The Departments of Defense and Veterans Affairs hosted its Biennial Suicide Prevention Conference recently. The event, which focused on suicide prevention efforts across both departments, is the only suicide prevention conference that specifically addresses suicide in military and veteran populations at a national level.
The conference, held May 18-20, opened with a session on “Caring for the Caregiver” and highlighted the critical role Families, caregivers and survivors play in suicide prevention and how Families and caregivers can find support, build resilience and connect with loved ones.
“This is a relevant and needed discussion”, said Mrs. Hollyanne Milley, spouse of Army General Mark Milley, and the current Chairman of the Joint Chiefs of Staff. “We often highlight the resilience and adaptability of our military Families and caregivers. While they are remarkable they are not immune to the impact of life’s stressors. We know the additional requirements that military Families and caregivers face can be really challenging,” she said. “Not just the frequent moves and long deployments experienced by so many military Families, but also the occasional isolation and around the clock care and the numerous medical appointments that are managed by caregivers.”
“Suicide is something that touches all of us. It’s an issue we are not comfortable talking about, but we must absolutely learn to talk about it before we all have to gather at a funeral home,” said Ms. Patricia Barron, Deputy Assistant Secretary of Defense for Military Community and Family Policy.
The DOD and VA provide many resources for caregivers and Families as do nonprofit organizations.
“At the Dole Foundation we believe that Family members and caregivers … are the key line of defense preventing and mitigating suicide,” said Steve Schwab, CEO, Elizabeth Dole Foundation.
“We need to arm our caregivers and Family members with not just training and education,” said Schwab, “but also the tactics and tools that they can use so that they become agents of suicide prevention.”
While many caregivers have received some level of training and education it varies widely based on the level of education and exposure that America’s military and Veteran caregivers are receiving.
“Caregivers are the epitome of selflessness, the backbone that provides much needed care to our service members and our Veterans,” said Colleen Richardson, the VA’s Executive Director, Caregiver Support. “We need to highlight what we can do to help folks do a better job of preventing suicide.”
A caregiver could be a Family member, spouse, children, parents of a loved one, friends, who provide care to service members or Veterans. Care needs vary from service member to service member and Veteran to Veteran. Care could be things from meal preparation, medication management, appointment reminder, helping with cognitive challenges resulting from traumatic brain injuries or managing emotional difficulty in behavior. It’s also providing emotional support. It could be hands on care such as assisting with activities of daily living like bathing, dressing, eating, and transportation.
The panelists spoke about what roles these Family members and caregivers play in suicide prevention.
“We know that Families can play a critical role since they may be the first to notice changes and they may be the most trusted person in the individual’s life and the only one they might turn to when experiencing suicidal thoughts,” said Ms. Richardson.
“I have spent a lot of time talking with both the Vet and his/her spouse or caregiver about the symptoms of suicide, specifically, about being aware of changes in behavior like changes in mood, increased isolation and withdrawal, she said. We talk about asking their partner if they are thinking about suicide and we also talk about suicide safety planning.”
“We take a holistic approach with respect to supporting caregivers, Family members and service members,” said Mr. Schwab. “That means looking at the community, looking at the Family. It means understanding the clinical interventions. So we documented the caregiver journey by developing a series of experience maps that helped us understand what caregivers face through the experiences and challenges they go through caring for their loved one at home.”
“We discovered they weren’t methodically being integrated into the healthcare journey from day one,” he said. “For many of them they didn’t feel included in the healthcare process throughout the journey. And so we worked with DOD and VA in developing a curriculum called “Campaign for Inclusive Care”, where we are methodically training clinicians across the VA system on how to integrate Family members into the care team from the very first day.”
Schwab said this includes how to create and nurture a relationship with clinicians of all kinds so that caregivers and Family members feel like a trusted agent of medical care in a clinical setting and also when they go home.
“We need caregivers to feel like they are an extension of the medical team so that when they are recognizing or witnessing or seeing concerning signs at home they are not shy or reluctant to pick up the phone or to send a text or go on a remote connection with a medical provider to tell someone at the VA or at DOD they’re concerned that their loved one may be showing signs of mental or emotional distress or suicide,” said Schwab.
Schwab advocated the need for clinicians to contact their caregiver support coordinator to let them know they’re interested in taking part in the campaign for inclusive care and becoming an inclusive care provider trained on how to integrate Family members and create a seamless medical relationship even when they are at home.
The goal is to see this campaign across the military because the VA is standing up a ground breaking program integrating those Family members into those medical teams, making them feel comfortable like they can be agents of health and suicide prevention in the home setting.
“Oftentimes we talk about reducing Veterans suicide or reducing the military members suicide. One of the most important conversations is that if you really want to address this then let the Family members sit at the table,” said Dr. Tina Atherall, CEO, PsychArmor Institute. “Those individuals are also at increased risk for other risk factors for mental health.”
“All they are asking for is help, tools and understanding on how to do the next thing and that’s done through individual clinicians, larger initiatives,” said Dr. Atherall. “We love the education and training part of it because it starts to engage them and raises their level of awareness and their level of engagement to resources.”
Among the many programs available to caregivers raising an awareness on certain prevention initiatives is the “Signs, Ask, Validate, Encourage and Expedite, or SAVE, course. SAVE is a foundational course at PsychArmor.
“It’s done in partnership with the VA and is utilized not only within VA, but within multiple levels from community to individuals, said Atherall, “and through that we are expanding SAVE for caregivers to utilize tools for themselves to help with the Veteran they are living with and other individuals who are caregivers so that they know the right signs, how to ask the right questions, how to validate and expedite. Within that is a very important conversation around lethal means.”
SAVE is offered at all VA Hospitals across the country, and the Caregiver support program in VHA is open to all caregivers. In addition, general caregiver support services are open to all caregivers and there is no registration requirement.
Including caregivers in clinical discussions regarding treatment is also favored by many professionals.
“I couldn’t agree more in including the caregiver in all the appointments and in the care plan of the service member and Veteran that is going through a chronic illness, injury or a wound that has impacted them for maybe the rest of their lives,” said Ms. Barron.
“Within the system we have, cancer patients already have this method of including
Family members in the discussion,” Barron said. “It’s not unusual for a team, a spouse, or a parent of a single service member to be part of all the conversations that surround the care of someone diagnosed with cancer. We really need to think about suicide prevention through that same lens.”
The type of education and training the DoD/VA provide to military spouses many times focuses on the military life cycle or on spouse employment. However, spouse employment is a victim of caregiving at times.
Barron, who can relate to the role of caregiver as she previously served in that capacity for her husband, and now for her mother.
“My ability to do my job has been impacted, and I couldn’t do it without the support of my husband and other people who have come into my life to help me with the care for my mother,” she said.
Barron understands the internal struggle of a caregiver.
“For a spouse who finds themselves in the role of caregiver, depending on how vast that role is, you might need to give up an identity that you have as a professional person as a person who has a career,” said Barron. This can be life altering to a person whose career is central to their identity.
“We really ought to talk about barriers to employment and what are some of the solutions out there that can support those who want to continue to work but for whatever reason are unable to,” Barron said.
Another resource for caregivers is Military OneSource, which is a one-stop shop for 24/7 support. It’s an online tool that contains a plethora of information on any subject you can think of an is accessible by anyone currently serving.
“For people who are in crisis, sometimes somebody has to be at the other end of that outreach immediately and Military OneSource can provide that,” said Barron.
“Military OneSource can help guide you and support you through many different situations, said Barron. One of them being the “I’m afraid, I’m worried, I’m seeing these things and I don’t know what to do” situation. This can be extremely scary for someone and Military OneSource provides that human contact and one-on-one support.”
Regarding protective factors, there are several things clinicians can do to educate families about practicing save firearm storage as well, according to Richardson.
“Safely storing other household items will also decrease the risk of suicide,” said Richardson. “Caregivers and Families can assist in medication storage. Keeping medications out of children’s sight and reach, portioning out pills for the week, and then locking the rest away and disposing of medication not in use for the last [six] months. Keep firearms unloaded, locked, and secure.”
Another resource is the suicide prevention toolkit, which provides information for caregivers about risk factors and the protective factors that decrease the risk of suicide. It includes what warning signs to look for and safety planning to include safe firearm storage and medication storage. It also includes information on support available to caregivers and service members on their health and wellbeing.
“It’s easy for those of us who have experience and background in mental health to say to Families go ahead and ask the question, ‘Are you thinking about suicide?’,” said Meg Kabat, National Director of the Department of Veteran’s Affairs Caregiver Support. For someone who is not trained and hasn’t been in that kind of space it can be a really scary question to ask because then you don’t know what you’re supposed to do next. If that individual says ‘Yes, I am’, the resources training we can provide can tell people what to do next when the answer is ‘yes’.”
“In addition, the Army provides Ask, Care, Escort Suicide Intervention, or ACE-SI, training for Soldier, Family members, and Army Civilians,” said Carrie Shult, the Department of the Army’s Suicide Prevention Program Manager. “The course is available for scheduling through installation, National Guard, and Army Reserve Suicide Prevention Program Managers.”
“I think providing these very specific tools, sitting with the Family and talking with them about the crisis point when they need to call the crisis line and when they need to call 911, and asking them to put the crisis line into their cell phones while they are sitting there are the kind of things that help our Families feel more prepared when they do ask the question and the answer is ‘yes’,” said Kabat.
Information regarding efforts of the Department of Defense Suicide Prevention Office can be found at www.dspo.mil. To learn more about the efforts of VA’s Office of Mental Health and Suicide Prevention, visit www.mentalhealth.va.gov/suicide_prevention.
Service members and veterans who are in crisis or having thoughts of suicide, and those who know a service member or veteran in crisis, can call the Military Crisis Line/Veterans Crisis Line for confidential support available 24 hours a day, seven days a week, 365 days a year. Call 1-800-273-8255 and Press 1, text to 838255 or chat online at VeteransCrisisLine.net/Chat.”
Military OneSource: Web: www.militaryonesource.mil
in Transition: Contact Information Phone: 800-424-7877 Outside the United States (international toll-free number): 800-424-4685 Outside the United States (collect): 314-387-4700 All calls are confidential and free.
Veterans/Military Crisis Line (VCL/MCL): Contact Information Phone: 800-273-8255, press 1 Chat: www.veteranscrisisline.net/get-help/chat Web: www.veteranscrisisline.net Calling from overseas: In Europe: Call 00800 1273 8255 or DSN 118 In Korea: Call 0808 555 118 or DSN 118 In Afghanistan: Call 00 1 800 273 8255 or DSN 111