The Intersection of Suicide Research and Public Health Practice: Suicide and Veterans

Transcription

1 The Intersection of Suicide Research and Public Health Practice: Suicide and Veterans Presenters: Robert Bossarte, Alan Holmlund, Cheryl Lussier Poppe Moderator: Julie Goldstein Grumet Audio will begin at 2:00PM ET You can listen through your computer speakers or call (855)

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3 Polls

4 Our Speakers

5 Veteran Suicide Robert Bossarte, PhD Injury Control Research Center Suicide Prevention Assistant Professor, Department of Psychiatry University of Rochester Acting Associated Director, VISN 2 Center of Excellence for Suicide Prevention

6 Background Recent reports have identified increasing rates of suicide among active duty military and some Veteran groups. Despite evidence of increased risk among some active duty and military populations, available data have limited opportunities to compare across populations or identify factors that may be unique to certain groups. Recently, the Department of Veterans Affairs released a comprehensive suicide data report including information on suicide among all Veterans in a sample of states, non-fatal event rates among those who use VHA services, and outcomes among callers to the Veterans Crisis Line.

7 Veteran Status and Suicide Risk Previous studies of all-cause mortality among Vietnam Veterans have concluded that members of this population had an increased risk of traumatic death following return from active service; most notably from motor vehicle accidents, homicides, accidental poisonings and suicide. More recent analyses of mortality among Veterans of the Persian Gulf War reported statistically significant elevations in accidental deaths (including motor vehicle accidents), but failed to identify increased rates of suicide among members of this cohort when compared to Veterans from other eras. Recent analyses of mortality among Veterans returning from the Iraq and Afghanistan war zones identified a statistically significant increase in suicide among active duty Veterans and those diagnosed with a mental disorder.

8 Suicide among Those Who Use VHA Services

9 Percentage of all Suicides Identified as Veterans

10 Estimated Number of Veterans Who Die From Suicide Each Day

11 Suicide among Males by Age Group

12 Suicide among Females by Age Group

13 Suicide by Age Group and Veteran Status

14 Suicide Behavior Reports by Month (FY09-FY12)

15 Events and Unique Veterans by Fiscal Year

16 Non-Fatal Event Rate by Sex and FY

17 Non-Fatal Event Rate by FY

18 12 Month Repeat Event Prevalence by Sex and FY

19 Weeks from Last VHA Service Use to Suicide Event

20 Point of Last Care Prior to an Event

21 Method of Non-Fatal Event Method Indicated in Nonfatal Attempt 02.1% - Sequelae of intentional self-harm % - Jumping - moving object - 1, % - Hanging, strangulation, suffocation - 3, % - Sharp object - 4, % - Firearms - 5, % - Intentional self-harm by unspecified means - 5, % - Poisoning - 24,058 OTHER

22 Main Findings The percentage of all suicides identified as Veteran has decreased since Nearly 70% of all Veteran suicides are among those aged 50 years and older. Male Veterans who die from suicide are older than non-veterans; however, the age distributions of female Veterans and non-veterans are similar. The rate of number of non-fatal suicide events among Veterans who use VHA services decreased in Gender differences in the rate of non-fatal events are decreasing. The 12 month repeat event rate decreased in FY Among those at risk, the first four weeks following service require intensive monitoring and case management. The majority of Veterans with report of a non-fatal suicide event were last seen in primary care.

23 Conclusions While the number of Veterans who die from suicide each day has remained relatively stable over the last 12 years (ranging from 18-22), the percentage of people who die from suicide in America who are Veterans has decreased slightly. At the same time, the number of Americans who die from suicide each day has increased. This provides some preliminary evidence that the programs initiated by the VA are improving outcomes. Broader considerations of risk for patients in mental health and other care settings should include reassessment of the value of traditional risk assessments and screening and adding ways to identify life stressors and concerns earlier. Population groups identified in the report that require additional interventions and engagement include women Veterans and Vietnam Era Veterans.

24 Conclusions Available data suggest that there has not been a marked increase in the percentage of Veterans identified among all suicides. The majority of Veterans who have died from suicide were aged 50 years and older. The relative risk for suicide among female Veterans may also be increased. Additional research on periods of risk, patterns of service use, and environments of risk is needed.

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26 Origins of the SAVE Program Lance Corporal Jeff Lucey, United States Marine Corps. Massachusetts Department of Veteran s Services in collaboration with Department of Public Health

27 Overall Mission of S.A.V.E. The S.A.V.E. program is a unique Peer Outreach program within the State of Massachusetts. The program is a collaboration between the Massachusetts of Department of Public Health and the Department of Veterans Services to prevent suicide within the veteran population. This resulted in an interagency collaboration that includes funding, program management, resources and clinical support. S.A.V.E.'s mission is suicide prevention and advocacy for veterans benefits and services through proactive outreach in the community. S.A.V.E. s outreach coordinators are completely mobile and can meet with our veterans in the field. The goal is to empower our veterans to navigate the system of benefits and services available to them and their families. Massachusetts Department of Veteran s Services in collaboration with Department of Public Health

28 S.A.V.E. Team Members Director, Special Populations Outreach 1 Program Support Specialist 5 Regional Outreach Coordinators 1 Family Outreach Coordinator 1 Clinical Advisor (Self/Care) ***Additional Clinical Consultation provided Riverside Community Care Massachusetts Department of Veteran s Services in collaboration with Department of Public Health

29 Peer to Peer Interaction The S.A.V.E. team is comprised of veterans and family members of veterans. Members of the team have struggled with some of the same issues as the veterans they assist --this has helped in fighting stigma of seeking help. Peer to Peer interaction is a key component in reaching veterans and has proven to be the most successful aspect of the S.A.V.E. program. Massachusetts Department of Veteran s Services in collaboration with Department of Public Health

30 Assessment and Referral The S.A.V.E. team works with all generations of veterans with special emphasis placed on recently returning Iraq and Afghanistan veterans. Veterans are assessed for mental health issues including post traumatic stress, suicidal ideation, Traumatic Brain Injury and substance abuse. S.A.V.E. Outreach Coordinators create an Individual Action Plan (IAP) to help the veteran address and resolve key issues that prevent the veteran s post-traumatic growth; I.A.P. s objectives are quantifiable and realistic. From the assessment, the veteran is referred to the most appropriate service provider based upon the veteran s needs. Many times veterans are referred directly to VSO s for Ch. 115 benefits; VSOs are a critical first step in getting veterans the help they need. Massachusetts Department of Veteran s Services in collaboration with Department of Public Health

31 Collaboration with Department of Public Health The Department of Public Health s professional training resources and clinical support to the SAVE Outreach Coordinators have been critical to the programs success. Other collaborations with the Department of Public Health include: A smoking cessation program for veterans and family members, resulted in over 4,000 veterans and family members taking the steps to quit. Initiative with Bureau of Substance Abuse services underway for substance abuse prevention for veterans and military families. Massachusetts Department of Veteran s Services in collaboration with Department of Public Health

32 S.A.V.E. Partnerships and Collaborations Local: Department of Public Health Riverside Community Care Clinicians Department of Mental Health Veteran Service Officers (VSOs) (i.e. Chapter 115) Massachusetts Rehab Commission Massachusetts National Guard Home Base Program ( MGH and the Red Sox Foundation) State funded Programs (32 Housing and Outreach Centers) National: Veterans Administration (VA) Vet Centers- providing counseling and support services to veterans in seven locations throughout Massachusetts Give An Hour- a national non profit program offering free, confidential mental health support for service members, veterans, and their families SOFAR (Strategic Outreach to Families of All reservists) focus on assistance to families of military service members. MA Coalition for Suicide Prevention UMASS Medical School Massachusetts Department of Veteran s Services in collaboration with Department of Public Health

33 Program Metrics Since February 2008 to date Over 20,000 Veterans have received outreach services. Over 4,000 Veterans have received link and referral services. Over 1600 Veterans have received direct assistance or active case management. Supported Storm Assistance centers in Western Massachusetts following 2011 tornadoes Veterans referred for assistance. Increased collaboration in Jail Diversion programs. Provided overview of Battlemind to First Responders, College Staff, Community Providers and Human Resource Professionals. Collaboration across all EOHHS and other state, federal, local agencies and non-profits has been vital to the program s success Capability for integration with Full Time staffing and flexible work schedules has been essential. Massachusetts Department of Veteran s Services in collaboration with Department of Public Health

34 National Crisis Prevention Lifeline Department of Veterans Affairs Crisis Prevention Lifeline T.A.L.K. (8255) ( Press 1 for Veterans) Massachusetts Department of Veteran s Services in collaboration with Department of Public Health

35 Resources Massachusetts Department of Veterans Services Massachusetts Veterans Web Portal SAVE Saves Lives Veterans Administration National Crisis Prevention Life Line TALK (8255)#1 For Veterans Massachusetts Department of Veteran s Services in collaboration with Department of Public Health

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37 Any Questions? Massachusetts Department of Veteran s Services in collaboration with Department of Public Health

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