Q&A with Dr. Barbara Van Dahlen to discuss how together, we will prevent suicide for Service members and Veterans. Submit questions below!

I went to a conference where the Navy briefed a program that was on one of their Maryland locations. They brought their very high suicide rate in that unit from extremely high to zero with an on call escort program.

Again, with the ACE program this is integrated into the Unit workings. The Chain of Command will coordinate a escort to get the individual ( who has been IDed as high risk with suicidal intent) to the hospital for proper treatment.

Thanks for your questions, Lt Col Brown. Regarding your first question, I consulted with my partners in Health Affairs, and they asked me to pass this along. The Defense Health Agency can and does create relevant policy that applies once the health care system is involved. In the case of commander-directed mental health evaluations for Service members who don't self identify, Department of Defense (DoD) policy directs the process to ensure the Service member is safely accompanied to a mental health clinic, in coordination with a mental health provider, and that the Service member's rights are protected. For those Service members who self-identify, compassion and support should be ensured by the commander. Within the Military Health System, health care providers engage in the standard of care for clinical practice and adhere to clinical practice guidelines (CPGs), including the 2019 Veterans Affairs/DoD "Assessment and Management of Patients at Risk for Suicide" CPG. This includes taking appropriate safety precautions, such as constant observation and limiting access to lethal means, for individuals identified as at-risk for suicide and conducting warm hand-offs to mental health providers for all individuals who speak about their intent to die by suicide. There is also current procedural guidance for health care providers on this clinical issue in coordination within the Defense Health Agency.

On your second question, there is a widespread stigma associated with suicide, which may lead people to be afraid to speak about it. Talking about suicide not only reduces the stigma, but also allows individuals to seek help, rethink their opinions, and share their story with others. Most people who attempt or die by suicide have communicated their distress or plans to at least one person. Talking about suicide with a person gives them an opportunity to express thoughts and feelings about something they may have been keeping secret, as well as obtain help and support as needed.

We must be supportive of Service members who need help. We must allow ample time for the Service member to gain access to help. We should speak as leaders about the importance of mental health. An effort to reduce stigma in the DoD is the Real Warriors Campaign, which is aimed at reducing the stigma of seeking mental health care by sharing the stories of Service members who successfully sought care and improved their mental health as a result. The campaign educates Service members, Veterans, and their family members about signs and symptoms of stress and strategies for building resilience. It reaches up to 4.5 million individuals each day through its social media channels. Almost 50 individuals per week reach out for help through the campaign's live chat, phone calls, and "seek help" webpages. At the policy level, the DoD completed reviews of mental health policies and procedures in order to identify stigmatizing language that could be influencing views on mental health issues and help-seeking behaviors. These reviews provided guidance on developing policies and procedures with language that is more supportive of mental health care and less stigmatizing toward mental health difficulties experienced by Service members.

Additionally, DoD has launched several pilot initiatives striving to reduce stigma and strengthen access and delivery of care. For example, DoD is piloting a barrier reduction training designed to address the most prevalent help-seeking concerns of Service members (e.g., career and security clearance loss concerns, loss of privacy and confidentiality), and encourage Service members to seek help early on, before life challenges become overwhelming.

I'm not Dr. Van Dahlen but as a Suicide Prevention Coordinator for VA I think the biggest mistake that well-intentioned people most often make is to ignore a person in crisis. So often we get busy with day to day life and forget that people around us could be struggling. We forget to have conversations, and sometimes fear takes over where we don't ask the question "Are you having thoughts of suicide?". That single question doesn't take a degree to ask, just a caring heart.
Kevin Hines a survivor of suicide from jumping off the Golden Gate Bridge said it best when he explained if someone stopped to ask him if he was okay while he stood there crying he wouldn't have jumped (paraphrasing). Instead someone asked him to take their picture. Having dialogue like this is a great start to opening up conversation and getting everyone comfortable asking the question.

Laura McCarthy - And based on my clinical research on combat trauma and suicide, very few completions are impulsive; so we have plenty of time for intervention.
Rich

Thank you for these thoughtful questions, CPT. Gowel. You touched on a very important point, particularly that everyone has risk factors for suicide but we also have protective factors that can decrease the risk for suicide. It’s important learn about risk and protective factors so we can help ourselves and our loved ones. Information is available on our public health campaign website: wearewithinreach.net.

Preventing suicide requires that everyone be part of the solution. Historically, people have been uncomfortable talking about our mental health concerns. But we can change this. We used to be uncomfortable talking about physical health concerns like cancer – but now we celebrate someone’s recovery from cancer – and we join our family and friends in their fight to beat cancer. We can do the same with helping friends and loved ones who are struggling with emotional pain and suffering.

We can start by reaching out to each other on a regular basis. If we have concerns about someone we care about, its helpful to ask “how are you, really?” and then really listen to the answer. We don’t need to have all of the answers – just offering to be part of the solution is tremendously helpful. Just letting someone know you are with them for this fight can save a life. People who feel suicidal often feel ashamed of these feelings – they may feel week. Letting someone know you are there and that you understand that they are in pain can make a huge difference.

In terms of mistakes that people make – sometimes we don’t notice or understand indicators that someone is suffering. This isn’t a mistake as most people don’t receive education about indicators of emotional health and well-being – but we can all be more mindful of these indicators. Efforts like REACH are working to increase awareness and provide education to all Americans. Sometimes people think that someone talking about suicide is just “blowing off steam” or that they will “get over it”. Sometimes well intentioned friends will say things like “this will pass” or “it could be worse”. We should always take someone’s statements about suicide seriously. It is important to ask directly “I hear what you are saying – are you thinking about hurting yourself?” We need to remember that asking the question won’t put the idea into someone’s head – this is a myth we are working to dispel. And if someone is seriously thinking about hurting themselves, you can call the Suicide Prevention Lifeline at [login to see] (press 1 if you are a Veteran or Service member). The people on the Lifeline will be helpful to anyone calling – and can offer assistance to someone who is trying to help a friend or loved one.

Barbara Van Dahlen, PhD

Waiting for you to answer my 3 questions posted last week..

SPC Paul Woolford - You're going to waiting a long, long time. So far, in my experience with Barbara Van Dahlen, she's big on rhetoric but never bothers to actually answer any questions that will move the needle. That includes http://www.greyteam.org reaching out to her on Twitter, LinkedIn, Facebook, and Instagram.

Thank you for your comment. It is my honor to help you and others who have served our nation. We greatly appreciate your kind response and we are glad you found this experience helpful. If any additional questions or remarks should come up, please feel free to reply to the thread or add your comment in the box. Thank you for your service, SGT Groth.

Barbara Van Dahlen, PhD Thank you for your support ma'am.

Well the first thing I found if you haven’t been there don’t answer with I know how you’re dealing other enough you probably don’t veteran of Vietnam 68 to 70 high contact scout with ptsd After almost 50 yrs I have learned a lot about how to deal with it in my opinion finding other veterans with similar experiences helps because more than likely they do know what your feeling.I always disliked the consoles that lead you to believe that they to were combat veterans

Thank you for this question, Capt. Charters. I understand. As the national conversation around mental health and suicide continues to change (for the better), there is hope that these types of interactions will become easier. The more open conversations we have with each other – including those who are struggling – the more we share our own struggles, the easier it will be to work together to ensure that we all have the help and support we need. When we think about helping a friend or loved one find care for a physical concern, it isn’t unusual that the process/journey to find the right “fit” or approach might take some time. We must take a long view approach when it comes to mental health challenges. We may not have all of the answers immediately for those who are hurting – but if we make it clear that we are here for the long run – to be part of the solution – we can make that journey together.

If you believe someone you know might be experiencing suicidal thoughts, it is critical, that you get help for him or her. Neither you nor the person who is struggling should face this alone. There is help 24 hours a day from Veterans Crisis Line provides free and confidential support and can be reached at [login to see] (press 1). You can also call 911, go to the nearest emergency room, or go directly to your nearest VA medical center. It doesn't matter what their discharge status is or if they’re enrolled in VA health care. You can find more information and resources here: https://www.va.gov/health-care/health-needs-conditions/mental-health/suicide-prevention/

Hello Secretary McDonald! It is such an honor to have you join this conversation. Yes - we are very concerned about the impact of social - and emotional - isolation on all Americans, especially our most vulnerable citizens - during this pandemic. As we know, some of our Veterans fall into this category - they may be isolated because of prior circumstances, COVID or both… Technology can play a tremendous role in helping reduce isolation and loneliness. But technology is only the vehicle. The critical element is the human connection. The more we can be open and honest with each other - the more we can share stories of struggle and healing - the more likely we are to prevent emotional pain and suffering - and the more likely we are to build relationships that will protect us from feeling hopelessness and despair. Through REACH, we are encouraging everyone to actively think about those in their community who might be vulnerable - REACH out and offer support.

Sean, I agree with your transition comments; although, most of what you said can also apply to old folks like me when I left service after 32 years. Every civilian that cut me off in traffic or cuts the grocery line risked being confronted for bad behavior, which usually escalates quickly due to everyone's sensitivity these days. We didn't deal with unruly civilians so much in our military service (active duty), and we just seemed to ignore them as the ill-disciplined people who we had to ocasionally deal with when in town. When you re-enter civilian life it is alien, and you constantly want to do on the spot corrections each time you leave the house. After a while, maybe a year or two, you begin to ignore the ill-disciplined civilians once again. At the VA Hospital where I work we definitly see a difference in age groups that use the VA. I could assume some reasons the younger folks don't go to the VA, but based on my experience I know our Vietnam, Korean and WWII Veterans seem to for the most part like and appreciate the VA Hospital where I work. They hang out there before, during and after appointments to swap War Stories/Experiences with their buddies. Its the younger generations of Veterans that I don't see, and who have much higher expectations, which should be met and never discounted. It's a shame we don't have more young Veterans holding the VA and its Staff to expectations. This might help influence some of the crusty VA staff who've had it easy over the years to start doing a better job. The vast majority of VA Staff are not Veterans.

LTC Brian W. Wright you are on point! I ran into the same issue the first few years. You also pointed out about the WWII, Korean and Vietnam vets using the VA and I see the same thing. What I don't see are Vets working in the VA at almost any level other than upper staff. I constantly ask and constantly get the same answer. "No, I wasn't in the military".

CW3 Sean Feely - The problem with suicide is your comment the Army trains us that it is life or death to accomplish the mission and people are not accepting that vets that want to die, that same mantra applies. Does not mean we should not try but understanding is half the battle. The other place we fail is using civilian behavioral health tactics on soldiers. The day you get off the cattle truck from reception to the day you leave it is all about the team and when a soldier is suicidal, it is all about them. If this game was just about me, I would have been dead years ago. It is not about you, it is about your buddy to your left and your right and if you kill yourself, your pain goes to them. There is always someone you are going to fail if you kill yourself but we are scared to treat them like we have since basic and that is the team comes first. That is all I know sitting at 28 years since basic.

Thanks for being part of the discussion, Chief! My office works very closely with the Military-Civilian Transition Office here at the Office of the Secretary of Defense and our partners at the Department of Veterans Affairs (VA) and Department of Homeland Security (DHS) to build a seamless process that helps prepare Service members for those transitions.

As you may know, the transition process now starts at least a year prior to separation or retirement. During the Transition Assistance Program (TAP), Service members receive information and training to help them make educated choices regarding their transition. It also gives them a safe space to ask questions, receive additional assistance from a TAP counselor, and more. Federal employment is one of the paths presented during that process, and our VA and Department of Labor partners work closely with us to ensure Service members are aware of their options prior to and following separation.

Knowing the first year of transition is critical for Service members and Veterans moving from the military to civilian life, President Trump signed Executive Order 13822, "Supporting our Veterans During Their Transition from Uniformed Service to Civilian Life," on January 9, 2018. The order works to address transition-related challenges, provide seamless, high-quality mental health care, and reduce suicide rates among the Service member and Veteran population. It directs the VA, Department of Defense, and DHS to work together to ensure newly discharged Service members and Veterans have access to any needed mental health care and other services for at least one year following their discharge from military service. To achieve this, we co-chair a Joint Action Plan Implementation Team to oversee progress on key tasks to identify and address potential gaps. You can see more at https://www.defense.gov/Explore/News/Article/Article/1947732/executive-order-aims-to-help-transitioning-troops/.

Thank you, SPC Higgins. We greatly appreciate your kind and helpful response. This information can never be repeated enough, and it is vital that people know how to access these resources. If any additional questions or remarks should come up, please feel free to reply to the thread or add your comment in the box.

Barbara Van Dahlen, PhD - Dear Barbara, if I may indeed, address you by your first name: It is a Great HONOR; to have you with us. Thank you; beyond compare; for commenting.

Cpl Adrian Blumberg - This is exactly what my SAVE VETS collaboration is trying to do. We are composed of several veteran-owned small organizations that do outreach in our communities. We do this 24/7, often with our own funds and little help from those that claim they are working to combat the suicide crisis. Those 9 to 5 Mon - Fri agencies seldom, if at all, conduct face to face outreach, but rather sit in their climate-controlled offices waiting for a vet to come in. Many vets are disillusioned with the VA and government programs. SAVE VETS will not leave anyone on the battlefield.

Based on my 4 yr. clinical research on combat trauma many come home w/ a great deal of lingering psychosocial trauma that is being under treated.
Rich

May I suggest you watch the documentary "The Hidden Enemy " which should shed a great deal of light on this very sensitive subject!! I am a firm believer that every military personnel being discharged be mandated to watch this documentary! Looking forward to your comments after you watch the film.

Cpl. Blumberg, you bring up many important questions and ideas about the way we reach Veterans and those who may be at risk for suicide. While you are right that privacy concerns may limit the personal information that organizations may be able to distribute, you are also right that there is more we can all do. It may not always be obvious when the people we love are struggling or in need of help, but we all have a role to play in preventing suicide, and programs and policies such as PREVENTS can only be effective when each of us takes action.

The REACH campaign launched this year as Recommendation 1 of the PREVENTS Roadmap: “Create and implement a national public health campaign focused on suicide prevention for Veterans and all Americans.” The REACH campaign encourages all Americans to do exactly what you describe– REACH out to everyone, because anyone may be at risk for suicide. There are so many ways we can all REACH, whether it is sending a quick text to a friend you haven’t talked to in a while, or including “how are you, really?” when you check in with others. We should all be taking a few moments each day to check in with friends, family members, and colleagues– especially those who we know may be going through a challenging time. A simple message can go a long way in letting someone know you care. When you REACH to someone who is hurting, you provide hope. We each don’t have to have all of the answers, but if we each get involved where and how we can, together we will prevent suicide. I think it has been difficult for people – and organizations – to know what to do to help. But we are working to change that. To your point – we want people to take action and we are providing information so they know what to do.

The REACH campaign will be successful when there is a strong awareness of risk factors and the adoption of help-seeking behaviors among all communities, and Veterans in particular, and when we have a culture of openness, support, and belonging surrounding the topic of suicide and mental health more broadly. In order to achieve success, PREVENTS is using Recommendation 4 of the Roadmap: “Develop effective partnerships across government agencies and nongovernment entities and organizations to increase capacity and impact of programs and research to empower Veterans and prevent suicide” to partner with organizations such as VSOs. When we all REACH, we will prevent suicide. Thank you for your passion and commitment to this issue.

Thanks for taking the time to do this Dr. Van Dahlen. PREVENTS work is so important in this mission of eliminating suicide across all sectors. We appreciate your tireless efforts.

Thank you so much for sharing these resources with the RallyPoint community, COL Burroughs. Victory for Veterans and Warriors for Life sound like powerful and effective initiatives – I look forward to learning more. The mission of PREVENTS is to identify and amplify efforts that are providing care and support to those in need. Our Veterans, first responders, Service members, caretakers, and military family members benefit from a range of services both inside and outside the VA. Every person and organization has a role to play in preventing suicide. Thank you for all that you’re doing to support the mental health and well-being of others and I look forward to seeing how VFV and WFL continue to make a positive impact in military communities across the country!