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Headquarters U.S. Air Force

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Squadron Commander’s Suicide Prevention Education

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Introduction

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USAF Suicide Awareness Policy and Guidance

AFI 44-154, Suicide and Violence Awareness Education and Training directs (under revision) Annual community awareness education

requirements Leader awareness education and training

(Squadron Commander Courses and other PME) Tracking of training completion Suicide Event Surveillance System

Suicide Awareness Community Education Program Curriculum Guide

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USAF Suicide Prevention Program and Associated Policy

AFPAM 44-160 The Air Force Suicide Prevention Program (Apr 01)

AFI 44-109 Mental Health, Confidentiality, and Military Law (Mar 00)

AFI 44-153, Critical Incident Stress Management (Jul 99)

AFI 90-500, Community Action Information Board (CAIB) (Unpublished)

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General Background Information

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Community Approach

Applying Public Health Model to Suicide

Define the Problem

Identify “Causes” andProtective Factors

Develop and TestInterventions

Implement Interventions

Evaluate Impact andModify Interventions

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Goals

Reduce adverse outcomes Increase function and improve the health-

related quality of life Prolong healthy life

DiseaseAverage HealthPerfect Health

Decrease - Risk Factors - IncreaseIncrease - Protective Factors - Decrease

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Strategies

Modify community norms Establish and enforce policies Establish incentives for change Enhance knowledge and skills Monitor impact and adjust strategies

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Implementing Intervention

Define intervention objectives Utilize multiple strategies Change underlying community norms

Key to widespread and long-term health Incorporate target population(s) in

intervention development

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Identifying the Problem

Factors directly or indirectly associated with suicide: Risk factors that increase the probability of

suicide are: Severe, prolonged, or unmanageable stress Major life transitions (relationship problems) Alcohol abuse Legal problems Others

Protective factors that decrease the probability of suicide are: Optimistic outlook Sense of belonging to a group and/or organization Others

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Examples of Modifiable andNon-Modifiable Factors

PROTECTIVE FACTORS

Modifiable Non-modifiable

Physical ActivityHealthy Intimate RelationshipsSocial SupportsWillingness to Seek Help Well-Developed Coping Skills

Female

RISK FACTORS

Modifiable Non-modifiable

Alcohol MisuseDepression or Other Mental IllnessTobacco UseFinancial ProblemsEasy Access to a FirearmPoor Impulse ControlSocial Isolation

MaleFamily History/Personal HistoryAge

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Balance

Risk Factors

Vulnerabilities

Problems Develop

Decreased ProbabilityOf Suicide

Increased ProbabilityOf Suicide

ProtectiveFactors

Strengths AndCompetencies

“Resilience”

Protective FactorsKeep

Risk Factors In Balance

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The Air Force Community

“We have a responsibility to our active duty members and their families to provide a safety net of support services that ensures a healthy and fit force and assistance to those in need. This is the foundation underlying the Air Force Suicide Prevention Program. Now more than ever, we need to remind ourselves that our Air Force is only as strong as those who serve.”

General John Jumper

Air Force Chief of Staff

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Squadron Commander’s Suicide Education

Program

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Identify actions and attitudes that encourage others to seek help

Identify advantages and consequences of seeking help

Unit 1

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Unit 1: Actions and Attitudes that Encourage Others to Seek Help

Self-Referral Best option Individual maintains control Increased motivation for change Focus on resolving the problem

AFI 44-109, Mental Health, Confidentiality, and Military Law Air Force policy to encourage seeking help Commander/supervisor should encourage

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Unit 1: Referrals

Commander-Directed Evaluation (AFI 44-109) Only commander directs Commander consults with SJA to review the facts and

the law Commander consults with mental health Mental Health provider determines appropriateness

Evaluates member’s mental health status, fitness for duty, and suitability for service

Rights of command referred airman Legal counsel/IG; congressional etc. Protected from reprisal Not a tool for punishment Two duty days written notice (except in emergencies)

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Unit 1: Advantages and Consequences of Seeking Help

48%

94%

0%10%20%30%40%50%60%70%80%90%

100%

Self-Referral Other Referral

ConfidentialityMaintained

ConfidentialityMaintained

Type of Referral to Mental Health and Whether Confidentiality was Maintained

Reference: Demographic, Clinical, and Military Factors Related to Military Mental Health Referral Patterns, Capt. Rowan, USAF BSC, Military Medicine Vol. 16, June 1996, page 324. Note: This study examined 693 cases of active duty members from all service branches seen in an Air Force outpatient mental health clinic over a 3-year period, 74% Air Force, 18% Army, 9% Navy and Marines.

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Unit 2

Understand the Limits of Confidentiality

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Unit 2: Confidentiality

AFI 44-109, Mental Health, Confidentiality, and Military Law Psychotherapist-Patient Confidentiality

Communications between a patient and psychotherapist are confidential and shall be protected from unauthorized disclosure

Confidential communications will be disclosed to persons or agencies with a proper and legitimate need

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AFI 44-109, Mental Health, Confidentiality, and Military Law Objective is to identify and treat those who

pose a genuine risk of suicide because of impending disciplinary action under the UCMJ Eligibility Initiation Duration Limited Protection Disclosing Case File Information

Unit 2: Limited Privilege Suicide Prevention Program (LPSP)

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Unit 3

Know the source for Air Force suicide demographic and epidemiological data

Be familiar with Air Force suicide demographic and epidemiological information

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Unit 3: Source for AF Suicide Data

Suicide Event Surveillance System (SESS) (under revision) Central surveillance database for fatal and

nonfatal self-injuries OPR: AFIERA/RSRH

2513 KENNEDY CIRCLE

BROOKS AFB, TX 78235-5123

DSN: 240-3471

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Unit 3: Information on Air Force Suicides, CY 2000

Of the 350,000 ADAF there were 128 deaths Thirty were due to suicide Suicide is the second leading manner of death

Second to unintentional injury Suicide rate was 8.7/100,000

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Unit 3: More Facts About ADAF Suicides For CY 2000

Males have a suicide rate that is twice that of females

Individuals separated, divorced or widowed are significantly more likely to commit suicide

No statistical difference in suicide rates among: Rank groups Age groups

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Unit 4

Know how to identify someone who may be at very high risk for suicide

Know how to implement policies and procedures that are necessary to use for getting immediate help when someone is at very high risk for suicide

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Current suicide ideation Detailed plan Lethal means Easy access to lethal means Intent to act on plan Consider evidence of risk to others

Unit 4: Warning Signs forVery High-Risk Individuals

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Unit 4: Very High RiskWhat to Do

Consult the Life Skills Support Center provider (mental health provider)

Do not leave them unattended Have member transported and evaluated in

emergency room or acute care clinic immediately

KEEP THEM SAFE!

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Unit 5

Understand the role and functions of the Integrated Delivery System (IDS) and identify resources and sources of information available within the IDS

Know what the Critical Incident Stress Management policies are and how to obtain this assistance

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Unit 5: Role and Functions of the Integrated Delivery System

FamilySupport

UniqueMission

FamilyAdvocacy

UniqueMission

HAWC

UniqueMission

Life Skills (Mental Health)

UniqueMission

Child and Youth

UniqueMission

Chaplains

UniqueMission

Integrated Delivery System for Preventive Services

AFI 90-500 (Unpublished)

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Unit 5: Critical Incident Stress Management

AFI 44-153 establishes a multidisciplinary Critical Incident Stress Team (CIST) at each base

It is intended for people experiencing NORMAL stress associated with potentially traumatic events

In the event of a critical incident local command post notifies CISTs team chief

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Final Thoughts

Despite everyone’s best efforts, someone may still take their life

“In a sense, no one deserves to be blamed for something that cannot ultimately be controlled –

the volition and act of another autonomous human being”

David A. Jobes, et al, Comprehensive Textbook of Suicidology

Our goal is to do all we can to encourage the choice to live

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A healthy and fit forceincreases resiliency toovercome adversity