The Importance of Instilling Hope

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The 4th Annual Department of Defense-VA suicide-prevention conference was a big deal here in the capital last week, with three days of presentations by top officials from the Pentagon and the Departments of Veterans Affairs and Health and Human Services. I put together the first military suicide-prevention conference, back in 2002. A decade ago, it was done on a shoestring budget (in other words, none), at the Marine Corps’ Henderson Hall near the Pentagon. It had about 100 attendees (some complained there was no coffee!). The keynoter was Kay Redfield Jamison, a great speaker and author of Night Falls Fast, on suicide, and numerous others that delve into the mind.

Since then the military conference has grown, merged with the VA, and routinely draws over 1,000 people to one of downtown Washington, D.C.’s biggest hotels. I have actually grown a little cynical about the conference over the last 10 years.

All this effort and money, but the suicide rate in the military grows every year – despite the Army and DoD task forces.

However I was impressed by this last conference, and want to share a few highlights.

Dr. Jonathan Woodson, the Pentagon’s assistant secretary for health affairs, not only mentioned firearms as a cause of suicides — about 70% in the Army — but called for a protocol to remove firearms in the case of suicidal service members at every base.

I spoke about how the public mental health system, military and VA could better coordinate on taking care of service members and veterans. Not just in terms of health care, but also helping veterans struggling in college. And there are major problems dealing with veterans caught in the criminal justice system.

Dr. David Rudd of the University of Utah presented a fascinating analysis of programs that seem to be effective in curbing suicide. The message was pretty simple: instill hope. Service members can move quickly from suicidal feelings to acts of suicide. Providers have to instill in those they counsel a hope of better days ahead, and not just focus on their backgrounds, parents, or other contributors to their current state.

For providers:

— Be simple and straightforward.

— Write things down for the patient.

— Consider 3-by-5 cards that the patient can carry.

— Develop a survival kit. Review the suicidal kit with your patients.

— Be concrete: what can happen if the suicidal feelings increase?

Beware: there are no simple answers. If there were, we would not need all these conferences and task forces.

The panel on suicide survivors shook all of us. A brother told of us his Marine little brother, Mike. He was a college student, who chose to join the Marines out of patriotism after 9/11. He served in Afghanistan. He was summarily dismissed from mental health services at Camp Lejeune when he admitted to drinking heavily to cope with his feelings of sadness, following his combat tour. He resolved never to go back to counseling, and ended up shooting himself.

The wives of two husbands who killed themselves on the same day told their stories. One was a physician in Hawaii, the other a pilot in Texas.

In both cases the theme was reaching out to military treatment services, and getting directed elsewhere or stonewalled. The physician could not get care outside of normal duty hours. The pilot was turned away repeatedly when he actively sought help.

This is despite all the public service announcements and other messaging about how “seeking help is a sign of strength.” All of those efforts to improve access to care, in my opinion, are defeated by an overburdened health care system.

I was not alone with dabbing tears, as family members told of frustrated attempts to get help for their service members.

We all left feeling deeply perturbed, and resolving to do better. Not quite sure how, but the conference offered some new strategies.