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.
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.
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 https://www.veteranscrisisline.net/chat.
It can also be helpful for the Veteran to take a self-check quiz at http://www.vetselfcheck.org/
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:
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:
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 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:
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
Suicide in the Military, Free Online Course
PsychArmor is a national non-profit organization dedicated to bridging the military-civilian divide through free online education. This course addresses suicide in the military. PsychArmor offers many additional courses focused on topics relevant to the well-being of military and Veteran populations.
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:
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.
Contact your local suicide prevention coordinator to learn more about the Operation S.A.V.E. training.
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: https://www.veteranscrisisline.net/ChatTermsOfService.aspx.
VHB, a smartphone application, provides help with emotional regulation and coping with stress. Clients and providers can work together to personalize the VHB content. The client can continue to add or change content as needed. VHB received the 2014 Department of Defense Innovation Award for its unique application of technology in supporting behavioral health in Servicemembers and military families. You can download the app from both Google Play and Apple App Store.