Brookhaven Hospital Seminar May 2, 2012 Suicide Prevention: Clinical Tools and Resources in the US Department of Veterans Affairs Juli McNeil, MSSW, LCSW Program Manager, Suicide Prevention Jack C. Montgomery VA Medical Center

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, LCSW Suicide Prevention Case Manager 918-577-3672 Alexa.Youngblood@va.gov Tawnya Wilson Suicide Prevention Program & SUD Intensive Outpatient Program Administrative Assistant 918-577-4111/3439

Oklahoma is 12th in the Nation. 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 Assessments Completed on those who present with risk factors (depression, anxiety, etc.) Initial MH Visit During Inpatient Psychiatric Stay Treatment Plan Updates During 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 skills Participating in treatment and/or good relationship w/their provider. Veteran acknowledges hopefulness Religious/Spirituals beliefs Life satisfaction (e.g., rating 1 to 10) Fear of suicide or death Family 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 Sense of thwarted belongingness (lacks meaningful connections to others, previous rel, strained or lost Perceived burdensomeness (burden to others, fails to make meaningful contributions, liability-These two together produce the desire 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 letters Collaborative Assessment & Mgmt of Suicidality (CAMS)-David Jobes DBT-M. Linehan CBT Safe Vet Addressing 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): Suicide prevention programs Suicide prevention research 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 www.mirecc.va.gov/visn19 www.suicidology.org Refer to VA Resource Guide www.veteranscrisisline.net www.suicidepreventionlifeline.org www.mirecc.va.gov/visn19 www.suicidology.org PTSD COACH APP SAFETY PLAN APP, COMING SOON

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