With September declared national Suicide Prevention Month and the rate of veteran suicides making headlines, the Homer S. Townsend Jr. Memorial Lecture at Wednesday's Paralyzed Veterans of America Summit + Expo was right on cue at the Gaylord National Resort & Convention Center in National Harbor, Md.
Three speakers, Sunil Sabharwal, MD, David Carroll, PhD, and Caitlin Thompson, PhD, made the case to clinicians and other health care professionals in attendance that suicide prevention is everyone's responsibility and therapeutic intervention should begin at the primary care level.
Sabharwal says while the Department of Veterans Affairs (VA) has made strides in suicide prevention and has formed community partnerships, there is little evidence-based research on suicide prevention among veterans with spinal-cord injuries (SCI), which sometimes makes it difficult for health care providers to figure out their role.
"Suicide is a public health issue," Carroll says. "In fact, I would say it's a public health crisis in the United States."
Between 2001 and 2014, the rate of suicide in the civilian population increased by almost 24%, and death by suicide is the 10th-leading cause of death in the U.S. The 2014 data also shows that 20 veterans each year die from suicide, even though some reports have set that number at 22. Roughly two-thirds of veteran suicides are among those over age 50, and two-thirds of suicides are the result of a firearm injury.
Those with SCI are three to four times more likely to commit suicide, think about suicide or attempt suicide than the general population, Sabharwal says. The first five to six years following injury were the highest risk for those patients.
Caitlin Thompson, PhD, speaks about suicide prevention at the Homer S. Townsend Jr. Memorial Lecture at PVA Summit + Expo on Wednesday, Aug. 30, 2017 in National Harbor, Md.
However, there is data that suggests the rate of increase in suicide among veterans increased significantly less among those who receive care in the VA than those who aren't connected to VA care.
"This is everyone's business," Carroll says. "This isn't just the responsibility for the folks who work in the mental health clinic at the end of the hallway or for the suicide prevention coordinators, but this is everyone's responsibility and we can all do something about it. That's really the great news."
Thompson gave an overview of some of the training available for VA staff to make them feel more comfortable broaching the subject of suicide with their patients. She also dispelled some myths regarding suicide, including if someone simply asks if a person is thinking about suicide, it puts the idea into that person's head and leaves the person who brought up the question feeling guilty. Another fear is what to do if the person says he or she is suicidal.
"If you ask somebody if they're feeling suicidal, if they feel like taking their own life, it in fact opens up this huge conversation for them," Thompson says. "It shows that you're not scared to talk about possibly the most difficult feelings in somebody's life."
Thompson said it's important to listen closely to the language people use in talking about how they feel and to follow up with those people, since about 80% of people who die by suicide gave some kind of warning.
"Most people who are feeling suicidal can get better. There's treatment," Thompson says. "It's going to the VA, it's going to a clinic, it's reaching out and talking with somebody."
The VA offers training for staff called Operation S.A.V.E., which stands for signs of suicidal thinking should be recognized, ask the most important question of all, validate the veteran's experience and encourage and expedite treatment.
Signs include feelings of hopelessness, changes in behavior, engaging in risky activities without thinking, increasing alcohol or drug use or withdrawing from family and friends. Primary reasons for suicide are relationship problems, physical pain and financial issues.
Signs that warrant immediate attention are when someone indicates he or she is looking for ways to die and buys firearms for that purpose or begins stockpiling medication. In those cases, the Veterans Crisis Line is available at 1-800-237-8255, ext. 1, and can help expedite treatment. The VA also employs 400 suicide prevention coordinators, and there are a variety of online resources available as well.
The bottom line, Thompson said, is people shouldn't be afraid to ask the question directly and shouldn't try to couch it in a condescending way or in softer terms.
"There isn't much that you can say that's wrong, it's just validating that person's experience," she says. "Even though inside you might be freaking out because right now you're with somebody who's saying they're suicidal and that is just so scary. But on outside, it's being confident and talking with the person. It's just saying, 'We're gonna get through this together. You're gonna be okay. We're going to get you some help, and I am here with you, not passing judgement ... the guilt is not going to work."
For health care professionals, it's important to communicate with others on a patient's care team if the patient exhibits any warning signs. While veterans may receive ongoing mental health assessment and treatment, Sabharwal says an inpatient psychiatric unit is currently the best option for those at immediate risk.
Carroll emphasized the importance of gun and opioid safety for people who are acutely suicidal. The VA has distributed over 3 million free gun locks, complete with the Veterans Crisis Line phone number printed on them.
"We know just in that moment, interrupting someone's moment of desperation, if the gun is locked, that saves lives," Carroll says.
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