The Army Suicide Prevention Program

1. The Army Suicide Prevention Program Suicide Prevention and Awareness Training for the United States Army Prepared by The American Association of Suicidology And The U. S. Army Center for Health Promotion and Preventive Medicine This new manual outlines a strategy for presenting the Army Suicide Prevention Program to the members of the Army Family. It allows the presenter great latitude to personalize the presentation and adapt it to the target audience. It provides resource material to build a suicide prevention presentation for soldiers, family members and civilians, however, it is not meant to be a packaged or �canned� presentation. The presenter must assimilate this information and then present it in his or her own way to make it most effective.This new manual outlines a strategy for presenting the Army Suicide Prevention Program to the members of the Army Family. It allows the presenter great latitude to personalize the presentation and adapt it to the target audience. It provides resource material to build a suicide prevention presentation for soldiers, family members and civilians, however, it is not meant to be a packaged or �canned� presentation. The presenter must assimilate this information and then present it in his or her own way to make it most effective.

2. Enabling Learning Objectives Describe primary, secondary and tertiary suicide prevention. Identify personal and environmental protective factors. Know information about local support resources and programs.

3. Enabling Learning Objectives 4. Promote cohesion and a sense of belonging. 5. Destigmatize and encourage help seeking.

5. Structure

6. Personal Protective Factors Easy temperament. Previous experience with self-mastery, problem solving, crisis resolution. Optimistic outlook. Social/emotional competence. High self esteem, self worth.

7. Personal Protective Factors Decision making, problem solving skills. Sense of personal control, self efficacy. Sense of belonging to a group and/or organization. High and realistic expectations. High spiritual resiliency.

8. Environmental Protective Factors Strong family relationships. Models of healthy coping. Encouragement of participation. Opportunities to make significant contributions

9. Environmental Protective Factors Available social supports. Available helping resources. Healthy spiritual/religious affiliation. Cultural and religious beliefs against suicide and in support of self-preservation.

10. Support The Reasons for Living Inventory, Linehan, Goodstein, Nielsen & Chiles (1983) Spirituality and Resilience Assessment Packet, Version 4.2, Kass (2000)

11. Connections save lives.

12. Seeking help is a sign of effectively dealing with problems, and of strength rather than weakness.

13. A good leader does not expose those under his/her command to unnecessary risk.

14. Support Promote a norm of mutual support among all military personnel: we are our brother�s keepers! Pay attention to warning signs and respond to those who need help.

15. Support Pay close attention to the personal needs of your people, and be on the lookout for signs of stress. Communicate in your words and actions that it is not only acceptable, but a sign of strength, to recognize life problems and get help to deal with them constructively.

16. Support Support and protect to the fullest extent possible those courageous people who seek help early, before a crisis develops.

17. Support Create a responsive, caring, and responsible community where individuals are motivated to seek help with personal struggles without fear of stigmatization.

18. Support Foster a social climate in your unit that communicates to everyone, �you belong here�.

19. Understand the benefits of gated screening. Be informed about the confidentiality of screening results. Be informed about secondary screening instruments.

20. Screen The Army Structure makes screening viable. Screening must be gated. The Suicide Prevention Task Force collects and reports anonymous data.

21. Screen Not No more A little more A lot more at all than usual than usual than usual

22. Screen Goldberg Well-being Scale information will be disclosed only to the individual and will be used only to assess and assist personnel during of times of distress Unit Trends may be reported to the Unit Commander as a gauge of his/her unit well-being

23. Screen

24. Gatekeeper Lesson 1 All Personnel

25. Gatekeeper Lesson 1Enabling Learning Objectives Understand The Suicide Model. Answer general questions about suicide. Identify common precipitants of suicide. Identify symptoms of depression. Identify myths about suicide. Identify warning signs of suicide. Take appropriate action in response to at-risk individual.

26. Main Points The Suicide Model. What is suicide? Why should we know about suicide? Why do people commit suicide? Some stressful situations that can trigger suicidal feelings in the Army. Who commits suicide?

27. Main Points Groups with special problems that can cause suicidal feelings. Misconceptions about suicide. How can you tell if someone is thinking about committing suicide? Common symptoms of depression & hopelessness. Referral procedures.

29. The Problem of Suicide Serious suicidal thoughts or threats. Self destructive acts Attempts to harm, but not kill oneself. Attempts to commit suicide. Completed suicide.

30. Categories of Suicide Lack of control related to needs for achievement, order, or understanding. Problems with self-image related to frustrated needs for affiliation

31. Categories of Suicide Problems with key relationships related to grief and loss in life. Excessive anger, rage, and hostility.

32. Numbers and rates per 100,000 of Suicides in the Army

33. Gatekeeper Lesson 2 Officers & NCOs

34. Gatekeeper Lesson 2Enabling Learning Objectives Inquire about suicide. Respond to phone callers. Obtain help for suicidal individuals.

35. Responding to Statements or Threats Stay calm. Send someone for help. Do not leave alone. Buy time.

36. Responding to Statements or Threats Acknowledge. Listen. Convey.

37. Responding to Statements or Threats

38. Asking About Suicide Review your evidence. Inquire or state about feelings. Persist. �Sometimes� approach.

39. Asking About Suicide Ask directly. Get help. Convey concern.

40. The only thing that will save a human life is a human relationship.

41. Gatekeeper Lesson 3 Formal Gatekeepers

42. Gatekeeper Lesson 3Enabling Learning Objectives Identify Risk Factors for Suicide. Conduct Basic Risk Assessment.

43. Risk Assessment Questions Have you been thinking of killing yourself? What has happened that makes life not worth living? How will you do it?

44. Risk Assessment Questions How much do you want to die? How much do you want to live? How often do you have these thoughts? When you think of suicide, how long do the thoughts stay with you?

45. Risk Assessment Questions Have you ever attempted suicide? Have you been drinking heavily lately or taking drugs? Has anyone in your family committed or attempted suicide? Is there anyone or anything to stop you? On a scale of 1 to 10, what is the probability that you will kill yourself?

46. Secure

47. Enabling Learning Objectives Become knowledgeable about Army suicide policies and procedures. Conduct Advanced Risk Assessment.

48. Local policies and procedures set by the Suicide Prevention Task Force An individual suspected of being at risk for suicide. An individual who is talking about/threatening suicide.

49. Local policies and procedures set by the Suicide Prevention Task Force An individual who attempts suicide. A completed suicide.

50. Steps in Suicide Assessment Set the stage for the interview. Assess for risk factors and warning signs for suicide. Inquire about suicidal ideation. Determine the level of suicide risk.

51. Assessing the Suicide Plan Perturbation. Cognitive construction. Intentionality. Lethality of the plan.

52. Assessing the Suicide Plan Specificity. Method or means. Availability & accessibility of means.