VA Suicide Prevention ProgramAssociation of Military Surgeons of the United States (AMSUS) Annual Meeting Presentations
November 29, 2018
DisclosuresPresenter has no interest to disclose.
AMSUS and ACE/PESG staff have no interest to disclose.
This continuing education activity is managed and accredited by Affinity CE/Professional Education Services Group (ACE/PESG) in cooperation with AMSUS. ACE/PESG, AMSUS, planning committee members and all accrediting organizations do not support or endorse any product or service mentioned in this activity.
2
Learning ObjectivesAt the conclusion of this activity, the participant will be able to:
1. Explain the most recent data surrounding suicide in the United States and suicide risk in the Veteran population.
2. Describe VA’s public health approach to suicide prevention and the important role communities play in preventing Veteran suicide.
3. Summarize the objectives, purpose, and recent updates regarding Executive Order 13822.
4. Explain VA’s suicide prevention resources and how they can be used to support Veterans.
3
CE/CME Credit
If you would like to receive continuing education credit for this activity, please visit:
http://amsus.cds.pesgce.com
Hurry,
CE Certificates will only be
available for 30 DAYS
after this event!
4
Agenda• Suicide in the United States
• The Public Health Approach
• Putting Strategy Into Action
• Executive Order 13822
• VA Suicide Prevention Resources
5
Suicide in the United States
6
Issue Overview:
Suicide• National Public Health Problem (cdc.org)
• 10th-leading cause of death (~twice as many suicides as homicides)
• ~45,000 deaths per year (up almost 30% since 1999)
• Costs $69 billion annually
• Veteran and Service member issue
• Veteran Populations at risk• Younger Veterans
• Women Veterans
• In a period of transition
• With exposure to suicide
• With access to lethal means
• Other than Honorable Discharges (“Bad Paper”)
7
VA Suicide Data Report: September 2018 Release• National Suicide Data Report
• Reports on trends in Veteran Suicide Deaths from 2005 – 2016
• Focuses on suicide counts and rates among various populations
• State Data Sheets
• Examined state level Veteran suicide deaths and compared to national and regional trends
• Available for all 50 states, D.C., and Puerto Rico
8
Access the reports online:https://go.usa.gov/xnMDE
Important Figures
9
Veteran Population
10
Veteran Population
11
Veteran Suicide Deaths: Count vs. Rate
Older Veteran population accounts for the bulk of suicide deaths due to
population size.
Younger Veteran population includes more recently transitioned Veterans
and has a higher rate of suicide.
12
Veteran Suicide Deaths in 2016
Data Should Drive Efforts to Prevent Suicide
13
58.1%of Veteran suicides were among
Veterans age 55 and older
69.4%of Veteran suicides resulted
from a firearm injury
The Veteran Suicide Rate and Count Increased from 2005 to 2016
14
Veterans Recently Using VHA Services Had Higher Rates of Suicide than Veterans Who Did Not Use VHA Care
15
VHA and Non-VHA Veteran Suicide Rates, 2005–2016
Veteran Suicide Rates by Age Group, 2005–2016
16
Rates of Suicide Have Increased Substantially Among Younger Veterans
10
Non-Federally Activated Former National Guard or Reserve Suicide Deaths, 2005-2016
Suicides increased for both former Guard and Reserve from 2005-2016.
0
100
200
300
400
500
600
700
2005 2007 2009 2011 2013 2015
Suic
ide
Co
un
ts
Year
National Guard Reserve
Veteran and Non-Veteran Deaths by Suicide, 2005-2016
0
5
10
15
20
25
30
35
40
45
Total Male Female
20
16
Su
icid
e R
ate
per
10
0,0
00
Veteran Non-Veteran
18
Death by suicide is more frequent among Veterans as compared to non-Veterans.
Veteran and Non-Veteran Adults Unadjusted and Age-and Gender-Adjusted Suicide Rates, 2005-2016
19
• Suicide rates for Veteran and non-Veteran adults increased from 2005-2016.• In 2016, the suicide rate was 1.5 times greater for Veterans than for non-
Veteran adults, after adjusting for age and gender.
Risk• Prior suicide attempt
• Mental health issues
• Substance abuse
• Access to lethal means
• Sense of burdensomeness
• Recent loss
• Legal or financial challenges
• Relationship issues
Protective• Access to mental health care
• Sense of connectedness
• Problem-solving skills
• Sense of spirituality
• Mission or purpose
• Physical health
• Social and emotional well-being
20
Risk and Protective Factors
Goal: Minimize risk factors and boost protective factors
50% of Veterans Do Not Use VA Benefits or Healthcare
21
Veterans whouse at least one VA benefit or healthcare service.
Of this group, about 6 million Veterans use VA health care (about 30 percent of all Veterans).
Veterans whodo not useVA benefits or healthcare.
9.7million10.2
million
The Public Health Approach
22
VA Suicide Prevention Strategy
Public Health Approach to Suicide Prevention• The public health approach
seeks to answer the foundational questions:
• Where does the problem begin?
• How could we prevent it from occurring in the first place?
• To answer these questions, public health uses a systematic, scientific method for understanding and preventing violence.
23
Suicide Prevention is Everyone’s Business
24
National Academy of Medicine (NAM) Classification
25
Prevention Levels and Example Efforts
Universal • Critical partnerships
established
• National Sports Shooting Foundation (NSSF) partnership
• Johnson & Johnson PSA
• #BeThere campaign
Selective• Mental Health hiring initiative
• Lethal means safety training
• Mental health care for Other Than Honorable discharged Veterans
• Executive Order to expand Veteran eligibility for mental health care
• DoD/VA transition MOA
• SAMSHA Mayor’s Challenge
• Telemental health
• Treatment engagement
• Open innovation safe gun storage challenge
• VCL info printed on VA canteen receipts
Indicated• REACH VET
• Discharge planning and follow-up enhancements
• Expansion of Veterans Crisis Line (VCL)
• VCL services
• S.A.V.E. training
• Postvention: follow-up care for family members and friends of someone who has died by suicide
Public Health Approach to Suicide Prevention
26
Putting Strategy Into Action
27
VA Suicide Prevention Strategy
National Strategy for Preventing Veteran SuicideGoal: Provide a framework for identifying priorities, organizing efforts, and contributing to a national focus on Veteran suicide prevention over the next decade.
• Aligns with the 2012 National Strategy for Suicide Prevention.
• Consists of 4 strategic directions, 14 goals, and 43 objectives.
• Leverages the public health approach to suicide prevention.
• Focuses on the importance of collaboration and urgency.
28
Download a copy at:Mentalhealth.va.gov/suicide_prevention
Leveraging the Public Health Approach
29
Our Implementation Model
30
Implementing Strategic DirectionsHealthy and Empowered Veterans, Families, and CommunitiesWork with community partners and policymakers to promote resources for Veterans and to promote mental health awareness and treatment.
Clinical and Community Preventive ServicesShare resources, training opportunities, interventions, and lethal means safety resources with providers outside VA and with clergy, first responders, law enforcement officials, and community partners.
Treatment, Recovery, and Support Services Work with local emergency departments and hospitals to promote Veteran suicide prevention resources and to ensure continuity of care for all Veterans admitted to an inpatient mental health unit.
Surveillance, Research, and EvaluationShare the VA National Suicide Data Report and National Strategy for Preventing Veteran Suicide with community partners.
31
A Call to Action
32
Executive Order: Supporting Our Veterans During Their Transition from Uniformed Service to Civilian Life
33
Executive Order and Joint Action Plan• Executive Order 13822: “Supporting Our Veterans During Their
Transition From Uniformed Service to Civilian Life”• Instructs VA, DoD, and DHS to work together to ensure newly separated
Veterans receive one year of mental health care from VA after discharge.
• The goal is to support new Veterans in making a successful transition to a fulfilling civilian life and to have access to any needed mental health care during the critical first year period following separation from active duty.
• Joint Action Plan Goals:• Ensure ALL transitioning Service members are aware of and have access to
mental health services.
• Ensure the needs of at-risk Veterans are identified and met.
• Improve mental health and suicide prevention services for individuals that have been identified (indicated populations) in need of care.
34
Risk and Protective Factors during Transition Time• Belongingness
• Thwarted belongingness was the risk factor communicated most by suicide decedents in a study of death investigation files for active duty U.S. Air Force (USAF) members.
• Social Support• In a study of active duty Air Force Security Forces personnel, esteem
support (feeling respected, encouraged, and valued) was associated with significantly less severe suicidal ideation.
• Unit Cohesion• In a study of redeployed Army soldiers, unit cohesion was a significant
protective factor. Soldiers with greater combat exposure but higher levels of unit cohesion had relatively lower levels of suicide-related ideation.
• In addition, those who had higher levels of combat exposure and lower unit cohesion were most at risk for suicide-related ideation.
35
36
• Outreach• Early and Consistent Contact (1.1), Messaging Campaign (1.4), Warm Hand-
offs for Peer Support (2.1), Peer Support Outreach (2.5), Peer Specialist Community Outreach Pilot (Clay Hunt; 2.6), Expand Military OneSource (3.3)
• Transition• Pre-transition VA Health Care Registration (1.2), Modification of Transition
Assistance Program (TAP; 1.3), Increased VSO Engagement Pre-Transition (1.5), Readiness Standards (2.3)
• Monitoring• Screening and Identification (2.2), Predictive Analytics (2.7), Improved
Monitoring (3.2)
• Access• Whole Health Peer Groups (2.4), Easy Button (3.1), Build and Expand
Partnership Models (3.4)
Buckets of Effort
36
VA Suicide Prevention Resources
37
Free, Confidential Support 24/7/365
• Veterans
• Service members
• Family members
• Friends
38
Veterans and Military Crisis Line
39
S.A.V.E Training
40
Available online for free: psycharmor.org/courses/s-a-v-e/
• Suicide prevention training video that’s available to everyone, 24/7
• Less than 25 minutes long
• Offered in collaboration with the PsychArmor Institute
Suicide Risk Management Consultation Program
41
42
Public Health Video
43
Questions?
44
Thank you.
Stay Connected
45
Follow us on social media!
U.S. Department of Veterans Affairs
Veterans Health Administration
Make the Connection
@deptvetaffairs
@veteransmtc
@deptvetaffairs
@veteranshealth
46
Back-Up Slides
Make the ConnectionOnline resource featuring hundreds of Veterans telling their stories about overcoming mental health challenges.
47
https://maketheconnection.net/conditions/suicide
Coaching into CareProgram for families and loved ones of Veterans, helping them encourage the Veteran in their lives to seek support.
48
#BeThere Prevention Initiative
49
https://www.youtube.com/watch?time_continue=60&v=MCSZ7FjTq5I
We All Have a Role to Play
bethereforveterans.com
50
#BeThere for Veterans PSA: