Suicide Prevention

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COL Sargent's Public Service Announcement on Suicide Prevention

COL Sargent discusses the seriousness of suicide prevention and the many options for those seeking behavioral health care. View this Public Service Announcement video.

Suicide is a leading cause of death in the Army during peacetime. It is important to take a proactive stance on this issue to prevent suicide and respond to those who may be at risk. This page covers getting help fast, risk factors, signs and symptoms, and things you can do to help someone who is feeling suicidal.

A Message From the TRICARE Management Activity

We regard each suicide that occurs within the U.S. military as a tragic event; even one is too many. The military services have vigorous suicide prevention programs designed to protect our service members and their families.

The Army's suicide prevention program formally began in 1984 when the Army Chief of Staff directed that a panel of experts be formed to review existing suicide prevention efforts and determine what additional steps could be taken to reduce the rate of suicide. The original action plan was based upon early leadership involvement through command policy and action. Installation efforts were coordinated through a Health Promotion Council, which synchronized various installation and community staffs and agencies.

In 2000, the Army refined its suicide prevention program to focus on five major strategies:

• Developing life-coping skills
• Encouraging help-seeking behaviors
• Raising awareness and vigilance to suicide prevention
• Integrating suicide prevention programs
• Conducting suicide surveillance and analysis

The Department of Defense (DoD) takes a community approach to suicide prevention and awareness. While there is a large health care component to the suicide prevention program, it is sponsored by the military leadership, and involves the chaplains, the family support centers, the chain of command and each individual service member in identifying someone in crisis who needs help.

For Families at Home

In this time of high operational tempo and long deployments, many families are under additional stress themselves and are concerned for their loved ones overseas. For families experiencing problems, help is available through their local family support center.

How To Get Help Fast

If you are feeling suicidal, or suspect someone you know might be, the following mental health agencies are available for help:

Resource		Building		Phone		Serves		Duty Hours
CHAPLAIN				287-CHAP				24 Hours
Psychology		Darnall Medical Center		285-6347		Active Duty, Dependents, Retirees		Monday – Friday 8:00 AM to 3:00 PM
Darnall Medical Center Emergency Department		Darnall Medical Center		288-8114		Active Duty, Dependents, Retirees		24 Hours

• The Chaplain Hot Line and the Carl R. Darnall Army Medical Center Emergency Room offer 24 hour, 7 day per week service.
• Soldiers from the 1st Cavalry Division and 4th Infantry Division should be referred to their respective mental health clinics.
• Non-divisional soldiers should be referred to the Community Mental Health Service at Darnall Army Medical Center.

How To Help Someone Who Is Suicidal

You are the first line of defense for the people you work and interact with on a daily basis, because you will be the first to detect the warning signs and changes. Below are some common warning signs of suicide and the actions you can take in assisting the suicidal individual in getting the help they need.

Know The Facts About Suicide

• Myth: People who talk about suicide rarely attempt or commit suicide.
  Fact: People who commit suicide almost always give clues or warning signs about their intentions.
  Talking about suicide is a warning sign and should be explored, not ignored. Do not try and determine if the person is serious or trying to avoid work. Always take the person seriously and immediately seek help. It is always better to be safe than sorry.
• Myth: Talking to someone about their suicidal feelings will cause them to commit suicide.
  Fact: Asking someone about their suicidal feelings usually makes them feel relieved that someone cares.
  A suicidal person already has thoughts of harming him/her self. Talking about it will not create or reinforce those thoughts. Most suicidal people want and need to talk to someone about their feelings but lack the courage to do it, or are unsure on how to approach someone about it. Asking them about their feelings may break the ice and ease the person's anxiety about openly expressing their thoughts. Talking about their thoughts allows them to express their feelings and to realize there are other options available, making it more likely they will be receptive to getting help.
• Myth: All suicidal people want to die and there is nothing that can be done about it.
  Fact: Most suicidal people are undecided about living or dying and frequently call for help before and after attempts.
  80% of suicidal people do not want to die. They believe they have used all their options and death is the only escape to their problems. They see death as a new beginning not an ending, "If I could fall asleep and wake up in a new life, or awake in a different place with all my problems solved." They fail to realize death is a permanent solution to a temporary problem.
• Myth: Suicide is an act of impulse with no previous planning.
  Fact: Most suicides are carefully planned and thought about for weeks.
  Suicide is a calculated response. People do not walk across a bridge and jump after one bad day.

Risk Factors

• Depressed - Depression is the most significant factor in suicidal behavior.
• Alcohol/Substance abuse - Increase of alcohol consumption may occur. A social drinker may start to drink heavily and a heavy drinker may get intoxicated more frequently. Increased consumption of tobacco products may occur.
• Recent Loss - The recent loss of an important individual may trigger suicidal impulses.
• Past Suicide Attempts - Previous suicidal behavior can predispose a person to use a suicide attempt as a coping mechanism.
• Lack of Support System - The person may become more withdrawn. He/she may not be active in unit programs, social events, church or religious groups, or appear to have any regular friendships. Suicides occur most often when the individual is unsupervised, away from the work place.
• Recent Divorce or Separation - Suicide is often preceded by deterioration in a significant personal relationship such as a break-up or divorce.
• Perceived Personal Failure - The suicidal person may feel that he or she has not met personal, military, or societal goals or expectations. He or she may be pending military or civil legal proceedings.
• Demographic risk factors - 85% of Army suicides are committed by younger soldiers. They overwhelming tend to be white, male, E-4 and below, and single either with no spouse or are divorced or separated.

Symptoms Of Depression

Depression is a major cause of suicide. Encourage soldiers to get help for depression. With proper treatment, 80 to 90% of people with depression can be helped.

• Appetite - The depressed person may increase eating and snacking all day or decrease from 3 meals a day to 1 or less.
• Helplessness, Hopelessness, Worthlessness - The depressed person feels like giving up on life, feels trapped and feels there is nothing anyone can do to change things.
• Crying Spells - The depressed person often cries for no apparent reason.
• Decreased Work Performance - The depressed person often shows changes in behavior such as showing up for formations late, forgetting appointments, not completing taskings or not doing them to standard, or receiving negative counseling, Article 15's, UCMJ action, etc.
• Decreased Motivation - The depressed person often has a lethargic attitude of "I just don't care any more", accompanied by decreased energy level and failure to find any pleasure in life.
• Sleeping - The depressed person may have increased sleep, up to 14 - 15 hours a day, or may have sleeping difficulty, 2-4 hours a day, with frequent wake-ups and restless sleep, which results in not feeling rested in the morning.
• Personal Appearance -The depressed person may appear in a wrinkled uniform and have uncharacteristically disheveled appearance.

Suicide Warning Signs

• Obsession with Death - An overall obsession with morbid thoughts, listening to music with death as a theme, writing poetry about death, talking frequently about what it would be like to be dead.
• Concrete Plans - A what, when, where, and how plan for suicide.
• Communication of Intent - Telling people about suicidal intentions.
• Access to Means - Most completed suicides are committed with personally owned firearms.
• Irritable - The pre-suicidal person may exhibit violent or aggressive outbursts. This sign is very predictive of suicidal risk.
• Withdrawn/Isolated - The pre-suicidal person may withdraw and isolate themselves from others.
• Increased Use Of Alcohol/Substances - The pre-suicidal person may increase the use of alcohol or other substances.
• Giving Away Personal Items - He or she gives away high-dollar and meaningful items for no apparent reason.
• Deliberate Self Injury - Deliberate self-injury may be a key warning sign of an impending suicide.
• Saying Good-Bye - The person who has decided to commit suicide may say good-bye to friends or acquaintances in either oral or written form.

Administer AID and Think LIFE

These useful acronyms can save lives. Remember AID LIFE if you are confronted with someone who exhibits one or more suicide warning signs. These actions are imperative to maximize the suicidal person's safety.

Provide AID:
A = ASK. Ask the person "are you thinking about hurting or killing yourself?" Don't be afraid to ask this question.
I = INTERVENE. Contact a family member, mental health clinic or the chain of command.
D = DON'T KEEP IT A SECRET.

THINK LIFE
L = LOCATE HELP. Help can be in the form of the Staff Duty Officer, Chaplain, a Doctor, a Nurse, a friend, a family member, a Crisis Line, or the Hospital Emergency Room.
I = INFORM. Inform the Chain of Command.
F = FIND SOMEONE. Find someone to stay with the suicidal person. Don't leave the person alone.
E = EXPEDITE EFFORTS. Expedite efforts to get help at once. Suicidal persons require immediate action.

Intervening

Certain rapid interventions are essential to minimizing the risk of a completed suicide in those persons who are at risk. Just as important are the negative interventions which must be avoided when confronted with a person at risk for suicide.

• Do Take the Individual Seriously - Do not make light of the situation. Let them know you believe them.
• Do Ask Key Questions - Ask some tough and direct questions. Asking these questions is an uncomfortable process. Do not shock the individual by frantically blurting these questions out. Try to establish a good rapport before asking the questions. Let them know these are tough uncomfortable questions to ask but that they must be asked. The information is necessary to get the help they need.
  • Do you want to kill yourself?
  • Do you have a plan? (how when where)
  • Do you have a weapon?
  • Do you feel you will be better off dead?
• Do Listen Carefully - Focus on truly listening. Listen for key facts, how, when, where etc. Be attentive with feedback but do not try to solve problems or "fix" the person. Give your undivided attention.
• Do Stay With Them - Stay with them until he/she receives appropriate assistance.
• Do Watch For Physical Indicators - Watch for the symptoms described above
• Do Check For Means (Weapons)
• Do Assist Soldier to Get Help - contact your chain of command chaplain or mental health professional and stay with them until they get the help they need.
• Do Support and Reinforce Need For Immediate Mental Health Intervention - "I would like to help take you to a counselor, chaplain, the chain of command, or a friend".
• Do Try To Establish Rapport - Try to establish rapport with the potentially suicidal individual so that he or she will be more amenable to referral and follow up.
• Do Identify and Explore the Positive - You can help the suicidal individual by helping them to see the good things in their life, the reasons they have to stay alive. Find out what the soldier values and holds important then focus on those things.
  • What has kept you from killing yourself?
  • What do you value in life?
  • Do you have religious beliefs?
  • Do you have children, pets, any close family members?
• Do Check for Support Systems - See if the individual has close friends or family, or is involved in church activities, clubs, or organizations. This will help you establish rapport with them as well as remind him/her of things they enjoy or might miss when they are gone.
• Do Stay Positive - Concentrate on positive aspects of the individual's life to include positive interpersonal relationships, as well as good memories and experiences.
• Do Find Out If the Individual Has a Religious Belief System - Ask him/her what faith group he or she belongs to. This may help refer them to a specific member of the unit ministry team.
• Do Let the Person Know That You Are Concerned and Care About Them - Show positive regard for them as an individual. Be sincere in letting them know that he/she is priority one and all other things can wait.
• Do NOT Blow Them Off - Do not say things like, "Suck it up" or "You will get over it"
• Do NOT Leave Alone - Never under any circumstances leave the individual alone. Make sure someone is watching them at all times.
• Do NOT Moralize or Judge - Do not preach to the individual or make them feel he/she is weak, cowardly, or less of a person for having suicidal ideations.
• Do NOT Publicly Shame or Humiliate - Similarly, shame and humiliation do nothing to encourage them to feel better about themselves.
• Do NOT Act Shocked
• Do NOT Dare The Person To Do It
• Do NOT Keep a Secret - Let them know up front that you have to let the appropriate people know about their feelings so they can get the help they need. Assure them you will not tell anyone who can not assist in the helping process.
• Do NOT Try to Solve the Problem - Do not offer quick fixes to the individual like, "Let's just go have a drink and forget about your troubles" or "What you need is a new woman/man".

Things to Remember:

• Do not leave those who are having emotional problems alone.
• True friends do not leave buddies who are having emotional problems.
• True friends do not try to bury the problem.
• True friends express concern.
• True friends intervene when necessary to save a buddy's life.
• Do not bury or try to solve their problems because you're uncomfortable (know yourself).
• Express genuine care and concern (positive regard)
• Be assertive/proactive intervene when necessary to save a life.
• Buddies DO NOT ignore buddies in emotional distress and DO NOT try to bury the problems which are presented to them.
• Buddies DO express concern, and DO intervene when necessary to save a buddy's life.

Other Related Resources

Additional Suicide Prevention Information for Unit Commanders
Dealing With Stress