WHAT WE ARE READING:
- Wenzel, A., Brown, G. K., & Beck, A. T. (2009). Cognitive therapy for suicidal patients. Washington, DC: American Psychological Association.
- Jobes, D.A. (2006). Managing suicidal risk: A collaborative approach. New York, NY: The Guilford Press.
- Joiner, T. (2010). Myths about suicide. Cambridge, MA: Harvard University Press.
- Joiner, T. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
- Rudd, M.D. (2006). The assessment and management of suicidality. Sarasota, FL: Professional Resource Press.
TRAINING HANDOUTS:
Columbia Suicide Severity Rating Scale (C-SSRS) Factsheet
VA Suicide Prevention Program Facts about Veteran Suicide July 2016
Appendices Air Force Guide Suicide Risk 27 JUNE 2014
AAS Risk Factors for Suicide and Suicidal Behaviors
MOBILE APPS:
Virtual Hope Box (VHB) – is intended to help patients who are already engaged in treatment by helping to decrease the subjective experience of distress. The app facilitates adaptive coping and emotion regulation skills. The VHB uniquely applied technology to support behavior health earning the app the 2014 Department of Defense Innovation Award. When using the app, patients can personalize the content, including adding custom supportive media (i.e., pictures, songs, videos). The Virtual Hope Box has four main categories. First, the Distract Me area, users will have access to games that can shift their attention away from upsetting thoughts or experiences. Second, the Inspire Me area, patients will be able to read inspirational quote and can save meaningful quotes of their own as well. Next, relaxation and meditation exercises are found in the Relax Me area of the app. Finally, the Coping Tools area includes Coping Cards and an activity planner.
https://deploymentpsych.org/resources/apps#VHB
BLOGS TO HIGHLIGHT:
Staff Perspective: Suicide Awareness Month by Elizabeth Parins
Staff Perspective: Suicide Postvention - Don’t Forget Clinician Survivors by Lisa French
Staff Voices: Review of The Bridge by Regina Shillinglaw
Staff Perspective: The Virtual Hope Box! by Sharon Birman
GUEST BLOGS:
ADDITIONAL BLOGS:
Staff Perspective: Substance Use as a Suicide Warning Sign or Risk Factor by Regina Shillinglaw
Staff Perspective: “The S Word” - A Must See Documentary! by Sharon Birman
Staff Perspective: The Importance of Self-Forgiveness by Regina Shillinglaw
Staff Perspective: A Look at the 2014 Department of Defense Suicide Event Report by Lisa French
Staff Perspective: A Look at the 2013 Department of Defense Suicide Event Report by Lisa French
Staff Voices: A Look at an Important Book for Therapists by Augusto Ruiz
Staff Voices: A Look at Social Cognition and Suicide Risk by Michelle Cornette
Staff Perspective: New VA Suicide Prevention Efforts by Christopher Adams
Staff Perspective: A Look at Suicide Risks Among Female Vets by Christopher Adams
Staff Voices: A Look at Pharmacotherapy and Suicide by Michelle Cornette
Staff Perspective: Self-Discrepancy and Suicidal Ideation by Michelle Cornette
REPORTS AND GUIDELINES:
Department of Defense Suicide Event Reports (2016-2008 DoDSER editions): The DoDSER is used for a variety of suicide behaviors including suicides, suicide attempts, and some other suicide related behaviors (e.g., deliberate self-harm or some cases in which only suicidal ideation is documented). Each Service conducts a professional review of records and conducts interviews where appropriate.
CY 2013 DoDSER Annual Report: http://www.dspo.mil/Portals/113/Documents/2013-DoDSER-Annual-Report.pdf
CY 2014 DoDSER Annual Report: http://www.dspo.mil/Portals/113/Documents/CY%202014%20DoDSER%20Annual%20Report%20-%20Final.pdf
CY 2015 DoDSER Annual Report: http://www.dspo.mil/Portals/113/Documents/CY%202015%20DoDSER%20Annual%20Report.pdf?ver=2017-06-23-151226-953
CY 2016 DoDSER Annual Report: http://www.dspo.mil/Portals/113/Documents/DoDSER%20CY%202016%20Annual%20Report_For%20Public%20Release.pdf?ver=2018-07-02-104254-717
VA/DoD Clinical Practice Guideline: Assessment and Management of Patients at Risk for Suicide (June 2013): The guideline describes the critical decision points in the management of Suicidal Risk Behavior (SRB) for suicidal self-directed violent behavior and provides clear and comprehensive evidence-based recommendations incorporating current information and practices for practitioners throughout the DoD and VA Health Care systems.
DoD Directive: Defense Suicide Prevention Program (June 2013):This directive a. Establishes policy and assigns responsibilities for implementation of the Defense Suicide Prevention Program in accordance with the recommendations of the final report of the Department of Defense Task Force on Prevention of Suicide by Members of the Armed Forces (Reference (a)) pursuant to section 733 of Public Law (PL) 110-417 (Reference (b)),section 533 of PL 112-81 (Reference (c)), and sections 580-583 of PL112-239 (Reference (d)). b. Establishes the Suicide Prevention General Officer Steering Committee (SPGOSC) and the Suicide Prevention and Risk Reduction Committee (SPARRC) under the authority of DoD Instruction (DoDI) 5105.18 (Reference (e)).
Suicide Prevention Efforts of the Veterans Health Administration (January 2013): Responsibility for prevention of veteran suicide lies primarily with the Veterans Health Administration (VHA), within the Department of Veterans Affairs (VA). The VHA Strategic Plan for Suicide Prevention is based on a public health framework, which has three major components: (1) surveillance, (2) risk and protective factors, and (3) prevention interventions. ... This report identifies challenges the VHA faces in each component of suicide prevention and discusses potential issues for Congress. A recurring theme is the need for the VHA to work in concert with other federal, state, and local government agencies; private for-profit and not-for-profit healthcare providers; veterans, their families, and their communities; and other individuals or organizations that might be able to help. Specific challenges in surveillance include timeliness of data, accurate identification of decedents as veterans, and consistent classification of deaths as suicides. Challenges in risk and protective factors research include a need for more collaboration and dialogue among agencies involved in suicide prevention and across other areas of public health (because suicide has some of the same risk and protective factors as other public health problems). Challenges in VHA suicide prevention interventions also include the need for more collaboration and dialogue, as well as an apparent gap between policy and practice, and misperceptions about mental illness and mental health care.
VA OIG -- Combined Assessment Program Summary Report: Re-Evaluation of Suicide Prevention Safety Plan Practices in Veterans Health Administration Facilities (March 2011): The VA Office of Inspector General, Office of Healthcare Inspections completed a re-evaluation of Veterans Health Administration (VHA) facilities’ suicide prevention safety plan (SPSP) practices. The purpose was to evaluate the extent VHA mental health (MH) providers consistently developed SPSPs for patients assessed to be at high risk for suicide. Inspectors evaluated SPSP practices at 45 facilities during Combined Assessment Program reviews conducted from January 1 through September 30, 2010. VHA facilities recognized the importance of developing comprehensive, timely SPSPs for high-risk patients. Additionally, VHA issued appropriate timeframes for initiating SPSPs. However, despite VHA’s efforts to comply with suicide prevention program requirements, problems with SPSP development continue to occur. We recommended that the Under Secretary for Health, in conjunction with Veterans Integrated Service Network and facility senior managers, ensure that MH providers develop and document timely SPSPs that meet all applicable criteria. The Under Secretary for Health concurred with the finding and recommendation. The implementation plan is acceptable, and we will follow up until all actions are complete.
The Challenge and the Promise: Strengthening the Force, Preventing Suicide and Saving Lives (August 2010): As directed by Section 733 of the National Defense Authorization Act for the fiscal year 2009, the Secretary of Defense established a Task Force "to examine matters relating to the prevention of suicide by members of the Armed Forces." The Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces was created and comprised of seven DoD and seven non-DoD professionals with expertise in national suicide prevention, clinical care in mental health, military chaplaincy and pastoral care, and military families. The report explains the evolution of suicide prevention programs within each of the Services and at the enterprise level with DoD. The Task Force arrived at 49 findings and 76 associated recommendations which are discussed within the body of the full report.
The Safety Planning Intervention Manual: Veteran Version (April 2018): This manual describes a brief clinical intervention, safety planning, that can serve as a valuable adjunct to risk assessment and may be used with veterans who have made a suicide attempt, have suicide ideation, have psychiatric disorders that increase suicide risk, or who are otherwise determined to be at high risk for suicide. This manual is intended to be used by VA mental health clinicians, including suicide prevention coordinators, as well as other VA clinicians who evaluate, treat, or have contact with patients at risk for suicide in any VA setting. A safety plan is a prioritized written list of coping strategies and sources of support that patients can use during or preceding suicidal crises. The intent of safety planning is to provide a pre-determined list of potential coping strategies as well as a list of individuals or agencies that veterans can contact in order to help them lower their imminent risk of suicidal behavior. It is a therapeutic technique that provides patients with something more than just a referral at the completion of suicide risk assessment. By following a pre-determined set of coping strategies, social support activities, and help-seeking behaviors, veterans can determine and employ those strategies that are most effective. The purpose of this manual is to provide a detailed description of how VA clinicians and patients may collaboratively develop and use safety plans as an intervention strategy to lower the risk of suicidal behavior. This approach is consistent with the Recovery Model, which views veterans as collaborators in their treatment and fosters empowerment, hope, and individual potential.
MILITARY RESOURCES FOR SUICIDE PREVENTION:
The Army Suicide Prevention Program has a comprehensive list of suicide prevention information to include policy guidance, frequently asked questions, training links, references/resources, and a Commander’s Tool Kit. In addition, you can also find a link to information pertaining to the Army’s Suicide Prevention Month efforts. Visit their website for more information on Suicide Prevention Month activities, training resources, talking points, posters, and other relevant information. US Army Reserve suicide prevention resources are made available through the US Army Reserve Psychological Health Program (PHP).
The Air Force Suicide Prevention Program (AFSPP) and the Air Force Medical Service (AFMS) provide an overview of the AFSPP and also have links to relevant policy/guidance, resources, suicide prevention videos, an outreach/communication toolkit, the Airman’s Guide for Assisting Personnel in Distress, frequently asked questions about suicide, as well as many other resources. In addition, the Air Force has developed the Wingman Project taking a public health approach to suicide prevention which encourages a strong Wingman culture by removing barriers to seeking help responsibly and encouraging Airmen to get help when they need it. The website provides various suicide prevention and resilience training resources, including numerous vignettes, videos, and other training tools. Wingman Online includes training materials and videos specifically addressing the needs of including Air Guard, Air Force Reserve members, focusing on building a resilient Wingman culture, including among other resources the Air Force Reserve Component Suicide Prevention Training Manual and the Air Force Reserve Component Suicide Prevention Group Discussion: Facilitator Manual. To further support the Wingman culture, the Air Force developed a Virtual Wingman smartphone app compatible with both IOS and Android.
The Psychological Health Advocacy Program (PHAP) advocates for Air Force Reserve members and their families regarding their mental health. Our case management and outreach services allow our clients to function within the demands of his or her environment. We accomplish this mission by using creative initiatives and collaboration with public & private organizations to effectively address the mental health needs of the Air Force Reserve community.
The Navy’s Suicide Prevention Program provides an overview of the Navy’s suicide prevention efforts and provides various links to relevant statistics and informational products, training materials, policy/guidance, resources, suicide prevention videos, and more. The Navy’s Command Suicide Prevention Program provides all materials relevant to Navy Commanding Officer's Responsibilities and Navy Suicide Prevention Coordinator's Responsibilities. In addition, the Navy developed the Sailor Assistance and Intercept for Life (SAIL) Program, an evidence informed approach designed for immediate intervention, ongoing risk assessment, care coordination and reintegration support for Service members with suicidal thoughts and behaviors. In addition, the Navy provides resources specific for US Navy Reserve members.
The Marine Corps Suicide Prevention Program (MCSPP) has information about the MCSPP as well as their “Never Leave a Marine Behind” suicide prevention training, including a list of “Never Leave a Marine Behind” resources. There are links for resources and information as well as specific links for Marines and Family, Command and Leaders, and Health Professionals. The website also provides a link to the Marine Corps DSTRESS Line that was developed by the Marine Corps to provide professional, anonymous counseling for Marines, attached Sailors, and families. The DSTRESS Line (1-877-476-7734) allows callers to seek assistance 24/7/365 from “one of their own” such as veteran Marines, former Fleet Marine Force Corpsmen, or civilians with exposure or specialized training in Marine Corps culture.
The Coast Guard’s Suicide Prevention (CGSUPRT) Program provides information about the purpose of the GCSUPRT Program, services/resources available, and related hotlines and websites. The website also provides information on the toll-free number (855)-CGSUPRT (247-8778) that is available to Coast Guard members 24/7 to assist with mental health emergencies.
National Guard suicide prevention efforts include various resources, including a six-part training series helping to cultivate resiliency at all levels of the National Guard.
Guard Your Health is a resource for National Guard and family members. The website includes a host of health-related tools and information, including a Risk Reduction Toolkit for Guard members.
The Department of Defense Guard and Reserve Support Network (GRSN) is a DoD-wide partnership of programs supporting the needs of the National Guard and Reserve community.
Defense Suicide Prevention Office (DSPO) provides advocacy, program oversight, and policy for Department of Defense suicide prevention, intervention and postvention efforts to reduce suicidal behaviors in Service members, their families and DoD civilians. DSPO strives to actively engage and partner with the Military Services, other Governmental Agencies, Non-Governmental Agencies, non-profit organizations, and the community to reduce the risk for suicide for Service members, their families, and DoD civilians.
Psychological Health Center of Excellence (PHCoE) collaborates across the Defense Department, the Department of Veterans Affairs and other agencies to provide leadership and expertise, inform policy and drive improvements in psychological health outcomes. Their missions are to improve the lives of our nation's service members, veterans, and their families by advancing excellence in psychological health care, readiness, and prevention of psychological health disorders. The website has information about suicide statistics, as well as links assessments tools, information about means safety counseling, recommendations for treatment and policy guidance.
The “Be There” Peer Assistance Line is the only dedicated Department of Defense (DoD) peer support call and outreach center available to all Service members across the Department (including the National Guard and Reserves) and their families. The program is staffed by peer coaches who are Veteran Service members and spouses of prior Service members, and is available 24/7 through chat, email, phone and text. Communications between peer counselors and Service members are confidential.
Military OneSource is a confidential Department of Defense-funded program providing comprehensive information on all aspects of military life at no cost to active duty, Guard and Reserve Component members, and their families. Military OneSource provides policy and programmatic information, helpful resources, products, articles and tips on numerous topics related to military life. Confidential services are available 24 hours a day by telephone and online. In addition, Military OneSource offers confidential call center and online support for consultations on a number of issues such as spouse education and career opportunities, issues specific to families with a member with special needs, health coaching, financial support, and resources.
The Department of Veterans Affairs (VA) Suicide Prevention Website has information on the Veterans Crisis Line (1-800-273-8255, and press 1 or text to 838255) that Veterans and their loved ones can call 24/7/365 to receive free, confidential support. Veterans Chat offers a similar service, but via online chat. Both services can be used even if individuals are not registered with VA or enrolled in VA health care. The website also has information about suicide warning signs, self-assessment tools, suicide prevention resources, brochures and information sheets, and campaign material. Additionally, individuals can locate their local Suicide Prevention Coordinator and/or download and print information sheets, posters, or editable contact and event flyers.
Rocky Mountain MIRECC for Suicide Prevention: The CoE is overseen by VA's Mental Health Services focusing on a public health approach to suicide prevention efforts in our nation's veterans. Rocky Mountain MIRECC had been a leader in the research and development of promising clinical interventions and innovative prevention strategies. The website provides a host of resources/information, clinical tools, training materials and more, including information about the Self-Directed Violence Classification System and the Therapeutic Risk Management assessment tool.
Make the Connection is a public awareness campaign by the U.S. Department of Veteran Affairs (VA) that provides personal testimonials and resources to help Veterans discover ways to improve their lives.
Real Warriors Campaign provides information/resources for service members, veterans, families, and health professionals. The Real Warriors Campaign, launched in 2009, is a multimedia public awareness campaign designed to address stigma reduction and encourage help-seeking behavior among service members, veterans and military families coping with invisible wounds.
Afterdeployment is a wellness resource for the military community featuring information, videos and assessment tools for various behavioral health issues.
Tragedy Assistance Program for Survivors (TAPS) is the 24/7 tragedy assistance resource for anyone grieving the loss of a military loved one, regardless of the relationship to the deceased or the circumstance of the death
ADDITIONAL WEBSITES:
American Association of Suicidology (AAS) is a charitable non-profit organization dedicated to promoting the understanding and prevention of suicide and support those who have been affected by it. The website provides resources, training and updated information on a wide range of topics related to suicide.
National Institute of Mental Health (NIMH) is the lead federal agency for research on mental disorders. NIMH is one of the 27 Institutes and Centers that make up the National Institutes of Health (NIH), the largest biomedical research agency in the world. NIH is part of the U.S. Department of Health and Human Services (HHS) focused on understanding and treating mental illness through clinical research. The website provides a variety of resources, information, summary of ongoing research and helpful links related to suicide prevention.
Suicide Prevention Resource Center (SPRC) is a government-sponsored website provides prevention support, training, and resources to assist organizations and individuals to develop suicide prevention programs, interventions and policies, and to advance the National Strategy for Suicide Prevention. The site also provides an opportunity to subscribe to the Spark, a weekly e-newsletter containing related announcements, news stories, and links.
Zero Suicide is an aspirational framework defined by a systemwide, organizational commitment to safer suicide care in health and behavioral health care systems. Zero Suicide is a key concept of the 2012 National Strategy for Suicide Prevention, a priority of the National Action Alliance for Suicide Prevention, a project of Education Development Center's Suicide Prevention Resource Center (SPRC), and supported by the Substance Abuse and Mental Health Services Administration (SAMHSA).
American Foundation for Suicide Prevention (AFSP) is the nation’s leading voluntary health organization developing a community bringing together people across communities and backgrounds to understand and prevent suicide. AFSP gives those affected by suicide a nationwide community empowered by research, education and advocacy to take action against this leading cause of death.
Suicide Prevention Action Network USA (SPAN USA) is the public policy program of AFSP, dedicated to preventing suicide through public education and awareness, community engagement, and federal, state and local grassroots advocacy
Substance Abuse and Mental Health Services Administration (SAMHSA) provides suicide prevention information and other helpful resources to behavioral health professionals, the general public, and people at risk. The website includes a comprehensive list of SAMHSA publications and related resources on suicide prevention.
National Alliance on Mental Illness (NAMI) is dedicated to building better lives for the millions of Americans affected by mental illness. Advocates for access to services, treatment, supports and research and is steadfast in its commitment to raising awareness and building a community of hope for all of those in need.
The Means Matter Campaign: Harvard University's School of Public Health supports an initiative devoted to reducing suicide by reducing a suicidal person's access to lethal means, especially firearms, during a suicidal crisis. The Means Matters Website contains research summaries, practical strategies, slideshows, brochures, state survey results, state data, and program examples.
Individuals in need of crisis assistance can contact the National Suicide Prevention Lifeline. Trained consultants are available 24/7 and can be contacted by dialing 1-800-273-TALK (8255) or by visiting their website at http://www.suicidepreventionlifeline.org.
CT-SP Resources:
Brown, G. K., Karlin, B. E., Trockel, M., Gordienko, M., Yesavage, J., & Taylor, C. B. (2016). Effectiveness of cognitive behavioral therapy for veterans with depression and suicidal ideation. Archives of Suicide Research, 20(4), 677-682. doi:10.1080/13811118.2016.1162238
Brown, G. K., Tenhave, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. Journal of the American Medical Association, 294(5), 563-570. doi:10.1001/jama.294.5.563
Bryan, C. J., Gartner, A. M., Wertenberger, E., Delano, K. A., Wilkinson, E., Breitbach, J., . . . Rudd, M. D. (2012). Defining treatment completion according to patient competency: A case example using brief cognitive behavioral therapy (BCBT) for suicidal patients. Professional Psychology: Research and Practice, 43(2), 130-136. doi:10.1037/a0026307
Guille, C., Zhao, Z., Krystal, J., Nichols, B., Brady, K., & Sen, S. (2015). Web-based cognitive behavioral therapy intervention for the prevention of suicidal ideation in medical interns: A randomized clinical trial. JAMA Psychiatry, 72(12), 1192-1198. doi:10.1001/jamapsychiatry.2015.1880
Henriques, G., Beck, A. T., & Brown, G. K. (2003). Cognitive therapy for adolescent and young adult suicide attempters. American Behavioral Scientist, 46(9), 1258-1268. doi:10.1177/0002764202250668
Leavey, K., & Hawkins, R. (2017). Is cognitive behavioural therapy effective in reducing suicidal ideation and behaviour when delivered face-to-face or via e-health? A systematic review and meta-analysis. Cognitive Behaviour Therapy, 46(5), 353-374. doi:10.1080/16506073.2017.1332095
Mewton, L., & Andrews, G. (2016). Cognitive behavioral therapy for suicidal behaviors: Improving patient outcomes. Psychology Research and Behavior Management,1(9), 21-29. doi:10.2147/PRBM.S84589
Stanley, B., Ph.D., Brown, G., Ph.D., Brent, D. A., M.D., Wells, K., Ph.D., Poling, K., L.C.S.W., Curry, J., Ph.D., . . . Hughes, J., B.A. (2009). Cognitive-behavioral therapy for suicide prevention (CBT-SP): Treatment model, feasibility, and acceptability. Journal of the American Academy of Child & Adolescent Psychiatry, 48(10), 1005-1013. doi:10.1097/CHI.0b013e3181b5dbfe
Wenzel, A., & Beck, A. T. (2008). A cognitive model of suicidal behavior: Theory and treatment. Applied and Preventive Psychology, 12(4), 189-201. doi:10.1016/j.appsy.2008.05.001
Wenzel, A., Brown, G. K., & Beck, A. T. (2009). Cognitive therapy for suicidal patients. Washington, DC: American Psychological Association.
Wenzel, A., & Jager-Hyman, S. (2012). Cognitive therapy for suicidal patients: Current status. The Behavior Therapist, 35(7), 121.