1. SUICIDE AWARENESS AND PREVENTION
Suicide is a real problem in the United States Army. Most suicides are preventable. This briefing is designed to equip you with the training and tools you need to help prevent suicide. NOTE: This brief is not designed to prevent you from killing yourself! It is designed to help you become a preventer of other people’s suicide.

2. AGENDA Causes Of Suicide Warning Signs of Suicide
Prevention of Suicide
Our agenda is simple. First, I will try to answer the question that everyone has about suicide: “What in the world would drive a person to commit suicide?” The problem is, that even if I do explain it, many of you are already convinced that someone who would commit suicide is weak. Some people even think we shouldn’t attempt to keep people from committing suicide. But let me try to put the problem into perspective.
A large percentage of the population has had thoughts of committing suicide some time in their lives. Statistically, I can say with some confidence that we have many people in this room who have, at some point in their lives considered killing themselves. Now, what if those people had committed suicide? They wouldn’t be on our team today. The point is clear, just because someone considers suicide doesn’t mean that they are weak or useless. There is no need for us to attempt to analyze the problem. We all simply need to adopt the mindset that we will help whoever we see is in need of help.
Another point I would make is that if a person completes a suicide, there are a lot more people affected by that suicide. The individual’s family, friends, and co-worker will be hurt by a completed suicide. So, if you reach out and help someone who is considering suicide you not only helping them, you are helping everyone who will be affected by their suicide.
After identifying some of the causes of suicide we will look at the warning signs which indicates a person is considering killing themselves.
Third, we will go over what to do to help someone who is thinking of killing themselves.

3. SUICIDE FACTS 3rd leading cause of death among soldiers
Attempts nearly 30 times the death rate
Females attempt 3 times more often
Males use more violent means
Most common cause: failed relationship
Here are a few facts about suicide. Even now, with war going on, suicide is the third leading cause of death among soldiers. For every completed suicide, there are 30 attempts. Notice that females are much more likely to attempt suicide, but men complete suicide more often because they tend to use more violent means to kill themselves such as shooting, hanging, jumping, etc. One of the most common ways that females attempt suicide is drug overdose. Many drugs won’t kill a person when they are taken in large quantities. And of those that do, it usually takes some time. Time which can be used to get the person to the hospital to have their stomach pumped.
One of the most common events which lead up to a suicide or a suicide attempt is a failed relationship. This speaks to the importance of human relationships for people. One of the best preventors of suicide is good human relationships. If I counsel someone who lacks good relationships with family members and friends, I consider that person at higher risk for suicide because good human relationships are a resource for an individual to use when going through times of loss.

4. CAUSES OF SUICIDE Depression
Loss of or breakup with a significant other
Loss of a significant support system
Loss of social or financial status
Feelings of failure on the job, at school, or at life in general
Feelings of Worthlessness, Hopelessness, and Helplessness
Well, depression is a serious problem which often requires professional help. If you or someone you know is experiencing depression, please seek help.
However, not all suicides are caused by depression. Notice some of these other causes of suicide…
The three causes listed after depression all begin with the word “loss.” This is significant because many suicides, which are not preceded by a time of depression, are preceded by the news of a sudden loss. In theater it is very common for soldiers to received dear John letters or phone calls. Many single soldiers left behind girlfriends and boyfrieds who they expected to reunite with after returning. For them to receive news that their boyfriend or girlfriend has found someone else can be devastating. Of course, all of us in hear are thinking, “No girl is worth killing yourself over!”
Another loss may be the loss of a significant support system. Death of family member falls into this category. Parents, grandparents, siblings, and other family members provide important support for many people. When they are gone it may feel as if that person’s world has been turned upside down.
The loss of social or financial status may contribute to suicide.
Facing significant failure may also contribute to suicide. Moral failure could also be added to this list.
Basically, these events may have the result of causing a person to feel worthless, hopeless and helpless. When a person feels worthless they feel as if their lives mean nothing to anyone. They may feel hopeless. They see nothing but pain and misery for the rest of their lives, nothing will ever get better. They also feel helpless. Though they may want to keep living they don’t know how they can. They see no solutions for their problems.

5. CAUSES OF SUICIDE Why some handle loss while others don’t
Negative Filter
All-or-nothing thinking
Overgeneralization
Disqualifying the Positive
Catastrophizing
Who knows what goes through a person’s mind when they face loss or failure? Why do most soldiers handle this sort of thing well, while others do not. Here are a few ideas.
Negative filter: The Soldier views all of his life including daily activities through a negative filter. Soldiers might attribute a benign glance from a fellow Soldier as a look of anger or view a simple mistake such as misplacing keys as a sign that he/she is truly a failure in life.
All-or-nothing thinking: The Soldier sees things in black and white categories. If the relationship fails, the Soldier sees himself/herself as a failure and as the sole reason for the break-up.
Overgeneralization: The Soldier sees a single negative event as a never-ending pattern of defeat. If the Soldier’s relationship ends, he/she may think that all future relationships will fail, too.
Disqualifying the positive: The Soldier disregards any positive experience, and maintains negative beliefs even if they are contradicted by everyday experiences. A Soldier may fail to find any positive about his/her relationship or about his/her current status, if newly single even if several members of the opposite sex express interest in a relationship.
Catastrophizing: The Soldier exaggerates the importance of negative events. If a relationship fails, the Solider might assume that the failure will now affect all aspects of life, will affect ability to be promoted, and will cause a loss of friends. It is important to help the Soldier identify his/her automatic cognitive distortions and beliefs and then work with the Soldier to create healthier, more rational cognitions and beliefs.
Some of you help me out. What are some other reasons that people may commit suicide?

6. SUICIDE WARNING SIGNS Talking or hinting about suicide
Marked withdrawal from family and friends
Unusual purchase of a firearm or a weapon
Giving away possessions
Suddenly making a will
Purchasing additional life insurance
If you know someone who has been facing the kinds of losses or failures that we have been discussing and they start to consider suicide as a way out they will probably begin to show some outward signs of what they are considering. Look at this list. These are warning signs that people often notice in those who are considering suicide.
One of the reasons that a suicidal person may show a sign like this is that they hope someone will notice and try to help them. They may be too ashamed to seek help on their own, so they lay out some bait to see if someone will bite. They may not be 100% sure about committing suicide and could be looking for reasons to live.
However, others, who have made definite plans to kill themselves may also exhibit these signs. They are simply tying up loose ends before they complete their suicide.

7. SUICIDE WARNING SIGNS
Marked mood swings, including a sudden change for the better
Sudden change in eating habits
Unexplained loss of interest in normal activities
Increased alcohol or drug use
History of a previous suicide attempt
Family history of suicide
Loss of a close friend by suicide
Here are some other signs.
Can anyone tell me why that first bullet might be true? (A person who makes the decision feels like a weight has been lifted from their shoulders.)
A change in eating habits, an unexplained loss of interest in normal activities, as well as an increased use of alcohol or drugs can signal depression, which again, is a major contributing factor to suicide.
Note carefully the last three. I have put them in descending order. If a person has attempted suicide in the past, they are 40 times more likely to attempt it again than someone who has never attempted suicide. If a person has a family member: Mother, father, brother, sister, uncle, etc. who has committed suicide, they are 10 times more likely to attempt suicide than someone who has not been exposed to suicide. Similarly, if someone has a close friend who has killed himself, that can also be a factor in bringing them to the point of suicide.

8. INTERVENTION ACE Ask your Buddy Care for your Buddy Escort your Buddy
Have the courage to ask the question, but stay calm
Ask the question directly, e.g. Are you thinking of killing yourself?
Care for your Buddy
Remove any means that could be used for self-injury
Calmly control the situation; do not use force
Escort your Buddy
Never leave your buddy alone
Escort to the chain of command, a Chaplain, a behavioral health professional, or a primary care provider
Now we are at the “What can I do?” part. The Army’s Preventive Medicine Department has developed this outline to remind us of what to do with someone that we are concerned about. We use the Acronym ACE to help us remember.
Ask your Buddy. I often refer to this as asking the dam questions. D-a-m “dam,” not d-a-m-n. You can think of someone who is considering suicide as being in a fast moving river. They are heading towards a water fall. Here I am on the bank, where it is safe. The goal is to be on the lookout for people who have fallen into the river and are in danger of going over the falls – that is, attempting suicide. I need to be there to throw them a lifeline. But, something else that we may be able to do is build a dam to slow down the river. We can do that simply by asking the dam question: “Are you thinking of killing yourself?” That sounds odd to ask, almost offensive. But it really isn’t. If a person is showing warning signs, they be showing them as a cry for help. So, to ask them about their intentions is a way of offering help. That may be just what that person needs to be brought onto the bank of the river.
Care for our buddy. If the person has expressed that he is thinking of killing himself, anything which may be readily available to use should be removed. I think this may explain why the suicide rate is higher in theater. Guns are everywhere available and ready for use. On the spur of the moment a suicidal individual can use one to kill himself.
Also, be calm about the situation. Don’t act shocked or surprised. Don’t condemn or attack. Remain calm and get the person to the help they need.
Next, Escort your Buddy. Don’t leave someone alone who is thinking of committing suicide. If you can’s stay with them get them to someone who can.

9. WHERE TO GET HELP Unit Chaplain Unit Surgeon
Community Mental Health Services
Army Community Services
Social Work Services
Alcohol and Drug Abuse Prevention and Control Program (ADAPC)
Well, this slide shows some of the places where trained individuals can help people who are considering suicide. There is really no shortage of helping agencies. Can anyone think of another place to get help?

10. Suicide Vignette #1
PVT Smith was a 22 year-old single, black male who was three months into his first
deployment. While surfing MySpace.com, he learned that his deployed girlfriend was
involved in another relationship. After that, PVT Smith began to abuse alcohol. One
evening, PVT Smith refused to go to the gym with his buddies, which was unusual. That
night, Private Smith shot himself to death.
Can you list the warning signs?
Given that you know PVT Smith, and are aware of his distress, which of the following
would be the best response.
Wait and see how things go because it’s not a good idea to interfere in another
Soldier’s personal matters. He might get angry.
2. If I knew about his girlfriend problems, I would talk to him to see if he was alright. I would ask him if he felt suicidal. If he said yes, I would escort him to see the commander.
3. Because of his alcohol abuse, I would inform the Platoon SGT that something was troubling PVT Smith i.e., he was drinking too much. I would suggest that the Platoon SGT talk to him.
Go over vignettes

11. Suicide Vignette #2
SGT Jones was a 34 year-old, married white male, 13 B, who was six
months into his first deployment. SGT Jones received a verbal counseling
for not following proper risk assessment procedures which may have led to
combat casualties. He declined mid-tour leave. One week before his death,
he received an Article 15 for falling asleep while on guard duty. SGT Jones
shot himself to death using his own military weapon.
Can you list the warning signs?
Given that you know SGT Jones, and are aware of his distress, which of the
following would be the best response.
Being in a war zone, he should have lost his stripes. Falling asleep on guard duty is unacceptable.
It was apparent that SGT Jones had issues. I believe that another NCO should talk to him to see if he is alright. This is NCO business.
Leadership should have recognized that it is not usual for an NCO to get an Article 15. SGT Jones must have been experiencing personal problems. I would have recommended that he talk to behavioral health.

12. Suicide Vignette #3
CPT Garcia was 25 year-old, married Hispanic male, who
was a dedicated career officer. He has deployed two
times since the beginning of the war in Iraq. His unit is
preparing for another deployment. CPT Garcia is highly
regarded by leadership. Recently, his spouse informed
him that if he deploys again she will divorce him. His
immediate commander has noticed changes in his mood
and behavior e.g., occasional angry outburst and
sadness. CPT Garcia appeared pre-occupied and
tired. His commander has decided to take action and
counsel CPT Garcia.
What can his leader do?

13. What Leaders Can Do Listen to your Soldiers.
Be interested in your Soldier’s problems.
Encourage them to seek help.
Recommend counseling.
Accept the unique qualities of each Soldier.
Treat each Soldier with the utmost respect.
Here is a special word to leaders. For the last several years the Army has been publishing a special study of the mental well being of soldiers in Theater. This came as the result of the recognition that the suicide rate was climbing upwards beginning in 2003.
Part of the questionnaires focus on the impact leadership has on the mental well being of soldiers. The results were very interesting.
The study found that leadership is one of the most important factors when it comes to the mental well being of soldiers. Those soldiers who view their leadership in a positive light have significantly less stress related problems than those who view their leadership in a negative light.
It was thought that the level of combat a soldier sees determines their level of stress. This study has shown that good leadership significantly reduces stress even in units with a high combat level. As a comparison, the study showed that when a unit experienced a high level of combat and had a high view of its NCOs and Officers, they experienced the same amount of stress as units in a low combat environment, but had a poor perception of NCOs and Officers.
Leaders who show they put their soldier’s first, who express appreciation for their subordinates, who maintain a high standard in a fair manner, who keep soldier’s informed, and who are competent in their job will do more than anything else to ensure that their soldiers receive what they need to accomplish their mission. That includes getting help when it is necessary.
As leaders, you have the most important role in suicide prevention. You can help to remove the stigma attached to seeking help. You can help instill a stronger more adaptive mentality in your subordinates. You can give them the coping skills they need to grow, now matter what kind of loss they may face in their lives.

14. Know the Causes Recognize the Warning Signs Intervene
SUMMARY
Know the Causes
Recognize the Warning Signs
Intervene
This briefing was produced using a template obtained from