Addressing Suicidal Behavior in the U.S. Military: Strategies for Assessment, Crisis Intervention, and Treatment

A. Perceptions of Suicide

  1. Global Burden of Suicide
  2. National Burden of Suicide
  3. Myths About Suicide
  4. Suicide, Military Culture, and Stigma

B.  Classification of Suicidal and Related Behaviors

  1. Self-Directed Violence Classification System
  2. Suicidal Intent
  3. Self-Directed Violence:  Nomenclature
  4. Definitional Pitfalls
  5. Classification Exercise

C. Epidemiology of Suicide

  1. Suicide Rates by Ethnicity and Age Group
  2. DoD Suicide Deaths by Component and Calendar Year
  3. Army Active Duty Suicide Deaths
  4. DoD Suicide Rates by Service, Component, and Gender
  5. Military Deployment and Suicidal Behavior
  6. Military Veteran Suicide Rates
  7. Military Protective Factors
  8. Military Protective Factors:  Leadership
  9. DoD/ VA Initiatives

D. General Population Suicide Risk & Protective Factors

  1. Conceptual Model of Suicide Risk
  2. Risk Factors for Suicide
  3. Risk Factors/ Warning Signs for Suicide with Significant Empirical Support
  4. Case Study
  5. Acute Warning Signs

E.  Characteristics of Military Suicides/ Military Risk Factors

  1. In what ways can certain risk factors be particularly military –relevant? 
  2. Unique Military Considerations
  3. Suicide Method
  4. Firearm Access and Availability
  5. Suicide Attempt History
  6. Mental Health Diagnosis and Treatment History
  7. Traumatic Brain Injury (TBI)
  8. Chronic Pain
  9. Sleep
  10. The Role of PTSD
  11. DoDSER 2010 Suicide Death Statistics
  12. Location/ Setting
  13. Method
  14. Substance Use at Time of Completed Suicide

F.  Suicide Risk Down Range

  1. Insomnia
  2. Agitation and Hyperarousal
  3. Social Support

G. Psychological Theories of Suicide Risk

  1. “Shoulder to Shoulder”
  2. History of Suicide Risk Theories
  3. Interpersonal-Psychological Theory of Suicide Risk (IPT)
  4. Thwarted Belongingness
  5. Perceived Burden
  6. Acquired Ability
  7. IPT and Implications for the Military
  8. Examining IPT in Military Veterans
  9. A Qualitative Study of Potential Suicide Risk Factors in Returning Combat Veterans
  10. Focus Group
  11. A Test of IPT in Active Duty Air Force Personnel
  12. Research Supporting Acquired Capability

H.  Suicide Risk Assessment

  1. Suicide Risk Assessment & Prediction:  Challenges
  2. Fluid Vulnerability Theory of Suicide
  3. Chronic (Baseline) Risk
  4. Multiple Attempters
  5. Acute Risk
  6. Nature of Suicidal Thinking
  7. Self-Report Measures of Suicidal Ideation/ Behavior
  8. Self-Report Measures:  Advantages
  9. Self-Report Measures:  Disadvantages
  10. Suicide Risk Assessment Via Clinical Interview
  11. Suicide Risk Assessment Down Range
  1. Forward-Deployed Combat Support Hospitals (CSHs)/ Medical Evacuation
  2. Command Considerations

I. Suicide Intervention Strategies

  1. Therapeutic Relationship
  2. Crisis Intervention
    1. Suicide Risk Continuum and Indicated Responses
    2. Crisis Intervention Tools
    3. Public Health Approach to Crisis Intervention
    4. Means Restriction
    5. Promising Means Restriction Intervention
    6. Means Restriction Counseling
    7. Crisis Intervention
    8. Crisis Intervention :  Hospitalization
    9. Crisis Intervention:  Symptom Matching Hierarchy
    10. Crisis Intervention:  Crisis Card
    11. Crisis Intervention:  Mood Graphing
    12. Crisis Intervention:  Survival Kit
  3. Psychotherapy
  1. Empirically-Supported Treatments
  2. Promising Treatments
  3. Dialectical Behavioral Therapy (DBT):  An Overview

    i.DBT:  Evidence

    ii.DBT:  Goals

    iii.Treatment Venues

    iv.Individual Psychotherapy

    v.Group Skills Training

    vi.Telephone Consulatation

    vii.Weekly Therapist Consultation

  4. Cognitive Therapy for Suicidal Patients

    i.Narrative Description of the Suicidal Crisis

    ii.Constructing a Timeline of the Suicidal Crisis

    iii.Cognitive Case Conceptualization

    iv.Identification of Core and Intermediate Beliefs

    v.Treatment Planning

    vi.Developing Treatment Goals

    vii.Intermediate Treatment Phase

    viii.Behavioral Strategies

    ix.Affective Coping Strategies

    x.Cognitive Strategies

    xi.Later Treatment Phase

    xii.Relapse Prevention

  5. Treatment of Suicidal Ideation and Behavior Down Range

i.Treatment of Insomnia

ii.Treatment of PTSD

iii.Treatment of Agitation and Hyperarousal

iv.“Unit Watch”

v.Limited Access to Mental Health Services

J. Special Considerations

  1.  Implications for Inpatient Treatment
  2. National Center for Patient Safety Criteria
  3. Challenging Patient Issues
  4. Therapist Attitudes Toward Suicidal Patients
  5. Provider Self-Care
  6. Gatekeeper Training

Notes: Demonstrations, role-plays, videos, and case examples will be incorporated throughout the presentation. recommend prerequisite for this course is Identification, Prevention, and Treatment of Suicidal Behavior for Service Members and Veterans