Zero Suicide Inland Northwest Conference Addressing Suicide among Veterans, National Guard, and Active Duty Military David Dickinson SAMHSA Regional Administrator HHS Region X (AK, ID, OR, WA) Zero Suicide Inland Northwest Conference Gonzaga University March 10, 2015 – Spokane, WA

~ 38,000 Americans die by suicide each year Scope of the Problem 3 ~ 38,000 Americans die by suicide each year

Suicides and Behavioral Health Disorders 4 ~50 percent of those who die by suicide have major depression…the suicide rate of people with major depression is 8x that of the general population ~90 percent of people who die by suicide have a mental disorder, substance abuse disorder, or both at the time of their death.

Service Members, Veterans, and their Families 5 The suicide rate in the U.S. military has historically been below the civilian rate. Since the beginning of the Iraq/Afghanistan conflicts, the rate has climbed. In 2008 it exceeded the demographically matched civilian rate. (Kuehn, JAMA 2009) Based on data from 17 NVDRS (Non-Violent Death Reporting System) states, just under 18% of all suicides in 2011 were among service members or veterans. (CDC, NVDRS, 2014)

Service Members, Veterans, and their Families 6 We do not know how many family members of service members and veterans die by suicide. The Departments of Veterans Affairs and Defense are studying this issue. In several studies, children with a deployed parent displayed increased mental health distress, especially anxiety (Mansfield et al, 2011; Aranda et al, 2011; Gorman et al, 2010)

Service Members, Veterans, and their Families 7 There were 304 confirmed suicide deaths and 869 suicide attempts among active duty service members in CY 2012. Suicide rates per 100,000 for CY2012 among: Active Duty: 22.7 Reserve: 19.3 National Guard: 28.1 Active Component Suicide Rates in CY 2012: Active Component Air Force 15.0 Army 29.7 Marine Corps 24.3 Navy 17.8

Army STARRS Data 8 In the Army, the suicide rate increased from 2004 – 2009 for soldiers, whether they were currently deployed, had previously deployed, or had never deployed. (Between 2004 – 2009 about 40% of soldiers never deployed.) (Schoenbaum, et al. 2014) Increased suicide risk was associated with being a man (or a woman during deployment), white race/ethnicity, junior enlisted rank, recent demotion, and current or previous deployment. (Schoenbaum, et al. 2014) Predictors of Army suicides are largely similar to those of civilians. Modeled after the Framingham Heart Study, the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is designed to identify salient risk and protective factors regarding suicide, adverse mental health outcomes, and functional impairment. Funded by the Army and managed by NIMH. The first three articles were published in JAMA Psychiatry in March 2014.

The Good News Is There is a coordinated, national effort to prevent suicide and the evidence about effectiveness continues to grow.

SAMHSA’s Strategic Initiative 1: Prevention of Substance Abuse and Mental Illness Prevention of Substance Abuse and Mental Illness—Creating communities where individuals, families, schools, faith-based organizations, and workplaces take action to promote emotional health and reduce the likelihood of mental illness, substance abuse including tobacco, and suicide. This Initiative will include a focus on the Nation’s high-risk youth, youth in Tribal communities, and military families. Goal 1.3: Prevent suicides and attempted suicides among populations at high risk, especially military families, LGBTQ youth, and American Indians and Alaska Natives.

National Suicide Prevention Lifeline 11 1-800-273-TALK (8255) 24 hours 163 networked crisis centers across the country Provides counseling and mental health referrals www.suicidepreventionlifeline.org Chat services available Answered more than 1,000,000 calls in CY2013 Received more than 7,000 calls on the day of Robin Williams’ death.

Partnership: VA Preventing Suicide Among Veterans Interagency Agreement 800-273-TALK “press 1” Veterans Crisis Line answered 6,125 calls monthly 85% identified themselves as veterans, service members, or their friends and family members (FY12) Majority of callers are men, ages 50 – 59. 7,960 emergency rescues (FY13) Chat service 24/7 (+4,000 chats/month) Texting VA adopted SAMHSA’s Treatment Improvement Protocol Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment and created a complementary training video.

New Frontiers in Crisis Intervention Chat-VA chat initiated 2009; Lifeline in 2012 Texting piloted by VA and Crisis Center followup grantees Facebook/Lifeline partnership to respond to suicidal content posted by Facebook users SAMHSA, NAASP, and New Media industry (Facebook, Twitter, etc.) developing industry-wide suicide prevention standards for responding to suicidal content posted by their users

Partnership: National Guard Bureau MOU for FTE National Guard Counterdrug Liaison on-site at SAMHSA. ↑ SAMHSA's understanding of NG behavioral health needs and identify community resources for NG members and their families.

Partnership: Health Resources and Services Administration Interagency Agreement to conduct military culture training in Area Health Education Centers across the country. (4,500 providers trained to-date in 112 AHECs)

Behavioral Health Service System: Program Examples Access to Recovery (ATR) Voucher program for substance abuse treatment and recovery support services. 24 of the 30 grantees cite Service Members, Veterans, and their Families as a priority population in their grant applications.

Behavioral Health Service System: Programs Jail Diversion & Trauma Recovery—Priority to Veterans Supports implementation of trauma-integrated jail diversion programs for justice-involved veterans and other individuals with PTSD and trauma-related disorders.

Behavioral Health Service System: Programs and Support Service Members, Veterans and Their Families Technical Assistance Center Helps states and territories develop effective, responsive behavioral health systems for Service Members, Veterans, and their Families (SMVF), through public/private collaboration among federal, state, territorial, tribal, and local agencies.

Service Members, Veterans & their Families (SMVF) Policy Academies Partnerships DoD, National Guard Bureau, VA, The National Council, NASMHPD, NASADAD Goal For States and territories to strengthen behavioral health systems for service members, veterans, and their families. Mechanism 46 states, 4 territories, and DC established a long-term, 10- member interagency team, endorsed by the Governor.

State/Territory Plans Strategic plans address Increasing access to appropriate care Closing gaps in the system Building the system’s capacity Increasing interagency communication/ collaboration Incorporating promising-, best- and evidence-based practices Sustaining efforts

Suicide Prevention Resource Center The Nation’s first and only federally funded suicide prevention resource center Advances the goals and objectives of the National Strategy for Suicide Prevention Acts as Executive Secretariat for the National Action Alliance for Suicide Prevention Technical Assistance for states, tribes, communities, and Garrett Lee Smith Grantees Best Practices Registry for Suicide Prevention Primary Care Toolkit Training Institute Partners with American Association of Suicidology, American Foundation for Suicide Prevention, Social Science Research and Evaluation, Inc. www.sprc.org

Suicide Prevention Publications

Warning Signs

SAMHSA Regional Administrator Questions? Thank you! Contact Information: David Dickinson SAMHSA Regional Administrator David.Dickinson@samhsa.hhs.gov 206-615-3893