emergency First Responder Training, policy
update
FOCUS
Expand the aperture to Total Force & the whole continuum of care
RESPONSE
All hands on deck, expand tools for civilians, post-vention tools, reintegration
FOCUS
Reduce Stigma and other barriers to care
RESPONSE
Policies, education, communication
Build Resilience
Strengthen Connections
Target Skills
All Hands
All of the Time
Reduce Barriers
Lives Worth Living