News media commonly report suicide in ways that contribute to increase in suicide risk. Often when a story is covered, the talking points suggest that military suicides are common and reflect a sense of hopelessness. The VA reports efforts to change media coverage is not accurately being pursued. There is a need to develop strategic communications promoting life, normalize help-seeking behaviors, and support Department of Defense (DOD) suicide prevention strategies while attempting to reduce stigma.
Studies show that media is more likely to report failed psychological treatment, which may unintentionally discourage members to seek help. Langford, Litts, and Pearson suggest creating effective health communication campaigns. A well-designed and effective campaign begins with strategic planning, followed by an analysis of the message and goal setting. Effective campaigns target a specific audience and a specific behavior; messages are more effective when directed to a well-defined population and articulate the desired change of behavior.
Researching the audience is an excellent way to understand the problem and desired behavior in order to produce a creative brief and evaluation plan. Langford, Litts, and Pearson say that program evaluation is a gap in suicide messaging field. Campaign messages and materials should carry out strategy and promote action; more persuasive messages use formative research to motivate action. Informing the audience of dire negative consequences of inaction is a comment motivator that experts caution due to possible backfired; it is recommended to suggest that the audience can do an action and the action is beneficial.
The way a message is conveyed should correspond with the audience’s preferences. For example, attempting to reach elderly veterans through internet is not effective due to the lack of exposure to these sources. There are a few unique considerations with suicide messaging. One of these unique considerations is mental illness stigma, because it is a barrier to treatment use; messages should be informed by literature on a stigma and interventions. Another unique consideration is safe messaging. The media may “glamour” suicide, coincidentally encouraging others at higher risk.
Langford, Litts, and Pearson suggest the media do not do the following: normalize suicide by making it sound common, glorify people who died by suicide, focus on personal detail of the deceased, present overly detail of the suicide method, and presenting suicide due to stress. Transitions associated with life events can increase suicide risk. Some life transitions associated with suicide risk include job loss, divorce or breakup, and physical injuries or illness. Brenner and Barnes (2012) suggest that facilitating treatment engagement, particularly during high-risk periods, might be an important means of reducing suicide.
A study of the general population found that 43% of suicides after inpatient psychiatric treatment happened within the first month after discharge; the first week is noted to be high risk. One study using inmates found an increase in suicide rates just two weeks after release. Another study conducted suggested the highest risk period for suicide vets was 12 weeks after a psychiatric hospitalization. Active military members may experience increased risk of suicide during deployment. Risks are highest around the second month of deployment, due to separation from family and friends.
Again, after six months, because usually this is when a soldier takes leave for home and returns to combat with increased stress and feeling of isolation. It is noted that around 12 months into the deployment, individuals may become increasingly focused on stressors at home. Once discharge from the military, veterans may experience a loss of sense of self and purpose, find it difficult to leave well-designed and meaningful military roles, experience heightened sense of burden to provide for their families with financial and emotional support, and feel disconnected from civilians. (Brenner & Barnes, 2012)
Providers have the potential to reduce the risk of suicide and promote resiliency through the delivery of evidence-based, suicide-specific interventions targeting Veterans. Systematic reviews, best practices, toolboxes and individual studies provide the evidence for these interventions (York, Lamis, Pope, & Egede, 2012). ” Research impact framework (RIM), is a standardized approach for developing issue narratives in societal-related impacts, research related impacts, and service related impacts. Societal impact is research on health status including suicide morbidity, mortality, and health disparities.
It also includes research on education and training to address knowledge, attitudes, and skills in suicide prevention. Research in this area has found evidence of elevated risk among those in psychiatric treatment, diagnosed with selected conditions or untreated depression, and in certain risk periods and age groups. Elderly veterans are more likely to be undiagnosed or untreated for psychiatric disorders; coincidentally, veterans between the ages 61 and 80 have the highest suicide rate. Health disparities include gender, race, ethnicity, and location.
Veterans who live in rural areas are more likely to be unemployed, disabled or receive VA disability compensation, and have a poor health-related quality of life. Clinical outcomes, hospitalization, and suicide attempts were discovered to be worse and rural areas than urban ones; this could be due to the difficulty of accessing services for veterans in rural areas. Research impact involves systematic reviews, studies, research funding and centers targeting veteran-specific suicide. In 1997, the Veteran Suicide Act called for research in suicide and report to Congress.
A Committee was tasked with completing the following: an assessment of the science base; an evaluation of the status of primary and secondary prevention; identification of strategies for studying suicide; and the development of conclusions regarding gaps in knowledge, research opportunities, and strategies for prevention of suicide (York, Lamis, Pope, & Egede, 2012). ” Policy impacts focuses on the type, level, and nature of policy activities and networks. Current federal activities include VA Suicide Prevention strategy, congressional bills and testimonies, and funding priorities.
Service impact deals with two levels; system and individual. Regarding system level, top of patient death list is inpatient suicide; hanging was the number one suicidal strategy followed by cutting. Emergency departments are the second most common setting to commit suicide. A mental health environment checklist has been implemented identifying 7,642 hazards in mental health facilities. One of the hazards discovered was anchor points for hanging. On the individual level, the VA is the largest tele-mental health network in the world.
It has placed video phones in homeless shelters and halfway houses and has made in home messaging devices. (York, Lamis, Pope, & Egede, 2012) Knox and Bossarte state that it is difficult to notice characteristics in veterans who have not used services from the VHA. Obtaining the information needed to evaluate a patient’s risk of suicide requires high levels of clinical skills, including the ability to instill a sense of trust. Additional training has been recommended to ensure that a broad range of conditions can conduct accurate assessments. (McCarthy et al. 2015) in a recent study, researchers collected data from electronic medical records and used it for predicting risk of suicide over periods ranging from 1 month to 1 year.
The study demonstrated that it is feasible to identify patients at define strata of elevated risk for suicide by using measures to ride from electronic medical records. New information about who is at risk can be provided through predictive modeling. According to the discussion the most direct clinical application of predictive modeling would be to allow a targeting of selective clinical and preventive services.
The most obvious need may be to do everything possible to address the needs of patients who are at highest risk. (McCarthy et al. , 2015) Suicidal individuals often come in contact with emergency departments (EDs) either immediately following a suicide attempt or when suicidal thoughts escalate and the individual feels in danger of acting on these thoughts. It can be said that these represent an important venue in which to identify and treat veteran to at risk for suicide. It has been recognized that ED providers may prefer to hospitalize moderate risk patients because of limited availability of interventions that can be provided in the ED.
The Blue Ribbon panel recommended that the VA address this gap in services. The VA developed a brief behavioral intervention to augment emergency mental health service delivery to enhance identification of veterans at risk for suicide, provide a brief intervention to reduce risk, and ensure that veterans receive appropriate and timely follow-up care. This became known as the Suicide Assessment and Follow-up Engagement: Veteran Emergency Treatment (SAFE VET) project. Protocols in this project facilitate the veteran’s transition to outpatient mental health care maintains veteran safety during transition.
SAFE VET allows for immediate reduction in distress; therefore, can provide an alternative to hospitalization. “Military and veteran suicide prevention encompasses many goals, for example increasing life skills and resiliency, promoting social connectedness, increasing help seeking, identifying and assisting individuals at risk, providing crisis services, increasing access to care, providing evidence-based care, and restricting access to lethal means (Langford, Litts, & Pearson, 2013). ” Providers in the VA need training and evidence-based suicide prevention and interventions. Studies using predictive modeling
