Working with Veterans in Crisis:
Unique and Shared Characteristics with Civilians in Crisis
Kimberley L. Mullen, Ph.D.
Veterans Crisis Line Clinical Care Coordinator
Outline
•
•
•
•
Overview of the Veterans Crisis Line
Understanding the VCL Caller: Myths and Truths
How to Help: PTSD
Discussion and Questions
VETERANS HEALTH ADMINISTRATION
Outline
•
•
•
•
Overview of the Veterans Crisis Line
Understanding the VCL Caller: Myths and Truths
How to Help: PTSD
Discussion and Questions
VETERANS HEALTH ADMINISTRATION
Overview of the Veterans Crisis Line
•
•
•
•
•
Partners with Substance Abuse Mental Health Services Administration (SAMHSA),
National Suicide Prevention Lifeline (Lifeline), American Foundation for Suicide
Prevention (AFSP), and Department of Veterans Affairs (VA)
Marketing via Reingold, VA Central Office Communications Department, Office of
Public and Intergovernmental Affairs (OPIA)
Network of Suicide Prevention Coordinators across the country
6 Lifeline-affiliated back-up centers for phones, 3 for Chat
365/24/7
VETERANS HEALTH ADMINISTRATION
Overview of the Veterans Crisis Line
•
Staff at Canandaigua VA
–
–
–
–
–
–
–
–
–
–
–
257 Responders (and rising)
18 Social Service Assistants
15 Shift Supervisors
8 Support Staff (Timekeepers, Schedulers, Administrative Officers)
3 Clinical Care Coordinators, Kimberley Mullen, G. Lee Judy (off-site), position to be filled
2 Assistant Program Managers, Julianne Mullane and Rich Barham
Program Manager, Vic Bridges
Deputy National Suicide Prevention Coordinator, Caitlin Thompson
National Suicide Prevention Coordinator, Jan Kemp (based in D.C.)
Information Technology and Housekeeping staff provided by Canandaigua VA
Staff are represented by AFGE and SEIU unions
VETERANS HEALTH ADMINISTRATION
Overview of the Veterans Crisis Line
Veterans Crisis Line Calls
350000
300000
250000
200000
150000
100000
50000
0
FY07 FY08 FY09 FY10 FY11 FY12 FY13
VETERANS HEALTH ADMINISTRATION
Overview of the Veterans Crisis Line
VeteransChat
60000
50000
40000
30000
20000
10000
0
FY09
VETERANS HEALTH ADMINISTRATION
FY10
FY11
FY12
FY13
Overview of the Veterans Crisis Line
Veterans Self-Check Quiz
25000
20000
15000
10000
5000
0
FY11
VETERANS HEALTH ADMINISTRATION
FY12
FY13
Overview of the Veterans Crisis Line
Veterans Crisis Line Texts
12000
10000
8000
6000
4000
2000
0
FY12
VETERANS HEALTH ADMINISTRATION
FY13
Overview of the Veterans Crisis Line
350000
300000
250000
VCL Calls
200000
VeteransChat
150000
Self-Check Quiz
Text
100000
50000
0
FY07 FY08 FY09 FY10 FY11 FY12 FY13
VETERANS HEALTH ADMINISTRATION
Outline
•
•
•
•
Overview of the Veterans Crisis Line
Understanding the VCL Caller: Myths and Truths
How to Help: PTSD
Discussion and Questions
VETERANS HEALTH ADMINISTRATION
Understanding the VCL Caller: Myths and Truths
“I don’t know anything about the military,
Veterans, or the VA, so I can’t help.”
VETERANS HEALTH ADMINISTRATION
Understanding the VCL Caller: Myths and Truths
“ I don’t know anything about the military, Veterans, or the VA, so I can’t help.”
MYTH!
Truths:
•
•
Veterans are people too!
Everything you know about working with civilian callers holds true.
– ASIST model
– Validate emotions, not content
•
•
VCL Responders don’t have extensive knowledge of the VA either! SPC’s are our
link.
One story you need to know to understand military culture: Bolt Cutters
VETERANS HEALTH ADMINISTRATION
Understanding the VCL Caller: Myths and Truths
“All Veterans have guns.”
VETERANS HEALTH ADMINISTRATION
Understanding the VCL Caller: Myths and Truths
“All Veterans have guns.”
Myth … and best to act as if it’s the truth.
Truths:
•
•
It’s important to ask about the presence of weapons and encourage separation
from the weapon and, ideally, disarming the weapon (placement in safe, removal
of ammunition, keys/combination to safe and/or ammo with trusted other.)
Veterans are more likely to have homicidal ideation.
– If you’re wondering if it’s an issue, ask.
– If you can assess suicide, you can assess homicide (plans, means, intent, timeline). The
only difference is consideration of duty to warn.
– As with suicide, differentiate between thoughts/urges and intention to act.
VETERANS HEALTH ADMINISTRATION
Understanding the VCL Caller: Myths and Truths
“I don’t have to listen to someone who is
yelling and cursing and will end the call.”
VETERANS HEALTH ADMINISTRATION
Understanding the VCL Caller: Myths and Truths
“I don’t have to listen to someone who is yelling and cursing and will end the call.”
MAYBE
Truths:
•
•
•
Veteran callers tend to be angrier than civilian callers. Working through the anger
may take longer, thus causing the average Veteran call to be longer (~20 minutes).
Notice the difference between ABUSE and ANGER.
Set limits if necessary.
VETERANS HEALTH ADMINISTRATION
Understanding the VCL Caller: Myths and Truths
“All Veterans have PTSD (posttraumatic
stress disorder).”
VETERANS HEALTH ADMINISTRATION
Understanding the VCL Caller: Myths and Truths
“All Veterans have PTSD (posttraumatic stress disorder).”
MYTH!
But it is very common in Veteran and 3rd party Callers concerned
about Veterans.
Let me help…
VETERANS HEALTH ADMINISTRATION
Outline
•
•
•
•
Overview of the Veterans Crisis Line
Understanding the VCL Caller: Myths and Truths
How to Help: PTSD
Discussion and Questions
VETERANS HEALTH ADMINISTRATION
PTSD Overview
Sources:
1. “Highlights of Changes from DSM-IV-TR to DSM-5,” American Psychiatric
Association
2. “Posttraumatic Stress Disorder in DSM-V,” American Psychiatric Association
3. National Center for PTSD:
www.ptsd.va.gov/professional/pages/diagnostic_criteria_dsm-5.asp
Learn more: Charles W. Hoge, M.D.
http://dcoe.health.mil/Training/Monthly_Webinars/2013_Webinars.aspx
VETERANS HEALTH ADMINISTRATION
PTSD Overview
PTSD MAKES SENSE!
If you experienced a traumatic event(s) (criterion A), that you kept
remembering even though you would prefer to forget (criterion B) and try
to avoid anything that reminds you about it (criterion C), wouldn’t you feel
badly, have a negative view on life (criterion D) and try to prevent anything
like that from happening again (criterion E)?
I would!
VETERANS HEALTH ADMINISTRATION
How to help: The Caller experiencing PTSD symptoms
•
•
•
•
•
•
As always, LISTEN, reflect, paraphrase, and empathize
Stay present with the Caller—just be with them, riding the waves of emotion.
Use a soothing tone of voice, but do not condescend
BE GENUINE
BE GENUINE
BE GENUINE
– Don’t pretend you have been there if you haven’t.
– Honestly reflect how their story makes you feel: “That sounds so overwhelming,” “That
would have made me angry too,” “Your story is heartbreaking,” “I can’t imagine how
awful this has been for you.”
– Your quiet tears and sniffles are okay! Just don’t make the call about you.
– It is an honor to be “the first person I’ve ever told.” Let them know that.
VETERANS HEALTH ADMINISTRATION
How to help: The Caller experiencing PTSD symptoms
•
Avoid pat answers and clichés
– Time does not heal
– They will not forget
– They don’t believe it will get better or that they will be okay
•
•
Avoid comparing or sharing your own experiences: even if you have experienced
the exact same type of trauma, even if you were standing next to them when the
trauma occurred, each person experiences trauma differently.
Support posttraumatic growth: “the positive changes individuals may experience
following a traumatic event. For example, following a traumatic event, some
people report positive changes in their goals, priorities, relationships with others,
and spirituality as a result of re-evaluating or modifying their assumptions about
the world and their life.”
VETERANS HEALTH ADMINISTRATION
How to help: The Caller experiencing PTSD symptoms
Sometimes Callers will be in the midst of a flashback or have just awoken from a
nightmare:
1. Help them calm their body first,
– Let them know you are there and have as much time as they need to help them get calm
(you may need to repeat yourself)
– Your tone is critical.
•
•
•
•
Speak more slowly than normal.
Use short sentences.
Say their name to bring them into the present with you.
Let them know they are not currently in danger, even though it feels like it.
– Encourage attention to the breath: in and out.
– Breathe slowly and audibly to model (think of the yawn effect)
VETERANS HEALTH ADMINISTRATION
How to help: The Caller experiencing PTSD symptoms
Sometimes Callers will be in the midst of a flashback or have just awoken from a
nightmare:
2.
Next help them calm their mind
–
–
–
–
Do you want to tell me about the dream/flashback? (And accept their answer!)
Has this happened before?
How have you coped before?
Grounding skills
• Bring awareness to their surroundings
– “Where are you now? Tell me what you see around you.”
– “Describe something in the room to me as if I’m an alien.”
• Strong physical sensations (ice water, snap of a rubber band) can help, but do not accidentally
encourage non-suicidal self-directed violence
VETERANS HEALTH ADMINISTRATION
How to help: The 3rd party caller/support person with a
loved one experiencing PTSD symptoms
–
–
–
Many of the suggestions for helping the Caller experiencing PTSD symptoms apply to the 3rd
party caller/support person who is coping with a loved one’s PTSD.
Deal with the current crisis as you would normally, especially if the 3rd party is in danger.
Additional resources:
•
•
Coaching Into Care
Caregivers Support Line
VETERANS HEALTH ADMINISTRATION
Listening to trauma stories
•
•
•
•
Never push someone to disclose a story, but instead ask if they would like to share
it.
Sometimes the story will pour out despite the Caller’s intention.
Remain non-judgmental.
Listen for changes in affect:
– If they seem to be becoming MORE upset, reflect that. You can (gently) stop them and
ask if they would like to continue. Always do so with the Caller’s comfort in mind, not
your own.
– If they seem to be calmer after telling the story, reflect that too. “I can hear that talking
has helped you calm down” paves the way for getting the person to a therapist/SPC.
VETERANS HEALTH ADMINISTRATION
Listening to trauma stories
• MOST IMPORTANTLY: TAKE CARE OF YOURSELF EVERY DAY
–
–
–
–
–
–
–
Self-care regimens are crucial
Take a break/walk after a tough call
Talk to a colleague in the moment
Try to leave your experience in the call center
Remember the trauma is theirs and you do not lessen their pain by taking it on
Use EAP or a personal therapist
Attend or begin discussion sessions
VETERANS HEALTH ADMINISTRATION
Outline
•
•
•
•
Overview of the Veterans Crisis Line
Understanding the VCL Caller: Myths and Truths
How to Help: PTSD
Discussion and Questions
Kimberley.mullen2@va.gov
585-393-7613
VETERANS HEALTH ADMINISTRATION