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

2. 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

3. 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

4. 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.

5. 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): %
Prior Suicide Related Behavior: %
Mental Health Treatment in Past Year: %
Prior Suicide Attempt: %
Alcohol Abuse: %
Ongoing Stressors
Experienced Loss: %
Intimate Relationship Problems: %
Work Problems: %
Disciplinary/Legal Issues: %
Financial Issues: %
Life Event %
Disrupted Social Network
Transition (Pending demotion/PCS/Upcoming
Separation from the Navy, Retirement): %
Warning Signs
Recent Event Causing
Shame, Guilt, Loss of Status: %
Recent Event Causing Feelings
of Rejection/Abandonment: %
Feelings of Hopelessness: %
Feelings of Helplessness: %
*Missed Opportunities to connect the dots
Judgment Factors
Sleep Problems: %
Recent event causing anger: %
Under the Influence of Alcohol: %
Access to Lethal Means
Access to Firearms: %
*NAVADMIN 263/14
Compressed Intervention Window
Source: 2014 Navy Suicide Prevention Annual Multi- Disciplinary Case Review

6. 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

7. 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

8. 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”

9. 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

10. 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

11. 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: > Command & Leaders > SAIL

12. 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

13. 2017 Suicide Prevention Month/ FY-18
New resources that can be used throughout the upcoming FY available on > 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