Suicide Prevention with Veterans, Military and Family · • Effect of military ethos, values, and experience on suicide ideation • Risk factors and specific warning signs • Military

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Always ready. Always there. 1

Suicide Prevention with Veterans, Military and Family



Objectives

• Effect of military ethos, values, and experience on suicide ideation

• Risk factors and specific warning signs• Military specific protective factors for

resilience and prevention• Resources to assist Veterans, Military

Members and Family



American Values and Beliefs:FreedomEquality

DemocracyChampion of the little guy

Helper of the oppressedDefender against tyranny

Beliefs about Military Service:DisciplineTeamworkLoyaltyA higher callingSelf sacrificeFighting spirit

Hidden: Ethos, Warrior Values and Beliefs

Salute



Deployment Challenges

National Public Radio

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Adaptive Behaviors while Deployed

• Hyper Vigilance• Scanning, Planning, Target,

Surveillance-Constant situational awareness

• Debriefing• Getting little sleep.• Recalling events repeatedly.• Emotional numbing.• Isolation from family

Symptoms of PTSD

• Recalling Events, nightmares• Loss of interest in activities and

life in general• Feeling detached from others and

emotionally numb• Difficulty falling or staying asleep• Difficulty concentrating• Hypervigilance (on constant “red

alert”)• Feeling jumpy and easily startled

Veteran Wiring



• While deployed and facing high stress situations, military members may form adaptive behaviors to help cope with the high stress situations/traumatic events.

• These adaptive behaviors may become maladaptive once the military member is back home.

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Veteran Wiring



Military Culture• Collectivistic• Interdependent/Self-Sacrifice• Fulfill Role within Group• Group Achievement• Hierarchical Decision Making• Maintain Tradition• Pain: Increased Tolerance• Emotional Suppression• Unique and Separate• Locus of Control: External• Model: Strength Based• Shame and Guilt due to Failing Group

Behavioral Health Culture• Pursue Individual Goal/Interests• Individual Achievement• Self-Determination and Individual

Choice• Progress and Change• Pain: Reduction• Emotional Expression• Common and Ordinary• Locus of Control: Internal• Model: Pathology• Shame and Guilt due to Individual

Failure

Photo by Chris Talbot [CC BY-SA 2.0 (http://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons

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Culture Clash – Bridging the Gap



22 Veterans a day

• This figure comes from 2012 VA study with 21 states data from 2009-2011

• Different study showed SMs discharged 2001-2007 showed 1 per day and mostly within the first three years post discharge



Barriers to help seeking

Anonymous Survey of OHARNG Soldiers• 17% identified known need for MH services• 63% of those were not accessing MH

services• 42% of those sought services from private

sector providers



• From 2015 to 2016, the Veteran specific suicide count decreased from 6,281 to 6,079 deaths (decrease of 202).

• From 2015 to 2016, the Veteran unadjusted suicide rate decreased from 30.5/100,000 to 30.1/100,000.

• Overall, the fact remains that on average about 20 current or former service members die each day, six have been in VA health care and 14 were not.

• Rates of suicide were highest among younger Veterans (ages 18-34) and lowest among older Veterans (ages 55 and older). However, because the older Veteran population is the largest, this group accounted for 58.1 percent of Veteran suicide deaths in 2016.

• The rate of suicide among 18-34-year-old Veterans continues to increase.



0

5

10

15

20

25

30

35

40

US Civilians All Veterans CivilianMales

VeteranMales

CivilianFemales

VeteranFemales

per 1

00,0

00Suicide Rates 2001-2014



23.0%

32.2%

0.3%

30.5%

39.7%

85.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

USCivilians

AllVeterans

CivilianMales

VeteranMales

CivilianFemales

VeteranFemales

Increases in Rates 2001-2014



ARNG Trend per 100k Suicides : 2013 - 2017



ARNG Suicides : 2013 - 2017

Information Current as of 29 March 2017

LA 22 MI 2MN 21 DE 1PA 21 VT 1IN 20 ME 1

MO 19 WY 1TX 17 AK 1OH 17 NH 1WA 14 PR 0CA 14 RI 0OR 13 GU 0

2013-2017 Cumulative SuicidesTop 10 Bottom 10

Suicides CY17Total 29

Equivocal Deaths 3

Slide 1

This is the information that is needed for Slide Number 1 on the Power Point Presentation. CY16CY15Total

Equivocal000

STEP 1: When you get an SIR from the ARNG Watch you can go ahead and update your Slides. I would recommend updating your information on the Excel Spreadsheet Prior to go into the Power Point Presentation.

Using the Table below, update "Pending" by clicking on cell C22 and increasing the number of suicides that you have received.

For example; if you receive one suicide SIR from the Watch, you would type 38 in the cell C22. This will increase your 6 year total and the total number of suicides for the year.

CY16CY15CY14CY13CY12CY116 Year



National and Local trend per 100k Suicides : 2017

• OHARNG 43 per 100k• NGB 25.4 per 100k, ARNG 30 per 100k• Highest State Rate Montana 23.8 per 100k• National General Public 13.26 per 100k• Ohio General Public 12.5 per 100k• Air National Guard National 10.4 per 100k• Men 45+ overall 30 per 100k



Death by suicide rates in OHNG are significantly higher than the general population and have drastically increased in the last several years.

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26

43

Gen population per 100,000 ONG per 100,000 since 2000 ONG per 100,000 since 2016

Chart Title



Nationally, rates are highest for white males age 45-64, then 85 and older. OHNG has few SMs that age and experiences death much younger

24

14

8

4

15-24 25-34 35-44 45+

Suicides by age group



Reasons for Suicide

• a sense of not belonging, of being alone, • a sense of not contributing, of being a burden • a capability for suicide, not being afraid to die



• In addition to having a higher probability of being exposed to Traumatic events, military culture can be quite different than the civilian world.

• In the military there is: • Lack of Control Over: Location, body, clothes, etc..• Constant changes in regulations, expectations, and position

security • Warrior Ethos

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Veteran Risk



• OHNG or Active Cannot just transfer or quit• Violence is a fact of life• Confidentiality is non existent• Frequent reintegration • Veterans make up 13% of population, small peer support

group

Military Risk, cont.



OHARNG 15-6 Investigations

• Warrior ethos to be strong, not ask for help• Financial struggles• Physical medical issues• Relationships ending were frequent trigger• Peers knew they drank too much• 80% of OHARNG suicide deaths are known to have

involved substance abuse• Family or friends all knew of some symptoms, few

knew all of them• Disconnect so they don’t communicate to Command• None of the last 10 deaths by suicide were currently

involved with MED DET case management



Lethal Means

Among survivors of near fatal suicides, when asked about time from their decision to complete suicide and the attempt:

● 24% said less than 5 minutes● 47% more said an hour or less

Firearm72%

Suffocation16%

Overdose6%

Other6%

METHODS OHIO 2000- 2017



Protective Factors

• Resiliency training since 2009• ACE since 2010• AoD Prevention• Suicide Prevention• Annual screening (PHA)• Military OneSource supports• VA programs/TriCare

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• In an ongoing study conducted by Case Western, University of Toledo and Boston University, the Rate of PTSD among soldiers who have deployed with the OHARNG (3%) is just barely lower than general population (3.5%).

• In participants, the prevalence of civilian related trauma events is higher than deployment related trauma events

• Community related events more likely to trigger onset of new alcohol abuse episodes than deployment events. (Assaults, robberies, sexual assaults, accidents, natural disasters)

• Currently 1% identified with symptoms significant enough to interfere with duties.

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Ohio Mental Health Initiative



• The Mental Health Initiative has shown that soldiers were actually well equipped to handle and cope with the stresses of deployment.

• Ohio Mental health initiative study revealed that training and preparation helps insulate service members from many long-term negative symptom response

• Higher levels of training, Unit support and post deployment support were factors that combined to lower the odds of developing PTSD.

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OHMHI, cont.



• For Service Members that had deployed, the support they receive when they return is the strongest factor affecting positive adjustment back to civilian life.

• Only combinations of Unit cohesiveness and preparedness that also includes strong community supports were effective as protecting against PTSD

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OHMHI, cont.



Resources

• VA eligibility and use• County Veteran Service Offices• Vet Centers• FRWS• ISFAC/RISFAC• OhioCares• Veteran organizations• Mental Health First Aid

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Summary

• GP suicide is the tenth leading cause of death in the US (more common than homicide) and the second leading cause of death for ages 15-34.

• Genetic predispositions can run in families (depression, substance abuse, schizophrenia, etc) Six times more likely to die by suicide if a family member died by suicide.

• 90% of those who die by suicide suffered from depressive symptoms, often present for many years,

• Immediate triggers then overwhelm limited coping strategies (financial stressors, relationship loss, intoxication, impulsivity).



Discussion

Suicide Prevention with Veterans, Military and FamilyObjectivesSlide Number 3Deployment ChallengesSlide Number 5Slide Number 6Culture Clash – Bridging the GapSlide Number 8Barriers to help seekingSlide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14Slide Number 15Death by suicide rates in OHNG are significantly higher than the general population and have drastically increased in the last several years.Nationally, rates are highest for white males age 45-64, then 85 and older. OHNG has few SMs that age and experiences death much youngerReasons for SuicideSlide Number 19Slide Number 20OHARNG 15-6 InvestigationsLethal MeansProtective FactorsSlide Number 24Slide Number 25Slide Number 26ResourcesSummarySlide Number 29

Documents

Suicide Prevention with Veterans, Military and Family · • Effect of military ethos, values, and experience on suicide ideation • Risk factors and specific warning signs • Military