1. Army Suicide Awareness and Prevention
Every One Matters!
The purpose of this briefing is to review with you the signs and symptoms that people often show and practice intervening in a way to save a life.
The sad fact is that in recent years, a small number of soldiers and family members, facing difficult challenges, chose to kill themselves. Fortunately, it’s really a pretty small problem. But for the soldier or family member who is sad, defeated, and hopeless, it is a huge problem. Their life literally may hang on how well you, as a buddy, recognize someone in need and respond to help.
This class is aimed at making you aware of what is going on with your buddy, and helping you to know how to respond.
Any day you save a life is a good day…
Prepared by the Office of Chief of Chaplains
&
The Army G-1

2. * Encourage help-seeking behaviors * Become proficient in “Buddy Care”
Mission
Minimize Suicides by Helping People to Seek help and Helping Soldiers to monitor each other and provide “Buddy Care”.
Notes adapted from Suicide Intervention Handbook:
“Most people, most of the time are able to cope with and manage the stresses of life without turning to the option of suicide. They accomplish this by using a variety of internal resources sometimes called resiliency, adaptation or coping, and by drawing upon external resources such as family and friends.”
“ Stress becomes distress when these resources are overwhelmed, whether gradually or catastrophically.”
Objectives:
* Encourage help-seeking behaviors
* Become proficient in “Buddy Care”

3. The Suicide Awareness and Prevention Campaign Plan
“The goal of suicide first-aid intervention is to keep the person at risk from suicide for a limited period of time.”
Most people who feel like killing themselves only feel that way for a little while. If we can keep them alive during the crisis, after awhile things get better and they no longer think about ending their life.
“Your job is to recognize some of the signs that a person is at risk of suicide, and intervene until the immediate danger or threat of suicide has passed or until additional assistance and resources can be accessed.”
The key to saving a human being
is a human relationship!

4. Learning Objectives Identify common triggers of suicide.
Identify risk factors of suicide.
Identify symptoms of depression.
Identify myths about suicide.
Identify warning signs of suicide.
Take appropriate action in response to an
at-risk individual.
Here are the learning objectives for this training.
Bottom Line: At the end of this training you will be able to recognize some signs of suicide and take appropriate action to save a life.

5. Suicidal Behavior Serious suicidal thoughts or threats.
Self destructive acts.
Attempts to harm, but not kill oneself.
Attempts to die by suicide.
Completed suicide.
There are really, a whole series of actions that constitute what we call “suicidal behavior.”
In this list, each is worse than the one above it. Some are not harmful as is ( thoughts aren’t necessarily deadly). But suicide tends to be progressive. People may move through these stages from one to the next. This movement can be very rapid. For example, in the IF Theater, where soldiers have ready access to weapons, soldiers could move very quickly from thinking about suicide to actually shooting themselves.
Another danger is that people can simply be attempting to draw attention to themselves through self-destructive behavior, and can accidentally end up killing themselves or others. Also, they sometimes can do damage to their career or sense of respect, putting them at greater risk of more serious suicide attempts.
One thing is clear. If you see someone in any of these behaviors, it’s time to act. Right now.
“Suicide is still a hidden or taboo topic. Denial, secrecy and avoidance remain common.”
“The taboo surrounding suicide and the stigma clinging to those who experience it has been with us for a long time. Both can influence the feelings of caregivers toward working with persons at risk in powerful and hidden ways.”
Serious Suicidal thoughts or threats should be addressed immediately
“Most suicidal people are unsure about dying right up to the point of acting. Part of them wants to die, but part of them wants to live.”
“Very few are absolutely determined or completely decided about ending their life.”
Viewing those who have made previous attempts to die by suicide is key. “The rate of suicide among people who have previously attempted suicide is 40 times greater than the rate in the general population.”

6. Triggers for Suicidal Behavior
The breakup of a close relationship
Witnessing death
Financial stressors
A bad evaluation
Drug or Alcohol Abuse
Reunion from a long field training or isolated tour
Leaving old friends and family
Being alone with concerns about self or family
New military assignments/deployments
The more you know about the stressors in a person’s life the more information you have to intervene before these lead to ideations about suicide.
We can generally agree on this list of stressors that person’s may experience in their life that may lead to stress overload. However, there is an almost unlimited number of stressors that can be influencing people. Also, people feel pain and stress differently. What may be “no big deal” to you may be emotionally crushing for your buddy.
Be keenly aware of how the persons you may have to assist may respond to stressors or the amount and kinds of stressors they may be experiencing.
Don’t let them reach “overload.” Help them talk about it, deal with it, and seek professional help where required.

7. Triggers for Suicidal Behavior
Recent interpersonal losses
Loss of self-esteem / status
Humiliation / Ridicule
Rejection (e.g., job, promotion, boy/girlfriend)
Disciplinary or legal difficulty
Exposure to suicide of friend or family member
Discharge from treatment or from service
Retirement
The defining trigger for suicide is Loss. This can include loss of a relationship, loss of self esteem, loss of respect in the community, or simply loss of money or possessions. But almost always, the person who becomes suicidal has lost something precious to him or her.
Some stressors are so great that they can singly place a person into a risk category for suicide (loss of a spouse)
Each of us are different and will deal with stressors in our own ways.
This list is by no means all inclusive but pretty representative of the types of stressors we need to be aware of and train others to be aware of as well.

8. Hopelessness Believing all resources to be exhausted
Feeling that no one cares
Believing the world would be better off without you
Total loss of control over self and others
Seeing death as only means of eliminating pain
The second defining characteristic of the person who has become suicidal is hopelessness. People turn to suicide when they feel there is “no hope” of regaining the thing they lost: Their love, respect, career, or other precious thing.
As stated earlier, suicidal thoughts form when a person has exhausted all their resources or coping mechanisms.
The cry for help may have subsided as a person reaches this stage in their life. They may no longer seek out help or feel they need to continue to bother anyone with their troubles.
This is a critical juncture in the life of a person undergoing stressors talked about previously. Now is when they may start seriously considering a “long term solution to a short term problem.”

9. Depression Difficulty concentrating or remembering
Loss of energy, or chronic fatigue, slow speech and muscle movement
Loss of self-esteem
Change in sleep habits; unable to sleep or wanting to sleep all the time
Change in weight
Anxiety
A key sign exhibited by most at risk personnel is depression. Above are some symptoms of depression. Officially, only a doctor can diagnose someone as depressed, but we all have two eyes and ears, and can recognize some of the symptoms above.
Depression is seen as a major contributing factor in many suicidal persons
Depression often leads to other symptoms that further increase the risks of suicide.
Physical changes in weight and a person exhibiting symptoms of anxiety may all result from a prolonged period of depression.
Beware of outward manifestations that clearly indicate the danger of suicide may exist
If you see someone showing these kinds of symptoms, by all means ask the question: “Are you thinking of killing yourself?”

10. SUICIDE Myths and Facts
MYTH: People who talk about suicide don’t die by suicide.
FACT: 80% of completed suicides had given definite indications of their intention.
MYTH: Talking about suicide will give some an idea to do it.
FACT: Suicidal people already have the idea. Talking about it may invite them to ask for help.
The best way to confront a myth is with factual information
The more facts you know about suicide, its signs, symptoms and roles of caregivers, the better you are able to respond appropriately

11. SUICIDE Myths and Facts (continued)
MYTH: All suicidal people are fully intent on dying. Nothing can be done about it.
FACT: 95% are undecided about it. They call for help before or after the attempt.
MYTH: Suicide is an impulsive act.
FACT: Most suicides are carefully planned and thought about for weeks.
MYTH: Suicidal people remain suicidal.
FACT: Most are suicidal for only a brief period. Timely intervention may save their lives.

12. SUICIDE Myths and Facts (continued)
MYTH: Suicidal persons are mentally ill.
FACT: Most suicidal persons are not mentally ill. Severe emotionally distress is not the same as mental illness.
MYTH: December has suicide the highest rate.
FACT: December has one of the lowest rates. Spring months have the highest.
MYTH: It’s not suicide if there is no note.
FACT: Only 1 in 4 suicides leave suicide notes.

13. Responding to Statements or Threats
Stay calm.
Ask the Question: “Are you thinking of killing yourself?”
Ensure the person receives help.
Do not leave person alone.
“Buy time” (i.e., Identify stressor and
reasons for living).
Your response as a friend or buddy is critical to the person at risk of suicide
Don’t give the person reason to become more alarmed and give them reason to react to your excited state. Remain calm and show concern by staying with the person.
Send someone else to get help so you can remain with the at risk person until appropriate higher skilled help arrives.
As the immediate care giver responding to the at risk person it is imperative you buy time and keep the person focused on living. Get them to talk if possible by showing empathy and not sympathy toward their situation.
- focus on something that the person can identify with as a positive even though this may be difficult.

14. Asking About Suicide
Ask directly (i.e., Are you thinking about killing yourself?).
Get help.
Convey concern.
There is no good way to ask a tough question. So just do it!
The direct approach is a good way to get the at risk person to dialog with you about what they are experiencing. Don’t avoid asking the difficult and straight forward question.
Exercise: In groups of two: Each assume the opposite person is demonstrating some behavior that concerns you. Practice asking the question “Are you thinking of killing yourself? (Take turns-2 minutes each way)
It is always appropriate to seek the help of professionals. Don’t assume you know just what to do for a person at risk of suicide. Get help and let them allow you to get help. “Let’s go talk to the Chaplain.” We can get you help with your problems to get you through it.
Convey concern for the person to build their confidence that you are genuinely concerned about offering assistance.

15. Stigmas to Help-Seeking Behavior
GOES ON
PERMANENT
RECORD
SEEKING HELP IS
A SIGN OF
WEAKNESS
This slide reflects perceptions that might exist as barriers to seeking professional counseling. Let’s address these now.
Permanent Record: Treatment for depression or something similar never goes in your personnel file or any other command document. The only place it resides is in your medical records, just like every other ailment. And if you get help from a chaplain, no records are kept at all!
Sign of weakness: Just the opposite: The man or woman who recognizes his or her limitations and gets help to over come them, is smart and courageous. As the Army Strong campaign puts it: “Army Strong: the strength to get yourself over, and the strength to get over yourself!”
If a soldier breaks an arm, he doesn’t hesitate to seek immediate professional care.
The pony blanket lists five tasks targeted to encourage help-seeking behavior. Some of these deal more with fighting perception than reality.

16. Don’t Let Your Buddy Fight Alone
Facing Challenges?
Don’t Fight Alone
Don’t Let Your Buddy Fight Alone
Here’s the sad truth. We all will face challenges, We all get beat, sometimes we get defeated, dropped by someone who loved us. Most of us will screw up and get in trouble for something sometime. And more than a few of us in our lives will face times when we just don’t know if we can go on.
If you are in that situation, wondering if you can go on. Face it: You’re fighting the fight of your life: Don’t do it alone! There are friends, Chaplains, Doctors, and leaders ready to help you win and get on track.
If you see your buddy struggling in the fight of her or his life, don’t let her fight alone. Stand with her and help her get through it.
We’re all in this together!
Be the one to throw the lifeline but the goal is to get the person to the safety of the harbor which is professional help.

17. Summary . . . Final Comments . . . Questions . . .
Each of us are faced with many stressors in our daily lives. Some are more stressful than others. We’ve discussed them in this briefing.
Each of us also are equipped with different abilities and resources to cope with the stressors we face. It is only when the stressors become too great to bear or our resources are depleted that we become a person at risk of becoming a victim of suicide.
You and I can also be the caregiver to someone at risk of becoming a victim of suicide by knowing the signs and symptoms we’ve discussed.
Once we recognize the signs and symptoms that may indicate the person is at risk we must respond appropriately:
- Don’t be alarmed
Confront the issue directly, ask if they are thinking about suicide
Don’t leave the person alone, show concern, get them to open up and talk
Send someone for help or go with the person to seek help from professional
Counselors.
Don’t let person find their own long term solution to a short term problem.