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Upstream Prevention in Suicide Prevention - Spotlight by WDVA Suicide Prevention Program Manager Codie Garza

As a spouse of a U.S. Army soldier of nearly 9 years, I have learned that US military service members and veterans are a group of incredible men and women. They possess amazing survival skills, physically and mentally. Yet, we continue to see high rates of suicide among our most brave and courageous heroes. Personally, my spouse has lost too many of his close brothers to suicide in the last decade. I know his story is not unique and I find that quite heartbreaking. Our country lost 511 service members and 6,139 veterans to suicide in 2017. So how do we combat these alarming suicide rates?

In order to reduce military and veteran suicide, we must fully understand why they might see suicide as an option. It’s important to understand that there is no one reason, cause, or problem that results in suicide. Ultimately, suicide related thoughts and behavior happen when an individual’s ability to cope gets overwhelmed, just like they might get physically sick when their immune system’s ability to cope with a pathogen gets overwhelmed. There are, however, important ways of understanding the multiple paths to suicide. The key to prevention is traveling back up that path and catching people well before they’ve even started their journey to hopelessness.

What we do know?

Generally, 3 things exist when a person chooses suicide.

1) Perceived burdensomeness – feeling worthless and weak in their community (regardless of whether or not others see them that way)

As a Veteran transitions, they may struggle with trying to gain purpose once again in a civilian world. For those still serving, this feeling may come due to a setback in their career or possibly feeling invisible to their command or unit.

2) Thwarted belongingness – feeling like they don’t belong or have lost connection to their community, regardless of what others think.

A person might start to isolate themselves or may be involuntarily isolated. As a Veteran transitions from service they may be separated from their once tight-knit military community. Current service members may find themselves in this position if they are being cast out of a group for unacceptable behavior or a change in their mental health.

3) Acquired capability for suicide

As evolutionary theory explains, we are not designed to die, but to live. Our bodies are evidence of this as they are designed to protect our most valuable organs with a rib cage for the heart and lungs and a thick skull for the brain. Our natural fear systems display this when we are threatened with death, as we instinctively react to protect ourselves without thought. Therefore, in order for suicide to occur, we must bypass this instinct, or desensitize, the brain to death and pain. For our service members and veterans, this may come with the job. “Boot Camp”, “Basic Training”, or “Recruit Training” is used as an opportunity to desensitize a service member to dangerous, sometimes painful, situations and the possibility of death. This becomes very useful as they must be ready to run towards danger, not away. They may also need to value the mission and/or others’ lives over their own. Furthermore, if they have a history of repeated or intense exposure to dangerous situations such as enemy engagement, this fear of death could decrease as well.

Why does this matter?

For many, this acquired capability takes time. This is usually accomplished through suicide attempts, thrill seeking behavior, and non-lethal self-harm. That means when someone has the desire for suicide, we have time to talk them down if we can pay attention to signs and symptoms. However, for military service members and veterans, this desensitization may exist before a desire for suicide develops in the first place. That means we have to act fast if we find our brothers or sisters in crisis.

What can we do?

Upstream suicide prevention is when we address the potential risk factors before they become a problem. As a member of the military and Veteran community, you can do this with a few simple actions.

1) Addressing perceived burdensomeness – We all need help every now and then. Sometimes that’s hard to admit. However, as a leader, trusted friend, or family member we can teach others that it is okay to need help sometimes and it does not make you a burden. You can do this by leading by example, sharing your struggles with others and asking for help.
2) Addressing thwarted belongingness – Separation and isolation can be huge risk factors for suicide. One very simple way we can address this is by checking in. Simply sending a text or making a phone call to a fellow service member or Veteran to let them know you are thinking about them can make them feel less isolated and show them you are a safe person to talk to if they are in crisis. Engaging in community activities with fellow military service members or Veterans can also be a good way to create a sense of belonging.
3) Addressing acquired capability for suicide – Normalize having conversations around lethal means safety. Talk about how to store firearms safely, what your options might be if you are ever in crisis, and who you might be able to turn to. Just like preparing for a mission, safety planning conversations are best to have long before someone ever reaches crisis.
If you or someone you know is in crisis, please reach out to the Military and Veteran Crisis Line at [login to see] . Press 1 to reach a Military/Veteran responder.