Addressing Suicide with Military-Connected Patients

This training module begins with a discussion of the rates of suicide in the civilian and military population. Next, stigma is discussed with an emphasis on the impact of stigma on help-seeking behaviors in the military. Participants are introduced to the Self-Directed Violence Classification System, a nomenclature for self-directed violence. The VA/DoD Clinical Practice Guidelines for Assessment and Management of Patients at Risk for Suicide are reviewed, highlighting best practices for assessment and treatment of suicide ideation and behavior. This is followed by a review of suicide risk assessment including discussion of risk factors, warning signs, and protective factors related to suicide, laying the foundation for discussion of the Fluid Vulnerability Theory of risk assessment. Initial management of suicidal patients is presented including in-depth discussion of safety planning for suicide. The presentation ends with an overview of evidence-based treatments and suggested resources for additional training.

1. Assess the prevalence of suicide in the civilian and military population.
2. Characterize components of risk assessment for suicide with a focus on military specific risk and protective factors.
3. Apply the steps used in developing a safety plan for suicide.

I. Scope of suicide problem

a. Global and national rates of suicide
b. Military health significance of suicide
c. Veteran health significance of suicide

II. Stigma related to suicide

a. Common myths
b. Mental health and stigma in the military

III. Nomenclature

a. Self-directed violence classification system
b. Terms to describe suicidal thoughts and behaviors

IV. Dr. David Rudd’s Fluid Vulnerability Theory

a. Acute risk
b. Baseline risk

V. Assessing risk

a. VA/DoD Clinical Practice Guidelines
b. Risk factors, protective factors, and warning signs
c. Risk Stratification Tool
d. Case example

VI. Initial safety management of suicide

a. Steps to completing a safety plan for suicide
b. Crisis intervention
c. Levels of care

VII. Treatment interventions

a. Empirically supported treatments
b. Commitment to Treatment statement

VIII. Resources