Study Makes Suicide-Prevention Program Recommendations

HAMPTON, Va. — A new study com­mis­sioned by the Defense Depart­ment affirms many of the sui­cide-pre­ven­tion efforts being made with­in DOD and the mil­i­tary ser­vices and rec­om­mends ways to strength­en them.
In prepar­ing “The War With­in: Sui­cide Pre­ven­tion in the U.S. Mil­i­tary,” the Rand Nation­al Defense Research Insti­tute exam­ined data on mil­i­tary sui­cides, iden­ti­fied what sci­en­tif­ic lit­er­a­ture and lead­ers in the field con­sid­er the best pre­ven­tion strate­gies and rec­om­mend­ed ways to ensure exist­ing pro­grams reflect the state of the art, offi­cials said.

“This is a very thor­ough effort,” Dr. Mark Barnes, direc­tor of the resilience and pre­ven­tion direc­torate at the Defense Cen­ters of Excel­lence for Psy­cho­log­i­cal Health and Trau­mat­ic Brain Injury, said of the report. “Rand inter­viewed each of the ser­vices and went out­side the mil­i­tary to look at sui­cide-pre­ven­tion prac­tices and iden­ti­fied gaps for the way ahead [and] rec­om­men­da­tions for the mil­i­tary sui­cide-pre­ven­tion pro­grams.”

The study’s find­ings track close­ly with those in the Defense Department’s own DOD Sui­cide Task Force Report, Barnes told mil­i­tary health care pro­fes­sion­als attend­ing the first Armed Forces Pub­lic Health Con­fer­ence held here this week.

“There is no dis­agree­ment. They are very com­pli­men­ta­ry in what they are rec­om­mend­ing,” he said. “So we have a nice resource here with qual­i­ty infor­ma­tion that our sui­cide-pre­ven­tion folks can refer to as we move for­ward with the task force rec­om­men­da­tions.”

Navy Capt. Paul Ham­mer, direc­tor of the Defense Cen­ters of Excel­lence for Psy­cho­log­i­cal Health and Trau­mat­ic Brain Injury, called the Rand report an impor­tant tool in help­ing the Defense Depart­ment bet­ter con­front an issue it takes “very seri­ous­ly.”

“The Rand study helps us to iden­ti­fy areas that need improve­ment so that we can con­tin­ue to pro­vide the most com­pre­hen­sive health care for our ser­vice mem­bers –- from the inside out,” he said.

The study, writ­ten for health pol­i­cy offi­cials and sui­cide-pre­ven­tion pro­gram man­agers, rec­og­nized crit­i­cal fac­tors in a com­pre­hen­sive pre­ven­tion pro­gram. These include:
— Rais­ing aware­ness and pro­mot­ing self-care;
— Iden­ti­fy­ing peo­ple at high risk, includ­ing screen­ing for men­tal health prob­lems;
— Elim­i­nat­ing actu­al or per­ceived bar­ri­ers to qual­i­ty behav­ioral health care;
— Pro­vid­ing high-qual­i­ty men­tal health treat­ment and spe­cif­ic inter­ven­tions focused on sui­cide when need­ed;
— Restrict­ing access to firearms and oth­er lethal means, with atten­tion to how lethal med­ica­tions are pack­aged and how door hinges and show­er rods are con­struct­ed; and — Respond­ing appro­pri­ate­ly when sui­cides occur.

Eval­u­at­ing the Defense Department’s sui­cide pre­ven­tion pro­grams, the study cit­ed the poten­tial ben­e­fit of a new DOD-wide sur­veil­lance pro­gram being used to track sui­cides and sui­cide attempts. The DOD Sui­cide Event Report replaced each service’s indi­vid­ual sui­cide-report­ing sys­tem, Barnes explained, help­ing to ensure “apples to apples” com­par­isons as infor­ma­tion is shared across the ser­vices.

“This is a data issue,” he said. “We need good data. The data informs us in how to be effec­tive with pre­ven­tion and health pro­mo­tion. So we are con­tin­u­al­ly improv­ing our data sys­tems.”

Rand also called for an eval­u­a­tion of exist­ing sui­cide pre­ven­tion pro­grams, along with a require­ment that any new ini­tia­tives include an eval­u­a­tion plan. Barnes acknowl­edged the chal­lenge of assess­ing pro­grams’ effec­tive­ness, but called clos­er col­lab­o­ra­tion and infor­ma­tion shar­ing across the Defense Depart­ment and ser­vices a pos­i­tive step toward shar­ing best prac­tices and deter­min­ing what works.

The Rand study rec­og­nizes most mil­i­tary sui­cide-pre­ven­tion pro­grams’ focus on rais­ing aware­ness, includ­ing telling peo­ple where to get help and help­ing them rec­og­nize peers in dis­tress. How­ev­er, it empha­sizes the impor­tance of also teach­ing mil­i­tary mem­bers how to rec­og­nize their own prob­lems and refer them­selves if need­ed to a behav­ioral health pro­fes­sion­al or chap­lain.

“Rais­ing aware­ness and pro­mot­ing self-care is some­thing we do and we can do bet­ter,” Barnes said, not­ing the val­ue of resilience cam­paigns. “The ideas is to give peo­ple skills,” and know how to rec­og­nize signs of risk in them­selves as well as oth­ers, and to know what to do.

The report also iden­ti­fied the impor­tance of part­ner­ships between agen­cies and orga­ni­za­tions respon­si­ble for men­tal health and sub­stance use and oth­er known risk fac­tors for sui­cide.

“We do fair­ly well in terms of part­ner­ships,” Barnes said. “One area we are look­ing at is, on an instal­la­tion, how well do all the dif­fer­ent part­ners work togeth­er in the sui­cide [pre­ven­tion] mis­sion? Because often times you have … one per­son who is the sui­cide pre­ven­tion per­son on an instal­la­tion. They are not going to be able to check in on every­body. It is real­ly the whole instal­la­tion that needs to be on board to be effec­tive with this.”

The study also cit­ed the need to ensure there’s no gap in ser­vices pro­vid­ed dur­ing mil­i­tary mem­bers’ tran­si­tions — between mil­i­tary bases, between com­mands or between active and reserve sta­tus.

“Ensur­ing a con­ti­nu­ity of ser­vices and care is real­ly impor­tant,” Barnes said. “One of the times of increased vul­ner­a­bil­i­ty is dur­ing tran­si­tions. … And we need to be cov­er­ing all the gaps like this proac­tive­ly for our ser­vice mem­bers and their fam­i­lies.”

The study called for for­mal guid­ance for com­man­ders so they know how to respond to sui­cide and sui­cide attempts. It rec­og­nized the lack of any direct pol­i­cy with­in the ser­vices and the risks of han­dling these sit­u­a­tions improp­er­ly.

“It is real­ly about our lead­er­ship,” Barnes said. “We need to empow­er our lead­er­ship, because they set the exam­ple. They set the tone. So we have to give them the tools. We need to give them the infor­ma­tion, the data, so they know what is going on, where we think is the right direc­tion to go, and then get behind them.”

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)

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