Squadron Commander

1
Squadron Commanders Suicide Prevention Education
2
Introduction
3
USAF Suicide Awareness Policy and Guidance

• AFI 44-154, Suicide and Violence Awareness
  Education and Training directs (under revision)
• Annual community awareness education requirements
• Leader awareness education and training (Squadron
  Commander Courses and other PME)
• Tracking of training completion
• Suicide Event Surveillance System
• Suicide Awareness Community Education Program
  Curriculum Guide

4
USAF Suicide Prevention Program and Associated
Policy

• AFPAM 44-160 The Air Force Suicide Prevention
  Program (Apr 01)
• AFI 44-109 Mental Health, Confidentiality, and
  Military Law (Mar 00)
• AFI 44-153, Critical Incident Stress Management
  (Jul 99)
• AFI 90-500, Community Action Information Board
  (CAIB) (Unpublished)

5
General Background Information
6
Community Approach

• Applying Public Health Model to Suicide

7
Goals

• Reduce adverse outcomes
• Increase function and improve the health-related
  quality of life
• Prolong healthy life

8
Strategies

• Modify community norms
• Establish and enforce policies
• Establish incentives for change
• Enhance knowledge and skills
• Monitor impact and adjust strategies

9
Implementing Intervention

• Define intervention objectives
• Utilize multiple strategies
• Change underlying community norms
• Key to widespread and long-term health
• Incorporate target population(s) in intervention
  development

10
Identifying the Problem

• Factors directly or indirectly associated with
  suicide
• Risk factors that increase the probability of
  suicide are
• Severe, prolonged, or unmanageable stress
• Major life transitions (relationship problems)
• Alcohol abuse
• Legal problems
• Others
• Protective factors that decrease the probability
  of suicide are
• Optimistic outlook
• Sense of belonging to a group and/or organization
• Others

11
Examples of Modifiable andNon-Modifiable Factors
PROTECTIVE FACTORS PROTECTIVE FACTORS
Modifiable Non-modifiable
Physical Activity Healthy Intimate Relationships Social Supports Willingness to Seek Help Well-Developed Coping Skills Female
RISK FACTORS RISK FACTORS
Modifiable Non-modifiable
Alcohol Misuse Depression or Other Mental Illness Tobacco Use Financial Problems Easy Access to a Firearm Poor Impulse Control Social Isolation Male Family History/Personal History Age
12
Balance
Risk Factors Vulnerabilities Problems
Develop
Protective Factors Strengths
And Competencies Resilience
Protective Factors Keep Risk Factors In Balance
Decreased Probability Of Suicide
Increased Probability Of Suicide
13
The Air Force Community

• We have a responsibility to our active duty
  members and their families to provide a safety
  net of support services that ensures a healthy
  and fit force and assistance to those in need.
  This is the foundation underlying the Air Force
  Suicide Prevention Program. Now more than ever,
  we need to remind ourselves that our Air Force is
  only as strong as those who serve.
• General John Jumper
• Air Force Chief of Staff

14
Squadron Commanders Suicide EducationProgram
15
Unit 1

• Identify actions and attitudes that encourage
  others to seek help
• Identify advantages and consequences of seeking
  help

16
Unit 1 Actions and Attitudes that Encourage
Others to Seek Help

• Self-Referral
• Best option
• Individual maintains control
• Increased motivation for change
• Focus on resolving the problem
• AFI 44-109, Mental Health, Confidentiality, and
  Military Law
• Air Force policy to encourage seeking help
• Commander/supervisor should encourage

17
Unit 1 Referrals

• Commander-Directed Evaluation (AFI 44-109)
• Only commander directs
• Commander consults with SJA to review the facts
  and the law
• Commander consults with mental health
• Mental Health provider determines appropriateness
• Evaluates members mental health status, fitness
  for duty, and suitability for service
• Rights of command referred airman
• Legal counsel/IG congressional etc.
• Protected from reprisal
• Not a tool for punishment
• Two duty days written notice (except in
  emergencies)

18
Unit 1 Advantages and Consequences of Seeking
Help
Type of Referral to Mental Health and Whether
Confidentiality was Maintained
Reference Demographic, Clinical, and Military
Factors Related to Military Mental Health
Referral Patterns, Capt. Rowan, USAF BSC,
Military Medicine Vol. 16, June 1996, page 324.
Note This study examined 693 cases of active
duty members from all service branches seen in an
Air Force outpatient mental health clinic over a
3-year period, 74 Air Force, 18 Army, 9 Navy
and Marines.
19
Unit 2

• Understand the Limits of Confidentiality

20
Unit 2 Confidentiality

• AFI 44-109, Mental Health, Confidentiality, and
  Military Law
• Psychotherapist-Patient Confidentiality
• Communications between a patient and
  psychotherapist are confidential and shall be
  protected from unauthorized disclosure
• Confidential communications will be disclosed to
  persons or agencies with a proper and legitimate
  need

21
Unit 2 Limited Privilege Suicide Prevention
Program (LPSP)

• AFI 44-109, Mental Health, Confidentiality, and
  Military Law
• Objective is to identify and treat those who pose
  a genuine risk of suicide because of impending
  disciplinary action under the UCMJ
• Eligibility
• Initiation
• Duration
• Limited Protection
• Disclosing Case File Information

22
Unit 3

• Know the source for Air Force suicide demographic
  and epidemiological data
• Be familiar with Air Force suicide demographic
  and epidemiological information

23
Unit 3 Source for AF Suicide Data

• Suicide Event Surveillance System (SESS) (under
  revision)
• Central surveillance database for fatal and
  nonfatal self-injuries
• OPR AFIERA/RSRH
• 2513 KENNEDY CIRCLE
• BROOKS AFB, TX 78235-5123
• DSN 240-3471

24
Unit 3 Information on Air Force Suicides, CY 2000

• Of the 350,000 ADAF there were 128 deaths
• Thirty were due to suicide
• Suicide is the second leading manner of death
• Second to unintentional injury
• Suicide rate was 8.7/100,000

25
Unit 3 More Facts About ADAF Suicides For CY
2000

• Males have a suicide rate that is twice that of
  females
• Individuals separated, divorced or widowed are
  significantly more likely to commit suicide
• No statistical difference in suicide rates among
  
• Rank groups
• Age groups

26
Unit 4

• Know how to identify someone who may be at very
  high risk for suicide
• Know how to implement policies and procedures
  that are necessary to use for getting immediate
  help when someone is at very high risk for suicide

27
Unit 4 Warning Signs forVery High-Risk
Individuals

• Current suicide ideation
• Detailed plan
• Lethal means
• Easy access to lethal means
• Intent to act on plan
• Consider evidence of risk to others

28
Unit 4 Very High RiskWhat to Do

• Consult the Life Skills Support Center provider
  (mental health provider)
• Do not leave them unattended
• Have member transported and evaluated in
  emergency room or acute care clinic immediately
• KEEP THEM SAFE!

29
Unit 5

• Understand the role and functions of the
  Integrated Delivery System (IDS) and identify
  resources and sources of information available
  within the IDS
• Know what the Critical Incident Stress Management
  policies are and how to obtain this assistance

30
Unit 5 Role and Functions of the Integrated
Delivery System
31
Unit 5 Critical Incident Stress Management

• AFI 44-153 establishes a multidisciplinary
  Critical Incident Stress Team (CIST) at each base
• It is intended for people experiencing NORMAL
  stress associated with potentially traumatic
  events
• In the event of a critical incident local command
  post notifies CISTs team chief

32
Final Thoughts

• Despite everyones best efforts, someone may
  still take their life
• In a sense, no one deserves to be blamed for
  something that cannot ultimately be controlled
  the volition and act of another autonomous human
  being
• David A. Jobes, et al, Comprehensive Textbook
  of Suicidology
• Our goal is to do all we can to encourage the
  choice to live

33
A healthy and fit forceincreases resiliency
toovercome adversity