- Suicide Prevention Basics
- Suicide Risk Assessment
- Initial Management of a Client At Risk
- Safety Planning
- Educational Materials
- Specialized Training
- Additional Resources
- Cool Tool
Suicide Prevention Basics
Crisis feels different for everybody and can stem from a wide range of situations. Some Veterans are coping with aging, stress, or lingering effects stemming from their military service, which were never addressed. Many recent Veterans have difficulty with their relationships or the transition back to civilian life.
Watch encouraging messages of support about reaching out for help.
Many VA resources exist to support Veterans, including suicide prevention staff, crisis call and chat line, and to support providers to assess suicide risk and safety planning. These resources are reviewed in this mini-clinic.
VA Suicide Prevention Coordinators:
VA Suicide Prevention Coordinators and Case Managers are present at each VA to connect with and support Veterans and providers in times of crisis. Use the VA resource locator to find the contact information for your local VA suicide prevention coordinator. You can also call your local VA Medical Center and ask the operator to connect you to the suicide prevention team.
Veterans, family members, or care providers can initiate a free and confidential conversation with an experienced and caring VA responder by calling the Veterans Crisis Line. If you are concerned about the safety and well-being of a Veteran call 1-800-273-8255 and press 1. Use the Veterans Chat to get online support anonymously. A text message can also be sent to 838255 to connect to a VA responder. These resources can be used even if a Veteran is not registered with VA or enrolled in VA health care.
If you have any questions, please refer to the FAQs page for more information about the Crisis and Chat line.
- Veterans can dial 1-800-273-8255 and Press 1 to talk to someone now
- Veterans can start a confidential online chat session at http://www.VeteransCrisisLine.net/chat now
- Veterans can send a text message to 838255 to connect to a VA responder now
- Veterans can take a self-check quiz at http://www.vetselfcheck.org/ now
Suicide Risk Assessment
What is a Suicide Risk Assessment?
Suicide risk assessment is a process in which a healthcare provider gathers clinical information in order to determine the client’s risk for suicide.
When to Conduct a Suicide Risk Assessment?
Any person suspected to be at possible risk for suicide should be formally assessed.
What are the key components of a suicide risk assessment?
A suicide risk assessment should first evaluate the three domains: suicidal thoughts, intent, and behavior including warning signs that may increase the client’s acuity.
The suicide risk assessment should then include consideration of risk and protective factors that may increase or decrease the client’s risk of suicide.
What are warnings signs?
Many suicidal individuals may reveal warning signs or signals of their intention to engage in suicidal behavior.
Warning signs are those observations that signal an increase in the probability that a person intends to engage in suicidal behavior in the immediate future (i.e., minutes and days). Warning signs may be experienced in the absence of risk factors.
In general, there are two different types of warning signs:
DIRECT WARNING SIGNS
- Threatening to hurt or kill self
- Looking for ways to kill self; seeking access to pills, weapons or other means
- Talking or writing about death, dying or suicide
INDIRECT WARNING SIGNS
Other INDIRECT WARNING SIGNS
Presentation(s) or behavioral expressions that may indicate increased suicide risk and urgency in a client at risk for suicide:
- Substance abuse: Increasing or excessive substance use (alcohol, drugs, smoking)
- Hopelessness: Expresses feeling that nothing can be done to improve the situation
- Purposelessness: Express no sense of purpose, no reason for living, decreased self-esteem
- Anger: Rage, seeking revenge
- Recklessness: Engaging impulsively in risky behavior
- Feeling Trapped: Expressing feelings of being trapped with no way out
- Social Withdrawal: Withdrawing from family, friends, society
- Anxiety: Agitation, irritability, angry outbursts, feeling like wants to “jump out of my skin”
- Mood Changes: Dramatic changes in mood, lack of interest in usual activities/friends
- Sleep: Insomnia, unable to sleep or sleeping all the time
- Guilt or Shame: Expressing overwhelming self-blame or remorse
Watch a video of a Veteran discussing his experience with some of these warning signs.
If these signs are present, the Veteran can contact the Veterans Crisis Line at 1-800-273-8255 and Press 1 or chat online at http://www.VeteransCrisisLine.net/chat.It can also be helpful for the Veteran to take a self-check quiz at http://www.vetselfcheck.org/
For more information on assessing suicide risk, please reference the resources in the drop down menu.
Assessment and Management of Clients at Risk for Suicide :
Clinical Practice Guideline Summary
Clinical Practice Guideline Summary
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 both primary care and specialty care practitioners throughout the DoD, VA and other health care systems.
Assessment and Management of Clients at Risk for Suicide:
Clinical Practice Guideline Pocket Card
Clinical Practice Guideline Pocket Card
The following key elements of the Suicide Risk Guideline and corresponding clinical algorithms are summarized in this reference guide:
- Assessment and Determination of Risk
- Initial Management of a Client at Risk For Suicide
- Treatment of a Client at High Risk for Suicide
Initial Management Of a Client At Risk For Suicide
Determine the level of risk for suicide
The objective of risk assessment is to stratify individuals into levels of risk. Specifically, a clinical judgment that is based on all the information gathered should formulate the level of acute risk for suicide (i.e., low, intermediate, and high acute risk).
Three areas must be addressed in the initial management of the suicidal client:
- Educate client and family on risk and treatment options
- Establish a Safety Plan
- Limit access to lethal means
Determine appropriate setting of care
The initial setting and level of care will be determined based on the conclusion of the assessment and the estimation of the level of suicide risk. The capacity of the client to follow through on a safety plan, the availability of a support system and assurance that access to lethal means can be restricted will allow transition to a less restrictive care setting.
What is a Safety Plan?
A safety plan is a written list of prioritized coping strategies and sources of support that clients deemed at risk for suicide can use during or preceding suicidal crises. The plan is brief, easy to read, and in the Veteran’s own words.
How Do You Develop a Safety Plan?
Safety planning is a provider-client collaborative process. Providers and clients complete the Safety Plan together, and clients keep it with them. Clients are instructed first to recognize when they are in crisis and then to utilize a prioritized list of strategies to help manage the crisis.
Safety plan should include the following elements:
- Early identification of warning signs or stressors
- Enhancing coping strategies (e.g., to distract and support)
- Utilizing social support contacts (discuss with whom to share the plan)
- Contact information about access to professional help
- Minimizing access to lethal means (such as, weapons and ammunition or large quantities of medication)
Fierce Loyalty: A Safety Plan Video
This video will help clinicians train health care providers about the importance of encouraging Veteran patients and their loved ones to create a safety plan they can implement if the Veteran is experiencing a crisis or may be at risk for suicide. The video includes testimonials from a VA Suicide Prevention Coordinator and a VA Medical Center clinician to explain the big impact a safety plan can have in helping a Veteran to get the help he or she needs.
Safety Plan Treatment Manual:
The Safety Plan Treatment Manual (MS Word) was developed for use by VA clinicians and staff. It 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. It details how clinicians and clients 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.
Safety Plan Quick Guide:
The pocket card, available in Color - Safety Plan Quick Guide and Black & White - Safety Plan Quick Guide (PDFs), describes safety planning and is intended for reference purposes.
Suicide Prevention: A Guide for Military and Veteran Families
Family members are often able to tell when a loved one is in crisis, because they know that person best. And there are ways you can help. This guide is designed to help family members recognize when a loved one is at risk for suicide and understand the actions you can take to help.
How to Talk to a Child about a Suicide Attempt in Your Family
This resource is designed as a guide for adults when talking with preschoolers, school-age children and adolescents about a suicide attempt in the family. They are not intended to replace the advice of a mental health professional. In fact, it may be best to use these guides along with professional support if you or your child is struggling to talk about this difficult topic.
Veterans Crisis Line Print Materials
You can download Veterans Crisis Line materials, including public fact sheets, and print them from your own computer. Multiple versions of full-color and black and white posters are available for download in both 8.5" x 11" and 11" x 17" formats. You can also download and insert your own contact information or event details in a Veterans Crisis Line flyer.
How to Recognize When to Ask for Help
This information sheet contains information on suicide prevention such as, understanding the warning signs, myths and realities, and Veteran specific risks.
Suicide Attempt Survivor Family Resource Guide (PDF)
This guide is designed to provide Veterans and their families with resources that can serve as sources of information and support. The guide contains information on self-care, care for others (particularly children), and care for the suicide attempt survivor. It is now also available in Spanish: Informacion y Apoyo para los Sobrevivientes del Suicidio: Guía de Recursos del Departamento de Veteran Affairs para las familias que estén lidiando con el suicidio
The Suicide Risk Management Training for Clinicians:
The Suicide Risk Management Training for Clinicians (PDF) is a guide intended to provide information necessary to recognize and bring into treatment Veterans who are struggling with suicidal thoughts. The goals of the training include:
- Understand the prevalence and scope of suicide in our society and among our veteran population
- Understand assessment of potentially suicidal veterans
- Recognize warning signs and make necessary referrals
- Become familiar with risks related to suicide in clients presenting with other medical and psychiatric concerns
- Learn about systemic and environment risks related to treating suicidal veterans
- Recognize the importance of what is termed "means restriction"
- Understand the basic concepts of formulating a safety plan
Operation S.A.V.E training will help you act with care and compassion if you encounter a person who is suicidal. The acronym summarizes the steps needed to take an active and valuable role in suicide prevention.
- Signs of suicidal thinking
- Ask questions
- Validate the person's experience
- Encourage treatment and Expedite getting Help
VA Suicide Prevention Campaign Materials
You can show support for our Nation's Veterans and their families and encourage them to get the care they deserve by downloading Veterans Crisis Line materials and helping us spread the word about this free and confidential resource available to all Veterans and their families. Download online ads and badges to use on your website, print materials, and logos.
VA Veterans Chat/Crisis Line
The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) has founded a Veterans Crisis Line to ensure Veterans in emotional crisis have free, 24/7 access to trained counselors. To operate the Veterans Crisis Line, the VA partnered with the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Suicide Prevention Lifeline. Veterans can call the Lifeline number, 1-800-273-TALK (8255), and press "1" to be routed to the Veterans Crisis Line.
Veterans Chat enables Veterans, their families and friends to go online where they can anonymously chat with a trained VA counselor. If the chats are determined to be a crisis, the counselor can take immediate steps to transfer the chatter to the Veterans Crisis Line, where further counseling and referral services are provided and crisis intervention steps can be taken.
Local VA Suicide Prevention Coordinator
Each VA Medical Center has a suicide prevention coordinator to make sure Veterans receive needed counseling and services. Calls to the Veterans Crisis Line are referred to those coordinators.
Make the Connection
Veteran stories and educational information about a variety of signs, symptoms (including hopelessness) and conditions for your client. This site also provides direction for the Veteran about next steps to take to seek treatment or resources.
National Center for PTSD
Learn about the relationship of PTSD to suicide risk.
Rocky Mountain Mental Illness Research, Education, and Clinical Centers (MIRECC)
The mission of the Rocky Mountain MIRECC is to study suicide with the goal of reducing suicidal ideation and behaviors in the Veteran population. Towards this end, the work of the Rocky Mountain MIRECC is focused on promising clinical interventions, as well as the cognitive and neurobiological underpinnings of suicidal thoughts and behaviors that may lead to innovative prevention strategies. Available on this site are a number of resources and tools for clinicians, Veterans and family members.
Information and materials on PTSD and other associated conditions for the Veteran and his/her family. In addition to general materials, the website provides a podcast series, including a podcast on suicide in the military.
DoD/VA Suicide Outreach: Resources for Suicide Prevention
Provides ready access to hotlines, treatments, professional resources, forums and multiple media designed to link you to others. This site supports all Service Branches, the National Guard and the Reserves, our Veterans, families, and providers.
Additional National Resources
Substance Abuse and Mental Health Services Administration (SAMHSA)
Substance Abuse and Mental Health Services Administration (SAMHSA) has launched a National Suicide Prevention Initiative (NSPI). NSPI is a collaborative, multi-project initiative designed to incorporate best practices and research toward reducing the incidence of suicide nationwide.
Order free suicide prevention materials from SAMHSA:
Medal of Honor Recipients: Speak Out! Save Lives
Our nation's greatest heroes - Medal of Honor recipients - speak out to save lives by encouraging America's military to seek help when adjusting to life after combat.
National Suicide Prevention Resource Center (SPRC)
The SPRC provides prevention support, training, and resources to assist organizations and providers, and to advance the National Strategy for Suicide Prevention.
American Association of Suicidology
Research, education, and training for scientific study and development of resources for suicidal Americans.
National Institute of Mental Health (NIMH)
NIMH publication, Suicide in the US: Statistics and Prevention is a fact sheet of statistics on suicide with information on treatments and suicide prevention (2009).
American Foundation for the Suicide Prevention (AFSP)
The American Foundation for Suicide Prevention is involved in suicide prevention initiatives and has over 50 community-based chapters. Find information and resources at their website.
Free Confidential Support: The VA Crisis Chat Line:
Veterans, family members, or care providers can initiate a confidential chat. Caring, qualified VA professionals are standing by to provide free and confidential support. Use the Veterans Chat to get online support anonymously, 24 hours a day, 7 days a week, 365 days a year - even if you're not registered with VA or enrolled in VA health care. Responders will work with you to help you get through any personal crisis, even if that crisis does not involve thoughts of suicide.
The VA Crisis Chat Line can be found at: http://www.veteranscrisisline.net/ChatTermsOfService.aspx.