Addressing Suicide among
Veterans, National Guard, and
Active Duty Military
David Dickinson
SAMHSA Regional Administrator
HHS Region X (AK, ID, OR, WA)
Zero Suicide Inland Northwest Conference
Gonzaga University
March 10, 2015 – Spokane, WA
Scope of the Problem
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~ 38,000 Americans die by suicide each
year
Suicides and Behavioral Health Disorders
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~50 percent of those who die by suicide have major depression…the suicide rate
of people with major depression is 8x that of the general population
~90 percent of people who die by suicide
have a mental disorder, substance abuse disorder, or both at the time of their
death.
Service Members, Veterans, and their
Families
• The suicide rate in the U.S. military has historically been below the
civilian rate.
• Since the beginning of the Iraq/Afghanistan conflicts, the rate has
climbed. In 2008 it exceeded the demographically matched civilian
rate. (Kuehn, JAMA 2009)
• Based on data from 17 NVDRS (Non-Violent Death Reporting System)
states, just under 18% of all suicides in 2011 were among service
members or veterans. (CDC, NVDRS, 2014)
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Service Members, Veterans, and their
Families
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• We do not know how many family members of service members and
veterans die by suicide. The Departments of Veterans Affairs and
Defense are studying this issue.
• In several studies, children with a deployed parent displayed
increased mental health distress, especially anxiety (Mansfield et al, 2011;
Aranda et al, 2011; Gorman et al, 2010)
Service Members, Veterans, and their
Families
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• There were 304 confirmed suicide deaths and 869 suicide attempts among
active duty service members in CY 2012.
• Suicide rates per 100,000 for CY2012 among:
– Active Duty:
22.7
– Reserve:
19.3
– National Guard:
28.1
• Active Component Suicide Rates in CY 2012: Active Component
– Air Force
15.0
– Army
29.7
– Marine Corps
24.3
– Navy
17.8
Army STARRS Data
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• In the Army, the suicide rate increased from 2004 – 2009 for soldiers,
whether they were currently deployed, had previously deployed, or had
never deployed. (Between 2004 – 2009 about 40% of soldiers never
deployed.) (Schoenbaum, et al. 2014)
• Increased suicide risk was associated with being a man (or a woman during
deployment), white race/ethnicity, junior enlisted rank, recent demotion,
and current or previous deployment. (Schoenbaum, et al. 2014)
• Predictors of Army suicides are largely similar to those of civilians.
The Good News Is
There is a coordinated, national effort to
prevent suicide and the evidence about
effectiveness continues to grow.
SAMHSA’s Strategic Initiative 1:
Prevention of Substance Abuse and Mental Illness
Prevention of Substance Abuse and Mental Illness—Creating communities
where individuals, families, schools, faith-based organizations, and
workplaces take action to promote emotional health and reduce the
likelihood of mental illness, substance abuse including tobacco, and suicide.
This Initiative will include a focus on the Nation’s high-risk youth, youth in
Tribal communities, and military families.
Goal 1.3: Prevent suicides and attempted suicides among
populations at high risk, especially military families,
LGBTQ youth, and American Indians and Alaska Natives.
National Suicide Prevention Lifeline
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• 1-800-273-TALK (8255)
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24 hours
163 networked crisis centers across the country
Provides counseling and mental health referrals
www.suicidepreventionlifeline.org
Chat services available
Answered more than 1,000,000 calls in CY2013
Received more than 7,000 calls on the day of Robin
Williams’ death.
Partnership: VA
Preventing Suicide Among Veterans
• Interagency Agreement
• 800-273-TALK “press 1”
• Veterans Crisis Line answered 6,125 calls monthly
– 85% identified themselves as veterans, service members, or their friends
and family members (FY12)
– Majority of callers are men, ages 50 – 59.
• 7,960 emergency rescues (FY13)
• Chat service 24/7 (+4,000 chats/month)
• Texting
• VA adopted SAMHSA’s Treatment Improvement Protocol Addressing Suicidal
Thoughts and Behaviors in Substance Abuse Treatment and created a
complementary training video.
New Frontiers in Crisis Intervention
• Chat-VA chat initiated 2009; Lifeline in 2012
• Texting piloted by VA and Crisis Center followup
grantees
• Facebook/Lifeline partnership to respond to suicidal
content posted by Facebook users
• SAMHSA, NAASP, and New Media industry (Facebook,
Twitter, etc.) developing industry-wide suicide
prevention standards for responding to suicidal
content posted by their users
Partnership:
National Guard Bureau
• MOU for FTE National Guard Counterdrug
Liaison on-site at SAMHSA. ↑ SAMHSA's
understanding of NG behavioral health needs
and identify community resources for NG
members and their families.
Partnership:
Health Resources and Services Administration
• Interagency Agreement to conduct military
culture training in Area Health Education
Centers across the country. (4,500 providers
trained to-date in 112 AHECs)
Behavioral Health Service System:
Program Examples
Access to Recovery (ATR)
Voucher program for substance abuse
treatment and recovery support services.
24 of the 30 grantees cite Service Members,
Veterans, and their Families as a priority
population in their grant applications.
Behavioral Health Service System:
Programs
Jail Diversion & Trauma Recovery—Priority
to Veterans
Supports implementation of trauma-integrated jail
diversion programs for justice-involved veterans and
other individuals with PTSD and trauma-related
disorders.
Behavioral Health Service System:
Programs and Support
Service Members, Veterans and Their
Families Technical Assistance Center
Helps states and territories develop effective,
responsive behavioral health systems for Service
Members, Veterans, and their Families (SMVF),
through public/private collaboration among federal,
state, territorial, tribal, and local agencies.
Service Members, Veterans & their Families
(SMVF) Policy Academies
• Partnerships
– DoD, National Guard Bureau, VA, The National Council,
NASMHPD, NASADAD
• Goal
– For States and territories to strengthen behavioral health
systems for service members, veterans, and their families.
• Mechanism
– 46 states, 4 territories, and DC established a long-term, 10member interagency team, endorsed by the Governor.
State/Territory Plans
• Strategic plans address
– Increasing access to appropriate care
– Closing gaps in the system
– Building the system’s capacity
– Increasing interagency communication/
collaboration
– Incorporating promising-, best- and evidence-based
practices
– Sustaining efforts
Suicide Prevention Resource Center
The Nation’s first and only federally
funded suicide prevention resource center
• Advances the goals and objectives of the National Strategy for Suicide
Prevention
• Acts as Executive Secretariat for the National Action Alliance for Suicide
Prevention
• Technical Assistance for states, tribes, communities, and Garrett Lee Smith
Grantees
• Best Practices Registry for Suicide Prevention
• Primary Care Toolkit
• Training Institute
• Partners with American Association of Suicidology, American Foundation for
Suicide Prevention, Social Science Research and Evaluation, Inc.
• www.sprc.org
Suicide Prevention
Warning Signs
Questions?
Thank you!
Contact Information:
David Dickinson
SAMHSA Regional Administrator
David.Dickinson@samhsa.hhs.gov
206-615-3893