Q&A with Dr. Barbara Van Dahlen to discuss how together, we will prevent suicide for Service members and Veterans. Submit questions below!

I went to a conference where the Navy briefed a program that was on one of their Maryland locations. They brought their very high suicide rate in that unit from extremely high to zero with an on call escort program.

Again, with the ACE program this is integrated into the Unit workings. The Chain of Command will coordinate a escort to get the individual ( who has been IDed as high risk with suicidal intent) to the hospital for proper treatment.

Thanks for your questions, Lt Col Brown. Regarding your first question, I consulted with my partners in Health Affairs, and they asked me to pass this along. The Defense Health Agency can and does create relevant policy that applies once the health care system is involved. In the case of commander-directed mental health evaluations for Service members who don't self identify, Department of Defense (DoD) policy directs the process to ensure the Service member is safely accompanied to a mental health clinic, in coordination with a mental health provider, and that the Service member's rights are protected. For those Service members who self-identify, compassion and support should be ensured by the commander. Within the Military Health System, health care providers engage in the standard of care for clinical practice and adhere to clinical practice guidelines (CPGs), including the 2019 Veterans Affairs/DoD "Assessment and Management of Patients at Risk for Suicide" CPG. This includes taking appropriate safety precautions, such as constant observation and limiting access to lethal means, for individuals identified as at-risk for suicide and conducting warm hand-offs to mental health providers for all individuals who speak about their intent to die by suicide. There is also current procedural guidance for health care providers on this clinical issue in coordination within the Defense Health Agency.

On your second question, there is a widespread stigma associated with suicide, which may lead people to be afraid to speak about it. Talking about suicide not only reduces the stigma, but also allows individuals to seek help, rethink their opinions, and share their story with others. Most people who attempt or die by suicide have communicated their distress or plans to at least one person. Talking about suicide with a person gives them an opportunity to express thoughts and feelings about something they may have been keeping secret, as well as obtain help and support as needed.

We must be supportive of Service members who need help. We must allow ample time for the Service member to gain access to help. We should speak as leaders about the importance of mental health. An effort to reduce stigma in the DoD is the Real Warriors Campaign, which is aimed at reducing the stigma of seeking mental health care by sharing the stories of Service members who successfully sought care and improved their mental health as a result. The campaign educates Service members, Veterans, and their family members about signs and symptoms of stress and strategies for building resilience. It reaches up to 4.5 million individuals each day through its social media channels. Almost 50 individuals per week reach out for help through the campaign's live chat, phone calls, and "seek help" webpages. At the policy level, the DoD completed reviews of mental health policies and procedures in order to identify stigmatizing language that could be influencing views on mental health issues and help-seeking behaviors. These reviews provided guidance on developing policies and procedures with language that is more supportive of mental health care and less stigmatizing toward mental health difficulties experienced by Service members.

Additionally, DoD has launched several pilot initiatives striving to reduce stigma and strengthen access and delivery of care. For example, DoD is piloting a barrier reduction training designed to address the most prevalent help-seeking concerns of Service members (e.g., career and security clearance loss concerns, loss of privacy and confidentiality), and encourage Service members to seek help early on, before life challenges become overwhelming.

I'm not Dr. Van Dahlen but as a Suicide Prevention Coordinator for VA I think the biggest mistake that well-intentioned people most often make is to ignore a person in crisis. So often we get busy with day to day life and forget that people around us could be struggling. We forget to have conversations, and sometimes fear takes over where we don't ask the question "Are you having thoughts of suicide?". That single question doesn't take a degree to ask, just a caring heart.
Kevin Hines a survivor of suicide from jumping off the Golden Gate Bridge said it best when he explained if someone stopped to ask him if he was okay while he stood there crying he wouldn't have jumped (paraphrasing). Instead someone asked him to take their picture. Having dialogue like this is a great start to opening up conversation and getting everyone comfortable asking the question.

Laura McCarthy - And based on my clinical research on combat trauma and suicide, very few completions are impulsive; so we have plenty of time for intervention.
Rich

Thank you for these thoughtful questions, CPT. Gowel. You touched on a very important point, particularly that everyone has risk factors for suicide but we also have protective factors that can decrease the risk for suicide. It’s important learn about risk and protective factors so we can help ourselves and our loved ones. Information is available on our public health campaign website: wearewithinreach.net.

Preventing suicide requires that everyone be part of the solution. Historically, people have been uncomfortable talking about our mental health concerns. But we can change this. We used to be uncomfortable talking about physical health concerns like cancer – but now we celebrate someone’s recovery from cancer – and we join our family and friends in their fight to beat cancer. We can do the same with helping friends and loved ones who are struggling with emotional pain and suffering.

We can start by reaching out to each other on a regular basis. If we have concerns about someone we care about, its helpful to ask “how are you, really?” and then really listen to the answer. We don’t need to have all of the answers – just offering to be part of the solution is tremendously helpful. Just letting someone know you are with them for this fight can save a life. People who feel suicidal often feel ashamed of these feelings – they may feel week. Letting someone know you are there and that you understand that they are in pain can make a huge difference.

In terms of mistakes that people make – sometimes we don’t notice or understand indicators that someone is suffering. This isn’t a mistake as most people don’t receive education about indicators of emotional health and well-being – but we can all be more mindful of these indicators. Efforts like REACH are working to increase awareness and provide education to all Americans. Sometimes people think that someone talking about suicide is just “blowing off steam” or that they will “get over it”. Sometimes well intentioned friends will say things like “this will pass” or “it could be worse”. We should always take someone’s statements about suicide seriously. It is important to ask directly “I hear what you are saying – are you thinking about hurting yourself?” We need to remember that asking the question won’t put the idea into someone’s head – this is a myth we are working to dispel. And if someone is seriously thinking about hurting themselves, you can call the Suicide Prevention Lifeline at [login to see] (press 1 if you are a Veteran or Service member). The people on the Lifeline will be helpful to anyone calling – and can offer assistance to someone who is trying to help a friend or loved one.

Barbara Van Dahlen, PhD

Waiting for you to answer my 3 questions posted last week..

SPC Paul Woolford - You're going to waiting a long, long time. So far, in my experience with Barbara Van Dahlen, she's big on rhetoric but never bothers to actually answer any questions that will move the needle. That includes http://www.greyteam.org reaching out to her on Twitter, LinkedIn, Facebook, and Instagram.

Thank you for your comment. It is my honor to help you and others who have served our nation. We greatly appreciate your kind response and we are glad you found this experience helpful. If any additional questions or remarks should come up, please feel free to reply to the thread or add your comment in the box. Thank you for your service, SGT Groth.

Barbara Van Dahlen, PhD Thank you for your support ma'am.