JULI MCNEIL, MSSW, LCSWPROGRAM MANAGER, SUICIDE PREVENTIONJACK C. MONTGOMERY VA MEDICAL CENTER

Brookhaven Hospital Seminar May 2, 2012

Suicide Prevention: Clinical Tools and Resources in the US Department of Veterans Affairs

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

Initiation -Suicide Prevention Program

2007 Joshua Omvig Veterans Suicide Prevention Act

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: 12365 (1st highest)

Jack C. Montgomery VAMC (Tulsa, Vinita, Hartshorne Clinics)

Suicide Prevention Team

Juli McNeil, LCSW Program Manager, Suicide Prevention 918-577-3087/4144 Juli.McNeil@va.gov

Tina Bevans, LCSW Tulsa VA Clinics (41st and 11th) Suicide Prevention Coordinator 918-628-2659

Suicide Prevention Team Cont’d

Alexa Youngblood, LCSWSuicide Prevention Case Manager 918-577-3672Alexa.Youngblood@va.gov

Tawnya WilsonSuicide Prevention Program & SUD Intensive Outpatient Program Administrative Assistant918-577-4111/3439

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 25-34 year olds

Suicide is the 3rd leading cause of death among 15-24 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.

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 18-29 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.

VA Screenings and Suicide Risk Assessments

VA Clinical Reminders: Screening for Depression, PTSD, Alcohol, etc.

Suicide Risk AssessmentsCompleted on those who present with risk

factors (depression, anxiety, etc.)Initial MH VisitDuring Inpatient Psychiatric StayTreatment Plan UpdatesDuring times of significant changes/stress/crisis

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

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

PROTECTIVE FACTORS

Positive social support (#1) History of adaptive coping skillsParticipating in treatment and/or good

relationship w/their provider.Veteran acknowledges hopefulnessReligious/Spirituals beliefsLife satisfaction (e.g., rating 1 to 10)Fear of suicide or deathFamily or friends that act as barrier to self-

harm

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

Other Theory/Interventions

T. Joiner’s Interpersonal-Psychological Theory: 3 variables must be present for one to die by suicide

1. Sense of thwarted belongingness (lacks meaningful connections to others, previous rel, strained or lost

2. Perceived burdensomeness (burden to others, fails to make meaningful contributions, liability-These two together produce the desire

3. 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

Interventions

Caring lettersCollaborative Assessment & Mgmt of

Suicidality (CAMS)-David JobesDBT-M. LinehanCBTSafe VetAddressing Suicide vs. Diagnosis, VISN 19

MIRECC

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):

1. Suicide prevention programs2. Suicide prevention research3. Suicide prevention education

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

Resources

Refer to VA Resource Guide

www.veteranscrisisline.netwww.suicidepreventionlifeline.org www.mirecc.va.gov/visn19www.suicidology.org

PTSD COACH APPSAFETY PLAN APP, COMING SOON

Questions…

Juli.McNeil@va.gov(918) 577-3087