My first professional experience with suicide occurred over 20 years ago. The suicide was not one of my clients, but was someone many felt they knew and his death had a huge impact on my professional life. In 1996, I had just moved to Yokosuka, Japan to work as a counselor on a Navy base. It was my first job working for the Navy and I was excited to support Sailors and their families in an overseas environment. At the time I had been out of graduate school only a few years. I was seeking an opportunity to have a positive impact and felt I had the skills and experience to do that on the Navy base.
However, just a few weeks after I moved to Japan, Admiral Boorda, then the Chief of Naval Operations, died by suicide in Washington, D.C. While his death occurred far from us, the impact in our community was immediate. People on the base were visibly impacted by his death and reported feeling as though someone in their family had died. There was confusion and surprise that someone so high-ranking, accomplished, and beloved by Sailors could take his own life. In the days and weeks that followed, I watched and participated in conversations about suicide as well as stigma and myths that surround it.
Despite the fact that the issue of suicide prevention was being discussed frequently, I realized I had limited knowledge about it. During graduate school and the four years since, I had not received much training on suicide prevention. The majority of my clinical training focused on treatment interventions for working with children, couples and families but very little on suicide. My clinical supervision provided guidance on ways to ask clients about intent, plans and means but the only intervention I was taught was how to write a “no-suicide contract” – something that today we actually know has evidence indicating it does not work.
Like many others, I wanted to know how to help. Addressing suicide was daunting and something many thought was an issue best left to researchers to study and experts in the field to treat. However, in the years since, I have found that staying informed about interventions that are known to be effective can be important aspect of making a difference and dealing with loss.
Military leaders and behavioral health providers are continually seeking ways to find a solution to suicide among military Service members. Each time there is a report of a suicide, people invariably wonder what could have been done to prevent the death. In the more than 20 years since Admiral Boorda’s death, we have learned a great deal about research-based interventions and programs which aim to prevent suicide and which are found to work.
One Navy initiative I recently learned about which addresses suicide is called the Sailor Assistance and Intercept for Life (SAIL) program. The SAIL program is a voluntary case management program (similar to one in the Marine Corps called the Marine Intercept Program). In this program, clinical case managers provide “caring” contacts at specified intervals during the critical first few months following a Service member’s suicidal ideation or attempt. SAIL is a program that supplements existing mental health treatment by providing support through the first 90 days after a suicide-related behavior. I am encouraged to see the wide range of services in place as well as the research upon which they are based.
The concept of caring contacts is one that research shows can decrease suicide rates. An early study of “caring” interventions involved 843 patients who had been admitted to a hospital for “depression and suicidal tendencies,” but who either refused or discontinued treatment upon release from the hospital. The patients were assigned to two groups - one received personalized, handwritten letters expressing care, concern and a desire to stay in contact four times per year over five years. The other group did not receive any letters. The group that received the caring letters had significantly lower suicide rates across all five years of the study compared to the group that received no letters (Motto & Bostrom, 2001).
Since 2001, numerous other studies have looked at different types of “caring contacts” including letters, postcards, emails, and texting. One randomized control trial used caring letters in the military and Veteran healthcare systems (Luxton et al., 2014). A component of all of these is a focus on support and sustained contact following incidents of suicidal thoughts or attempts. The outcomes of these studies consistently show promising results.
Over the last 20 years, I have maintained my commitment to stay informed by and involved with organizations addressing suicide prevention. I have learned about treatment that works, programs that are making a difference and ways to address the stigma associated with asking for help. These are the best way I have found to manage the feelings associated with the issue of suicide.
For more information about the Navy SAIL program: https://www.public.navy.mil/bupers-npc/support/21st_Century_Sailor/suicide_prevention/command/Pages/SAIL.aspx
Please visit the CDP's Suicide Prevention Spotlight page for additional information and resources on sucide prevention.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
April Thompson, LCSW, is a clinical social worker currently working as a Military Behavioral Health Social Worker with the Center for Deployment Psychology (CDP) at the Uniformed Services University of Health Sciences (USU) in Bethesda, Maryland.
Luxton, D. D., Thomas, E. K., Chipps, J., Relova, R. M., Brown, D., McLay, R., Lee, T., Nakama H., & Smolenski, D. J., (2014). Caring Letters for Suicide Prevention: Implementation of a Multi-Site Randomized Clinical Trial in the U.S. Military and Veteran Affairs Healthcare Systems. Contemporary Clinical Trials. 37(2), 252-260.
Motto JA & Bostrom AG. A Randomized Controlled Trial of Postcrisis Suicide Prevention. Psychiatr Serv. 2001 Jun; 52(6):828-33.