Tag Archives: suicide prevention

Communications Between Line Leaders and Mental Health Providers

2.10Upholding a culture that supports seeking help as a sign of strength is an all hands effort that is built upon trust, one of the five Principles of Resilience. This trust must be cultivated between Sailors and their leaders through ongoing engagement and support, which will in turn help Sailors trust in the many resources available to them should they need additional care.

As we continue to make progress in breaking down the barriers that may prevent Sailors from seeking help for psychological health concerns, commanders must ensure that they are acting in ways that support Sailor wellness while enhancing unit readiness. To that end, Navy Suicide Prevention and the Bureau of Navy Medicine and Surgery (BUMED) recommend that all commanders familiarize themselves with the policies in place to balance their need to monitor the welfare of their unit with the confidentiality protections that medical providers must adhere by in the best interest of Sailors. In order for Sailors to gain maximum benefit from mental health care services, they must feel reasonably certain that the details they share with a provider will remain private, helping to mitigate the potential decision to not to seek assistance out of fear of consequences. Line leaders and providers share in the responsibility of upholding Sailors’ rights and promoting recovery.

Department of Defense Instruction (DoDI) 6490.08 provides guidance on information flow to balance the challenges between patient-provider confidentiality and the rights of commanders, outlining the level of detail a commander can access to ensure the well-being of their unit members and maximize unit readiness. Based on this instruction, BUMED’s Psychological Health Advisory Board has developed a graphic outlining communications between the line and medical communities which is now available on the Suicide Prevention website. This graphic provides at-a-glance information on topics such as notification to commands, clarification of the minimum notification standard, best practices for sharing mental health information and additional resources. This tool is not only useful for commanders to facilitate a closer understanding of the decision making process providers must adhere to, but for key personnel (such as suicide prevention coordinators) to help dispel misperceptions among their shipmates regarding mental health treatment.

To facilitate productive dialogue—and trust—between providers and commands, line leaders should seek to develop ongoing relationships with local health providers. Proactive discussion about policies and procedures will better serve both the commander and provider when making key decisions and determining ongoing support needed for Sailors during and beyond the reintegration process. Most importantly, Sailors will feel more comfortable seeking the resources available to them knowing that their leadership has a full understanding of what can and cannot be discussed. This is yet another way we can take proactive measures to improve the lines of communication and support every Sailor, every day.

An Intensely Personal Issue

By: Lt. Mark Peugeot, Ph.D., Clinical Psychologist, U.S. Naval Hospital Guam

September is Suicide Prevention Month, but what does that mean for us? 

SP Month CartoonWill it mean more training on suicide prevention? For some suicide prevention is a very sensitive issue. Others, who have not been impacted by suicide, please don’t roll your eyes just yet. Suicide prevention is an intensely personal issue for those who believe that barriers to care are what led to the loss of their loved one, friend, battle buddy, or member of their unit. It is entirely possible that if someone had realized the distress the person was experiencing and acted on it that death was preventable. This is where you are needed! You can help prevent death from suicide and you are the front line in the battle against suicide.

Some may not be convinced to read further, but I challenge you to continue reading and understand the importance of the problem we face as service members together. According to the Veterans Administration, in 2010 we lost 105 people each day to suicide, making suicide the third largest cause of death in the United States for persons under the age of 25. Of the suicides in the United States, roughly 1 in 5 persons who complete suicide is a veteran. This means we lose nearly 18- 22 veterans a day to suicide or as many as 8,000 of our brothers and sisters who have served this country each year. In the past, active duty military service members were significantly less likely to complete suicide and exhibited rates far below that of the general population (VA/DoD, 2013). Department of Defense data from 2012 however indicates that active duty member suicide rates have peaked significantly above the general population (DoD, 2013). If this doesn’t show that the fight against suicide is at our front door, I don’t know what will.

As a clinical psychologist, I know that psychologists, psychiatrists, and other allied health care providers can make a difference when caring for an actively suicidal person. Unfortunately, many times health care providers do not ever get the opportunity to intervene because we were not aware of the need. As a clinical psychologist, one of the greatest hurdles to preventing suicide I see is getting the person to walk through our door. The perceived stigma associated with seeking mental health care is one of the most often cited reasons by my patients when I ask why they have delayed seeking treatment. Often times, after seeking and receiving care, my patients adopt a radically different view of mental health treatment, mental health stigma, and what mental health care means to them.

Many of my patients express concern during our initial meetings regarding the long term impact of seeking mental health care. I have heard people tell me that if they go to mental health that it will be the “end of my career”, “limit my ability to pursue specific jobs/assignments”, and “will prevent me from attaining future success.” Frankly, there is always the possibility that mental illness or a specific mental condition might result in any of those outcomes. In practice, however, that is not often the case for the majority of patients. In my experience, many of the patients that are seen in mental health are able to achieve symptom resolution/management and are able to continue their careers without significant adverse impact. This includes depression, anxiety, and a wide variety of other conditions. In other cases, mental health care has prevented the premature ending of careers by providing the support and treatment needed to return service members to full duty. So, while it is true that some conditions are service disqualifying or limiting, many can be successfully treated with the final result being the return of the service member to full duty.

Accurately identifying those who are suicidal can often be more difficult than identifying persons who are experiencing psychological or emotional distress. Should you be aware of a person experiencing emotional or psychological distress, share your concern with them and encourage them to seek professional care. Ask if they are feeling suicidal or have a desire to harm themselves or others, and if they do, stay with them until you can get additional help. There are three direct warning signs that should never be ignored regarding suicide:

  1. Suicidal communications (talking, writing, etc.)
  2. Preparations (divesting of responsibility or assets)
  3. Seeking access to lethal means (firearms, medications, or dangerous/isolated areas)

If you observe any of these warning signs: Don’t think; ACT to ensure the safety of the individual.

In closing, I hope to have achieved two goals in this article. First provide information about how to identify and protect those in need of care. Second, to dispel misinformation surrounding mental health care and reduce the stigma that serves as a boundary to seeking care. Both issues are critical to preventing suicide amongst service members. Seeking help for emotional or psychological problems is important. Seeking help for suicidal thoughts, plans, intent, or behavior is critical! Simply seeking help for emotional or psychological problems will not automatically end your career. Seeking help is not a sign of weakness, but a sign of strength and resilience. Take care of yourself and the sailors around you and don’t let stigma get in the way of your health.

Together we can prevent suicide.

Bibliography

  1. DoD. (2013, 12 20). Department of Defense SuicideEvent Report. Retrieved August 17, 2014, from National Center for Telehealth and Technology: http://www.t2.health.mil/sites/default/files/dodser_ar2012_20140306-2.pdf
  2. VA/DoD. (2013, June). Assessment andManagement of Patients at Risk for Suicide (2013). Retrieved August 17, 2014, from U.S. Department of Veterans Affairs: http:// www.healthquality.va.gov/guidelines/MH/srb/VADODCP_SuicideRisk_Full.pdf

About the Author
LT Mark Peugeot is a licensed clinical psychologist at U.S. Naval Hospital Guam. He graduated from Uniformed Services University of the Health Sciences with a Ph.D. in clinical psychology in February of 2014. LT Peugeot completed a clinical internship at Portsmouth NMC in 2012 before being assigned to U.S. Naval Hospital Guam in October 2012. Prior to being selected to attend USUHS LT Peugeot served 9 years on active duty with the United States Air Force.

Bonus: Check out the September issue of Pacific Pulse, USNH Guam’s monthly newsletter, featuring additional health promotion resources.

Upcoming Webinar to Recognize Mental Health and Suicide Prevention Month

Recognizing and understanding the factors that place Sailors and Marines at risk for suicide and communicating with one another to connect the dots and take 120604-N-KS651-015action play important roles in suicide prevention and intervention efforts, from the deckplate to leadership levels. The Department of the Navy recognizes September as Suicide Prevention Month, and in 2014, the theme for this observance is “Every Sailor, Every Day.” This month serves as a launch pad to promote suicide prevention resources, continuous engagement in suicide prevention efforts, and overall psychological and emotional well-being throughout the year.

In observance of Mental Health and Suicide Prevention Month, Navy and Marine Corps Public Health Center’s Health Promotion and Wellness Department will co-host a webinar with Navy Suicide Prevention Branch (OPNAV N171). Learn more from psychological health experts about the public health approach to suicide prevention. OPNAV N171 will discuss strategies for enhancing your command’s suicide prevention program as well as evidence-based suicide prevention tools.

Participate in the upcoming webinar on September 15, 2014 from 1200-1300 ET. To view the webinar on the day of the event, click on or copy and paste the following link:

https://connect.dco.dod.mil/r5gqvevou2a/

The webinar is intended for command suicide prevention coordinators, transient personnel unit staff, chaplains, first responders, primary care and behavioral health providers, and Navy and Marine Corps health professionals and health educators who can share their resources with the Sailors, Marines, and beneficiaries they support. The webinar is designated for Certified Health Education Specialists (CHES) to receive up to 1 Category 1 CECH. To register, visit http://www.med.navy.mil/sites/nmcphc/health-promotion/Pages/webinars.aspx.

Gearing up for 2014 Suicide Prevention Month

Suicide prevention goes beyond training people to recognize risk factors or what to do in a crisis. It starts with every day actions we can all take to build meaningful connections with our shipmates, staying actively engaged and making sure they know they’re never alone. The theme of 2014 Navy Suicide Prevention Month is Every Sailor, Every Day, focusing on peer connections and personal responsibility. Vice Adm. Matthew L. Nathan, Navy Surgeon General, publicly introduced this message in an October 2013 All Hands Magazine article, imploring Sailors to strengthen their connections with one another and “break the code of silence” when it comes to discussions that may prevent suicide.

To that end, Every Sailor, Every Day messaging for Suicide Prevention Month will promote open communication between shipmates to encourage ongoing support and involvement during both calm waters and rough seas. Every day, we each have the opportunity to be there for our shipmates—and ourselves. By taking simple steps to promote personal resilience (taking care of our physical health and seeking support for stress issues), we can lead by example.

Navy Suicide Prevention Month is a launch-pad for continuous engagement at the deckplate level throughout the year. There is no mandatory project or activity for 2014 Suicide Prevention Month. Rather, to emphasize ongoing engagement and underscore the Every Sailor, Every Day concept, commands are encouraged to utilize Navy Suicide Prevention Month products and messaging to tailor efforts at the deckplate, encouraging open communication, personal wellness, peer support and bystander intervention skills all year long.

Throughout the month of September, the Navy Suicide Prevention Branch will release supporting products including information sheets, blog posts, social media messages, videos and more. Navy Suicide Prevention has also partnered with Navy and Marine Corps Public Health Center this year to offer additional resources, including a targeted training webinar for SPCs, Health Promotion Coordinators and other key influencers on new and updated tools to enhance local suicide prevention efforts. Bookmark Navy and Marine Corps Public Health Center’s Health Promotion and Wellness department webpage for more information.

Together, we can make a difference. It’s about being there for Every Sailor, Every Day.

For more information and resources, click here for the 2014 Navy Suicide Prevention Month webpage.

Postvention is Prevention

Losing a shipmate to suicide is one of the most difficult situations Sailors may face. Those left behind may experience immediate or delayed emotional reactions including guilt, anger, shame or betrayal, and no two people will grieve the same. In the aftermath, finding balance between the grief process and mission demands can be challenging. It’s important for our Navy family to recognize how postvention efforts can serve as psychological first aid to shipmates and loved ones.

Postvention refers to actions that occur after a suicide to support shipmates and family affected by the loss. Because each situation is unique, examples of postvention efforts can include thoughtfully informing Sailors about the death to minimize speculation, one-on-one outreach to those most affected by the suicide, encouraging utilization of support resources and monitoring for reactions.

For a command that has experienced a suicide, fostering a supportive environment is vital to sustaining psychological and emotional resilience. For many, the impact of suicide will not go away just because the memorial service is over and duty calls again. The Five Principles of Resilience can assist with the recovery process following a suicide, helping to promote a healthy grieving process and a return to mission-readiness.

  • Predictability – While suicide is not necessarily predictable, a command’s commitment to a healthy and supportive environment can be. Encourage your shipmates to speak up when they are down, and reassure them that seeking help is a sign of strength. Ensure that support resources are in place and accessible (chaplain, medical, Deployed Resiliency Counselor and/or SPRINT team).
  • Controllability – After a suicide, it’s normal for things to seem out of your control. The grieving process may seem overwhelming at times. Be patient with yourself and with those around you who may be grieving differently. To allow yourself time to regroup, it’s ok to set limits and say “No” to things that may hamper the healing process.
  • Relationships – Our connections with peers and loved ones can be protective factors during challenging times, providing us with a sense of community, hope and purpose. Take a moment out of each day to ask how your shipmates are doing—and actively listen. Start the conversation. It’s all about being there for “Every Sailor, Every Day.”
  • Trust – Trust plays a critical role in withstanding adversity and extends beyond individual relationships. Similar to predictability, the presence of trust before and after a tragedy promotes a supportive command climate and can help preserve mission readiness while promoting emotional health.
  • Meaning – Following a suicide, it’s common to search for answers. While you may never understand the events leading up to the tragedy, leaning on the support of your shipmates and leaders can help strengthen the recovery process by sharing meaning and fostering hope.

The Defense Centers of Excellence has a comprehensive fact sheet with the common emotions experienced while coping with a suicide, in addition to suggestions on how individuals can navigate those emotions.

For additional suicide postvention resources and support, visit: