Suicide Prevention Awareness United States Army Cadet Command Suicide Prevention Awareness

Understanding Dysfunctional Health-Risk Behaviors Visible to Command Behaviors NOT Visible to Command Stressors Current Environment Developmental History Genetic Vulnerability to Psychiatric Illness Relationship loss “The best predictor of future behavior is past behavior.”

Outline Warning Signs Suicidal Triggers Risk Factors Leadership Responses Challenges Resources Summary 4 4 4

Warning Signs Feelings: Hopeless-“Things will never get better” “There’s no point in trying”; can’t see a future. Helpless-“There’s nothing I can do about it” “I can’t do anything right”. Worthless-“Everyone would be better off without me” “I’m not worth your effort”. Guilt, shame, self hatred-“What I did was unforgivable”. Pervasive sadness. Persistent anxiety. Persistent agitation. Persistent, uncharacteristic anger, hostility, or irritability. Confusion-- can’t think straight or make decisions.

Warning Signs Actions: Uncharacteristic aggression. Risk taking. Obtaining weapon. Withdraw from friends/activities. Becoming accident-prone. Unauthorized absence. Getting into trouble; discipline problems.

Warning Signs Changes: Personality-more withdrawn, low energy, apathetic, or more boisterous, talkative, outgoing. Increased use of alcohol/drugs. Loss of interest in personal appearance, hygiene, neatness of personal items, space. Loss of interest in hobbies and work Marked decrease in work performance. Sleep, appetite increase or decrease Prolong negative attitude

Warning Signs FACT: Threats: Statements--talking about suicide directly or indirectly, e.g., “How long does it take to bleed to death”, written themes of death, preoccupation with subject of death. Threats-“I won’t be around much longer”, writing suicide note, making direct threat. Plans-Give away prized possessions, making final arrangements-putting affairs (e.g., finances) in order. Sub lethal gestures or attempts, e.g., overdose, wrist cutting.

Verbal Warnings “I’m going to kill myself!” “I’d be better off dead.” “I just can’t go on any longer.” “You won’t be seeing me around anymore.” “I’m getting out, no matter what.” “I’m going home real soon.” 24 24 24

Behavioral Warnings Organizing business and personal matters. Giving away possessions. Composing a suicide note. Buying a gun. Planning one’s own funeral. Obsession with death. A sudden lift in spirits. 25 25 25

Risk Factors Previous attempts Lethal, available, specific suicide plan Family History of Suicide Personality Disorder Inability to resolve emotional pain History of violent or self destructive behavior Long Term Medical Illness Loss of significant relationship Low tolerance for distress Lack of future plans Lack of personal and social support Access to firearms Negative attitude toward help seeking

RISK Highest when: The person sees no way out and fears things may get worse. The predominant emotion is hopelessness and helplessness. Thinking is constricted and dichotomous. Pervious attempts Judgment is impaired by use of alcohol or other substances. Lethal means are available.

Potential Suicidal “Triggers” LOSS OF: - a significant, intimate relationship a child custody battle friendship or social status (social isolation or ostracism) Legal action financial security (pay loss, excessive debts, bankruptcy) self-esteem (humiliation, pass over for promotion or schooling) hope (feeling helpless) change in lifestyle Here is a list of possible triggers that can lead to suicide. Again - these are just triggers. The majority of all suicides can be contributed to a mental illness or substance abuse. You will quickly find one common theme - which is a significant loss in one’s life.

Potential “Triggers”

First Line Supervisors Get to know your personnel Find out about person’s developmental history Assess the person’s life-coping skills Know when your personnel are experiencing a “life crisis” Anticipate dysfunctional behavior Consider implementing gate keeper’s screening process Know potential suicide triggers & warning signs for mental illness Alcohol and drug abuse Relationship issues Overwhelming personal problems Promote help-seeking behavior Encourage use of Army One-Source for Active Duty Assist in reducing stigma regarding mental health Set the example - take advantage of helping services

Leadership Responses Promote a norm of mutual “Buddy Care” among all military/ civilian personnel. “We are our brother’s keepers!” Pay attention to warning signs and responds to those who need help. If anyone suspects or knows that a cadet, cadre, civilian, family member, or anyone else is troubled. Be aware that heightened stress, relationship problems, and impending holidays can trigger inappropriate coping behaviors in vulnerable individuals. Be aware that the spring time is also a time risk season.

Leadership Responses Pay close attention to the personal needs of your people, and be on the lookout for signs of stress. Communicate in your words and actions that it is not only acceptable, but a sign of strength, to recognize life problems and get help to deal with them constructively. Support and protect to the fullest extent possible those courageous people who seek help early, before a crisis develops. Create a responsive, caring, and responsible environment where individuals are motivated to seek help with personal struggles without fear of being singled out.

Leadership Responses Create and promote opportunities for social interactions that are important in defining a unit’s supportive structure. These range from group and battalion/squadron events to private gatherings. Ensure that you foster a social climate in your unit that communicates to everyone, ‘you belong here’. Efforts to foster a supportive environment and to destigmatize help-seeking may be the most potent form of suicide prevention currently available. Arrange follow-up assessments and counseling support

All Personnel Know suicidal danger and warning signs and leading causes for suicides Become aware of local helping services Take immediate action when suspecting someone is at risk for suicide Never ostracize any member of your team Remain Vigilant

Challenges People do not always seek the help they need when they need it There is a “stigma” perception that hinders help seeking behavior Personal issues are sacrificed at the expense of maintaining a professional image Some may do not think that anyone can help them 32 32 32

Professional Help Chain of Command Social Work Counselors Mental Health Professionals Chaplain- Nearby installation Family Life Consultants Student Counseling Services Social Work Counselors Crisis Hotlines Emergency Rooms 32 32 32

Suicide is substantially preventable, IF: Summary Suicide is substantially preventable, IF: We target those at risk of or currently suffering from treatable mental/behavioral disorders(primarily substance abuse/mood disorder) We minimize stigma associated with accessing mental health care. Leaders know and demonstrate care to their peers & subordinates. Leaders constructively intervene early on in their personnel’s problems. Leaders pay close attention & provide constructive interventions to those small numbers of peers and subordinates facing major losses from legal, marital, occupational or financial problems

l Questions or Comments?