From Awareness to Action: Lessons Learned from Navy’s Annual Cross Disciplinary Case Reviews CDR Tara N. Smith September 12, 2017

Agenda Future direction of Suicide Prevention Instruction and Command Resilience Team Deep Dive findings from past five years Recognizing warning signs: what to do Practicing lethal means safety

2016 Webinar Recap and Updates Working together to keep Sailors in the Green Zone Partnering with Health Promotion Coordinators Command Resilience Team Education on Lethal Means Safety NAVADMIN 263/14 New posters and graphics Free gun locks available at FFSCs and NOSCs Columbia Suicide Severity Rating Scale (C-SSRS) Self-paced targeted training for gatekeepers coming soon Thomas Joiner’s Theory of Suicide Belonging, Burdensomeness, Acquired Capability

Navy Suicide Prevention Branch Navy Suicide Prevention Branch, OPNAV N171, is comprised of the Suicide Prevention and Operational Stress Control (OSC) Programs. Together, these programs provide policies, resources and support to the fleet, helping to foster an organizational climate that supports and develops leaders, builds resilience and encourages Total Sailor Fitness. The goal of the Navy Suicide Prevention Program is to reduce suicides by enabling Sailors— through knowledge, personal responsibility and resources—to thrive as a psychologically healthy, resilient and mission- effective force. Every leader has a responsibility to foster a command climate that encourages Sailors to seek help, receive help and be welcomed back to the unit.

Connecting the Dots – Who is at Risk? Distorted Thinking + Lethal Action Ongoing Stressors Disrupted Social Network Judgment Factors Access to Lethal Means History History History of Abuse (Physical, Sexual, Emotional): 22% Prior Suicide Related Behavior: 62% Mental Health Treatment in Past Year: 41% Prior Suicide Attempt: 19% Alcohol Abuse: 35% Ongoing Stressors Experienced Loss: 78% Intimate Relationship Problems: 75% Work Problems: 58% Disciplinary/Legal Issues: 35% Financial Issues: 7% Life Event 78% Disrupted Social Network Transition (Pending demotion/PCS/Upcoming Separation from the Navy, Retirement): 77% Warning Signs Recent Event Causing Shame, Guilt, Loss of Status: 49% Recent Event Causing Feelings of Rejection/Abandonment: 42% Feelings of Hopelessness: 38% Feelings of Helplessness: 35% *Missed Opportunities to connect the dots Judgment Factors Sleep Problems: 42% Recent event causing anger: 38% Under the Influence of Alcohol: 30% Access to Lethal Means Access to Firearms: 62% *NAVADMIN 263/14 Compressed Intervention Window Source: 2014 Navy Suicide Prevention Annual Multi- Disciplinary Case Review

Individual Factors Sailors still face numerous internal and external barriers to seeking help Rage and suicide highly correlated Less than half sought mental health care or suffered a mental illness Most impulsive and reactive to multiple stressors Emotional regulation, coping, cognitive flexibility PRT scores, sleep, social media use

Family and Friends Don’t want to impact Sailor’s career Families unfamiliar with resources Didn’t notice any changes in behavior, warning signs Didn’t recognize risk factors Access to lethal means

Leadership Recognizing risk factors (transition, legal, losses, relationships, connectedness) Lack of coordination with medical Command climates that support self-care and help seeking Leaders who promote and “tell the truth” about seeking help “Old School Leaders”

Medical Risk assessments, documentation, noting past suicide related behaviors, asses impulse control and coordinate care with providers Risk assessments in ER, Primary Care, IDCs Increased visits to PCM prior to death Coordination with command Seeking collateral information Corpsmen are gatekeepers and also at risk

Policy Standardize suicide prevention training in accordance with DSPO training competencies Sailor Assistance and Intercept for Life Targeted training for Gatekeeper communities New OPNAV instruction for suicide prevention Broadest dissemination of Deep Dive findings and strategic communication products

Sailor Assistance and Intercept for Life (SAIL) Program Voluntary service offered to all Sailors identified with a suicide- related behavior (SRB) Series of caring contacts during the first 90 days following an SRB conducted by Fleet & Family Support Center counselors Risk is assessed at key intervals using the Columbia Suicide Severity Rating Scale (C-SSRS) and managed using the VA Safety Plan Care coordination and reintegration support SAIL Program Snapshot Program became available Navy-wide in February 2017 Supplements mental health treatment at regular intervals through a Sailor’s first 90 days after a SRB (highest risk period) Contact occurs at 3, 7, 14, 30 and 90 days after SRB Not intended to replace needed mental health services SAIL case managers are Navy Fleet and Family Support Center (FFSC) counselors Additional information: www.suicide.navy.mil > Command & Leaders > SAIL

Navy Suicide Prevention Deckplate Engagement Command Suicide Prevention Coordinator General Military Training Communications tools and program resources Ongoing engagement and health promotions Ongoing Reporting and Analysis Cross Functional Case Reviews (Deep Dives) Analysis and reporting of destructive behaviors from message traffic, DoD Suicide Event Report tracking and analysis Post-suicide review and command consultation Behavioral Health Quickpoll, studies with Navy and Marine Corps Public Health Center and Uniformed Services University of Health Sciences. Strategic Focus On-demand Mobile Training Teams providing leader-focused education to commands worldwide Reducing barriers, reshaping perceptions through strategic communications resources and campaigns Evidence-based prevention and intervention tools Prevention Model Fostering Resilience Vigilance & Early Intervention Crisis Response Post-vention Operational Stress Control-Life Skills-Strengthen Families-Awareness ACT Risk Factors Referrals & Counseling Warning Signs Every Sailor, Every Day Leaders Individuals Shipmates Families Caregivers First Responders Suicide Behaviors Treatment-Follow-up Globally Dispersed Standardized Training Comprehensive and sustainable program integrating resilience, total force fitness, evidence based prevention and intervention practices = all hands, all of the time approach Strategic Communications 12

2017 Suicide Prevention Month/ FY-18 New resources that can be used throughout the upcoming FY available on www.suicide.navy.mil > Every Sailor, Every Day > Get Involved FY18 1 Small ACT Toolkit Means safety facts, posters, social media graphics Suicide warning sign facts, posters and social media graphics Updated Navy Suicide Prevention Handbook Articles and sharable content https://navstress.wordpress.com www.facebook.com/navstress www.twitter.com/navstress