Navy Suicide Prevention Program

1. 1 Navy Suicide Prevention Program LCDR Bonnie Chavez (901) 874-6613 / DSN 882-6613 bonnie.chavez@navy.mil

2. 2 Overview of Navy Suicide Prevention Introduction Some Information Prevention Approach Command Programs Initiatives Suicide is the third leading cause of death among active duty Sailors. Suicide rates are higher in the U.S. population. Most of these tragedies can be prevented. This web tool gives an overview of Navy�s Approach to Suicide Prevention, Essential Elements of Command Suicide Prevention Programs, and what Sailors need to know about suicide prevention.Suicide is the third leading cause of death among active duty Sailors. Suicide rates are higher in the U.S. population. Most of these tragedies can be prevented. This web tool gives an overview of Navy�s Approach to Suicide Prevention, Essential Elements of Command Suicide Prevention Programs, and what Sailors need to know about suicide prevention.

3. 3 Navy Suicide Rates/100K(CY-91 to CY-07)

4. 4 Navy Associated Stressors Common Risk Factors Recent Feelings of Depression 40% History of Psychiatric Condition 32% Recent Feelings of Anxiety 27% Recent Feelings of Guilt 26% Alcohol Abuse in the last year 25% Psychiatric history, substance abuse, and recent feelings of depression, anxiety, or guilt are common risk factors for suicides in the Navy. However, the most common observation associated with Navy suicides are recent life stressors including relationship problems or loss, work problems, or legal problems. Even Sailors that normally perform and cope well with most challenges can become overwhelmed or lose perspective when faced with a loss of important relationships or career. Psychiatric history, substance abuse, and recent feelings of depression, anxiety, or guilt are common risk factors for suicides in the Navy. However, the most common observation associated with Navy suicides are recent life stressors including relationship problems or loss, work problems, or legal problems. Even Sailors that normally perform and cope well with most challenges can become overwhelmed or lose perspective when faced with a loss of important relationships or career.

5. 5 Why Do People Commit Suicide Current research and theory in the field of suicidology point to 4 key elements that combine for a suicide to occur (Joiner 2005) Psychological pain Person�s belief that s/he is ineffective and has become a burden to others Person�s belief that s/he does not belong and that any important relationships are disrupted Acquired ability to enact lethal self-injury Theory suggests that the vast majority of suicides follow a person�s experience of psychological pain, a belief that he or she is no longer effective or is a burden to others, and a belief that he or she no longer belongs. Theory also suggests that people have to work up to lethal self harm with: mental rehearsal, non-lethal self harm, or pain exposure. Objective circumstances that can be more readily measured and reported are not as critical as the person�s reaction to and interpretation of those circumstances. The process leading to suicide invariably includes distorted and increasingly rigid thinking. The suicidal state of mind is generally temporary and reversible with timely assistance. Prevention efforts are focusing on preventing or catching early situations that may spiral into problems (in self and shipmate) and on recognizing and appropriately intervening when warning signs are observed in a shipmate. Awareness that times of transition and change often interrupt effectiveness and belonging suggests additional vigilance at those times. Such times include return from deployment, divorce or breakup, death of a friend or family member, injury, transfer, and change of residence. Theory suggests that the vast majority of suicides follow a person�s experience of psychological pain, a belief that he or she is no longer effective or is a burden to others, and a belief that he or she no longer belongs. Theory also suggests that people have to work up to lethal self harm with: mental rehearsal, non-lethal self harm, or pain exposure. Objective circumstances that can be more readily measured and reported are not as critical as the person�s reaction to and interpretation of those circumstances. The process leading to suicide invariably includes distorted and increasingly rigid thinking. The suicidal state of mind is generally temporary and reversible with timely assistance. Prevention efforts are focusing on preventing or catching early situations that may spiral into problems (in self and shipmate) and on recognizing and appropriately intervening when warning signs are observed in a shipmate. Awareness that times of transition and change often interrupt effectiveness and belonging suggests additional vigilance at those times. Such times include return from deployment, divorce or breakup, death of a friend or family member, injury, transfer, and change of residence.

6. 6 I IDEATION. Thoughts of suicide expressed, threatened, written or otherwise hinted at by efforts to find means to suicide. S SUBSTANCE USE. Increased or excessive alcohol or drug use. P PURPOSELESSNESS. Seeing no reason for living or having no sense of meaning or purpose in life. A ANXIETY. Feeling anxious, agitated, or unable to sleep. (Or sleeping all the time). T TRAPPED. Feeling trapped, like there is no way out. H HOPELESSNESS. Feeling hopeless about self, others, the future. W WITHDRAWAL. Withdrawing from family, friends, usual activities, society. A ANGER. Feeling rage or uncontrolled anger, seeking revenge for perceived wrongs. R RECKLESSNESS. Acting without regard for consequences, excessively risky behavior, seemingly without thinking. M MOOD CHANGES. Experiencing dramatic changes in mood.  Warning Signs�IS PATH WARM� Warning signs include thoughts or hints of suicide, substance abuse, purposelessness, anxiety, feeling trapped or hopeless, withdrawal from people and activities, anger, recklessness and mood changes. You can remember these warning signs with the acronym IS PATH WARM.Warning signs include thoughts or hints of suicide, substance abuse, purposelessness, anxiety, feeling trapped or hopeless, withdrawal from people and activities, anger, recklessness and mood changes. You can remember these warning signs with the acronym IS PATH WARM.

7. 7 Resilience Factors Factors that improve a person�s capacity to get through adversity include strong relationships and unit cohesion, use of humor, healthy lifestyle, problem solving skills, positive attitude about getting help, a positive outlook, spiritual support, and beliefs that support self-preservation. Factors that improve a person�s capacity to get through adversity include strong relationships and unit cohesion, use of humor, healthy lifestyle, problem solving skills, positive attitude about getting help, a positive outlook, spiritual support, and beliefs that support self-preservation.

8. 8 ASK ~ Don�t be afraid to ask CARE ~ Listen, offer hope, don�t judge TREAT ~ Take action, get assistance, follow up!! Every Sailor has a responsibility to ACT. ASK Ask the shipmate that had a few drinks�. � �Do you need a ride home?� Ask the friend who�s looking tired�. - �Are you having trouble sleeping? Something on your mind?� Ask the person that nags at your gut feeling�.. �Are you thinking of suicide?� CARE Are you listening? - Don�t underestimate the power of real listening. Pay attention and listen without judgment Offer hope � most problems really can be solved with time and the right support Let the person know you will stick with them through tough times TREAT Take suicidal threats seriously � don�t leave a suicidal person alone Get to appropriate support to tackle problems before reckless behaviors make things worse If you are helping someone who is suicidal, stay with them until you get them to professional care Follow up � ACT � keep Asking, Caring, and TreatingEvery Sailor has a responsibility to ACT. ASK Ask the shipmate that had a few drinks�. � �Do you need a ride home?� Ask the friend who�s looking tired�. - �Are you having trouble sleeping? Something on your mind?� Ask the person that nags at your gut feeling�.. �Are you thinking of suicide?� CARE Are you listening? - Don�t underestimate the power of real listening. Pay attention and listen without judgment Offer hope � most problems really can be solved with time and the right support Let the person know you will stick with them through tough times TREAT Take suicidal threats seriously � don�t leave a suicidal person alone Get to appropriate support to tackle problems before reckless behaviors make things worse If you are helping someone who is suicidal, stay with them until you get them to professional care Follow up � ACT � keep Asking, Caring, and Treating

9. 9 Be direct Be willing to listen Be non-judgmental Get involved Don�t dare him or her to do it Don�t act shocked Don�t be sworn to secrecy Offer hope ACT Get help Helping a Suicidal Person Even when you know what to do, many people feel anxious or unsure when faced with needing to ACT to help a shipmate. Practice through role play or mental rehearsal can help muster the confidence needed to save a life. Even if you are not sure what to say, stay present, listen, offer hope and help the person get to help.Even when you know what to do, many people feel anxious or unsure when faced with needing to ACT to help a shipmate. Practice through role play or mental rehearsal can help muster the confidence needed to save a life. Even if you are not sure what to say, stay present, listen, offer hope and help the person get to help.

10. 10 Prevention Approach

11. 11 Command Suicide Prevention ProgramsOPNAVINST 1720.4 Appoint a Suicide Prevention Coordinator Navy Suicide Prevention Program at the Command level consists of 4 key areas: Training, Intervention, Reporting, and Response Each command is required to appoint a suicide prevention coordinator to make sure that their command has an appropriate program implemented. Policy is detailed in OPNAVINST 1720.4, dated 28 Dec 2005..Navy Suicide Prevention Program at the Command level consists of 4 key areas: Training, Intervention, Reporting, and Response Each command is required to appoint a suicide prevention coordinator to make sure that their command has an appropriate program implemented. Policy is detailed in OPNAVINST 1720.4, dated 28 Dec 2005..

12. 12 Leader messages on suicide prevention topics Annual Training (GMT) Helping shipmates -every member�s duty Factors that increase and decrease Risk Appropriate actions responses How to obtain assistance Health Promotion / Life Skills (OPNAVINST 6100.2A) Training Suicide Awareness training is required. While training materials can cover the overall topic, it is essential for command to supplement with information on the procedures and plan at each command, what local support resources are available and how to get to them. At a minimum, all Sailors must have annual training that includes understanding their responsibility to help a shipmate, factors that increase and decrease risk, how to appropriately act to help a shipmate, and how and where to get assistance.Suicide Awareness training is required. While training materials can cover the overall topic, it is essential for command to supplement with information on the procedures and plan at each command, what local support resources are available and how to get to them. At a minimum, all Sailors must have annual training that includes understanding their responsibility to help a shipmate, factors that increase and decrease risk, how to appropriately act to help a shipmate, and how and where to get assistance.

13. 13 Written Suicide Prevention and Crisis Response Plan Identify Sailors in need of assistance Command-Directed Mental Health Evaluation SECNAVINST 6320.24A Provide support for those seeking help Ensure access to supportive resources Follow up Intervention Each command must have a written suicide prevention and crisis response plan. That includes procedures to identify Sailors in need of assistance and ensuring access to supporting resources. When a Sailor appears to have thoughts of suicide but declines self referral for mental health evaluation, Commands can initiate a Command Directed Mental Health Evaluation using the guidance in (SECNAVINST 6320.24A) Follow up is very important. For example, often in depression, energy comes back before thinking processes fully change and people may have greater risk of acting out their thoughts of self-harm. Also, recovery and re-integration takes time and continued support.Each command must have a written suicide prevention and crisis response plan. That includes procedures to identify Sailors in need of assistance and ensuring access to supporting resources. When a Sailor appears to have thoughts of suicide but declines self referral for mental health evaluation, Commands can initiate a Command Directed Mental Health Evaluation using the guidance in (SECNAVINST 6320.24A) Follow up is very important. For example, often in depression, energy comes back before thinking processes fully change and people may have greater risk of acting out their thoughts of self-harm. Also, recovery and re-integration takes time and continued support.

14. 14 DoDSER (Department of Defense Suicide Event Report) All suicides or undetermined deaths where suicide has not been ruled out Keep copies of medical/personnel records to complete report Used to understand factors related to Navy suicides to inform prevention efforts and policy Personnel Casualty Report / OPREP /SITREP Suicide Attempts Other Suicide Related Behaviors Reporting In addition to the casualty report, commands must complete a DODSER - Department of Defense Suicide Event Report We recommend you keep copies of medical and personnel records to more easily complete the report. The information is used to understand factors related to Navy suicides and inform prevention efforts and policy decisions.In addition to the casualty report, commands must complete a DODSER - Department of Defense Suicide Event Report We recommend you keep copies of medical and personnel records to more easily complete the report. The information is used to understand factors related to Navy suicides and inform prevention efforts and policy decisions.

15. 15 Chaplain / Fleet and Family Support Centers SPRINT � Special Psychiatric Rapid Intervention Teams CACO � Casualty Assistance Calls Officer Suicide Response Suicide often results in significant grief and distress for those left behind. Active efforts to assist can facilitate healing and recovery. Chaplains, Fleet and Family Support Counselors, and Special Psychiatric Rapid Intervention Teams are all available to assist Leaders in responding to a suicide. As with all casualties, a Casualty Assistance Calls Officer is assigned to provide administrative help to next of kin. Commands are encouraged to send representation or participate in memorial services and facilitate support resources for families.Suicide often results in significant grief and distress for those left behind. Active efforts to assist can facilitate healing and recovery. Chaplains, Fleet and Family Support Counselors, and Special Psychiatric Rapid Intervention Teams are all available to assist Leaders in responding to a suicide. As with all casualties, a Casualty Assistance Calls Officer is assigned to provide administrative help to next of kin. Commands are encouraged to send representation or participate in memorial services and facilitate support resources for families.

16. 16 Initiatives Big Picture � Operational Stress Control OPNAV N135 Personal Readiness Summits www.suicide.navy.mil FY09 poster series and new brochure Front line supervisor training Policy changes One of the ways Behavioral Health and Operational Stress Control personnel in OPNAV N135 assist commands is through the Personal Readiness Summits held around the world at major Fleet concentration areas and large installations. At the PR Summits, subject matter experts provide command-level personnel information and training on suicide prevention and stress control. . One of the ways Behavioral Health and Operational Stress Control personnel in OPNAV N135 assist commands is through the Personal Readiness Summits held around the world at major Fleet concentration areas and large installations. At the PR Summits, subject matter experts provide command-level personnel information and training on suicide prevention and stress control. .

17. 17 If we ACT to look out for those in need & get them needed help, we can dramatically reduce this preventable cause of death Resources Chain of Command Fleet and Family Support Center Chaplains / Religious Services Medical Treatment Facility / Mental Health Military One Source 1-800-342-9647 Use your support resources to resolve problems early before they get worse and to help assist a Sailor in trouble. These resources include the chain of command, Fleet and Family Support Services, Chaplains, Medical and Mental Health, and Military One Source. For more information on Navy Suicide Prevention go to www.npc.navy.mil/CommandSupport/SuicidePreventionUse your support resources to resolve problems early before they get worse and to help assist a Sailor in trouble. These resources include the chain of command, Fleet and Family Support Services, Chaplains, Medical and Mental Health, and Military One Source. For more information on Navy Suicide Prevention go to www.npc.navy.mil/CommandSupport/SuicidePrevention

18. 18 Navy Suicides During and Post OIF/OEF Deployment Transition times can be particularly challenging. Note the increase in suicides in the 6 months after deployment. Moves, turnover, change in family circumstances all add stress and may temporarily reduce supportive resources as Sailors readjust to the new situation. - These are important times to reach out and make sure people are taken care of. Transition times can be particularly challenging. Note the increase in suicides in the 6 months after deployment. Moves, turnover, change in family circumstances all add stress and may temporarily reduce supportive resources as Sailors readjust to the new situation. - These are important times to reach out and make sure people are taken care of.

19. 19 Support Service Use Prior to Suicide Research shows most Navy suicides did not see any supportive resources in the month before their death. On the flip side, those who are getting assistance, by and large get better and stay alive and mission capable.Research shows most Navy suicides did not see any supportive resources in the month before their death. On the flip side, those who are getting assistance, by and large get better and stay alive and mission capable.

20. 20 If you have thoughts of suicide, realize people are willing to help with more solutions than you can think of on your own � give help a chance � don�t wait until your thinking closes in on you Time and again when we lose a shipmate to suicide, those left behind would have been more than willing to help � if given a chance Give Help a Chance Depression and stress can affect how we think and see situations to make them seem hopeless when there really are solutions and hope. If you have thoughts of suicide, this is a flag to say your thinking may not be clear and flexible at the moment. This lets you know its definitely time to talk to someone who can to help you understand alternatives and get to some emotional relief and clearer thinking. Give Help a ChanceDepression and stress can affect how we think and see situations to make them seem hopeless when there really are solutions and hope. If you have thoughts of suicide, this is a flag to say your thinking may not be clear and flexible at the moment. This lets you know its definitely time to talk to someone who can to help you understand alternatives and get to some emotional relief and clearer thinking. Give Help a Chance

21. 21 Reaching out when problems are small keeps them from growing to be overwhelming If you or someone you know is Feeling unhappy often Not enjoying things as much Having trouble sleeping or eating Getting irritable Making poor choices about alcohol Having relationship problems ACT � reach out to the support team and get back up to full speed as early as possible Take Care of Each Other It is our duty to take care of each other and It is OK to get help before behavior escalates into more damaging consequences It is our duty to take care of each other and It is OK to get help before behavior escalates into more damaging consequences

22. 22 Navy Suicide Characteristics CONUS 89% Occurred while on liberty 67% Location was residence 67% Method was firearm 54% Alcohol factor 33% Most suicides in the Navy occur in CONUS on liberty at the residence. Alcohol is a factor in a third of suicides. Firearms are the major method used.Most suicides in the Navy occur in CONUS on liberty at the residence. Alcohol is a factor in a third of suicides. Firearms are the major method used.