Page 143 - Journal of Special Operations Medicine - Spring 2016

o a sense of failure in connecting with others and could be the single most important measure to prevent
maintaining relationships suicide and might even apply to addiction prevention
o the learned ability to hurt oneself (through previous and treatment as well. As much as any one individual
6
experiences with violence or self-injury, the person might believe that he or she prefers to be alone or enjoys
has grown accustomed to the negative aspects of solitude, we are social creatures. On this, the science is
suicide, such as fear and pain, that prevent others decidedly decided.
from attempting it)
• Talking about wanting to die To understand fully the highest risk factors,
o looking for a way to kill oneself it is important to cover the current prevailing
o talking about feeling hopeless or having no purpose model of suicide. This model is the three-step
o talking about feeling trapped or in unbearable pain theory of suicide. 7
o talking about being a burden to others
o increasing the use of alcohol or drugs In step one, a combination of physical or
o acting anxious, being agitated, or acting recklessly emotional pain and hopelessness spurs
o sleeping too little or too much thoughts of killing oneself. “Depression and
o withdrawing or feeling isolated other traditional risk factors matter to the
o showing rage or talking about seeking revenge extent that they increase hopelessness and
o displaying extreme mood swings pain,”

This list, however, is only as good as the people who Second, . . . thoughts further intensify for
use it. Once you identify one or more of these warning people who lack connections to loved ones, to
signs, what do you do? It is important to understand valued roles or to any sense of purpose in life.
what to do as well as what not to do. The Centers for
Disease Control and Prevention (CDC) and the Depart- Finally, . . . researchers hold that suicide
ment of Defense lay out an immediate plan for what attempts occur only among people with a
to do when someone exhibits warning signs of suicide, low sensitivity to pain—a partly genetic trait,
but there is arguably a very large gray area before these according to studies of animals, human genetic
warning signs seem overt enough to take the measures variants and human twins—and an ability to
outlined next: overcome fears of death.

• Stay with the Servicemember until help arrives. Never Based on this, my advice to leaders is to guide subordi-
leave a suicidal person alone. nates and peers and take the following concrete steps.
• Remove any weapons, drugs, or other means of self- Have your subordinates program the hotline number
injury from the area, if possible. (800-273-8255) into their ubiquitous smartphones and
• If you are on the phone with a Servicemember and order them to call that number if they have no other
you believe the individual is in immediate danger, try connection that they feel comfortable contacting. Edu-
to keep him or her on the line while you or someone cate them on the importance of having connections,
else calls 911 or 1-800-273-TALK (8255). Ask if there even if it goes against what they believe is a predisposi-
is someone nearby who could offer support, and keep tion toward solitude.
talking until help arrives.
• If the Servicemember is unwilling to accept help, con- Next, talk to them about how any suicidal ideation mer-
tact command or law enforcement or take the person its them talking about it and that there are anonymous
to an emergency department. resources, such as the hotline, for them to do so.

While this list saves lives, it provides no guidance on Next, I would also talk to them about risk-taking be-
how to talk to about suicide in the early stages when havior that could be linked to the third step. A Ser-
no crisis may exist. Applying prevention measures early vicemember who gets a speeding ticket while driving a
when risk factors are present should be the goal. There motorcycle at 90mph is probably a good candidate for
are actionable steps that leaders can and should take a leader to spend a good deal of time talking to about
without even mentioning suicide but just concentrating connectedness without necessarily talking about risky
on risk factors. behavior or suicidal ideation, unless brought up by the
person engaging in the behavior.
Access to firearms, risk-taking behavior, and abuse of
alcohol are risk factors that all leaders are probably well Last, I would consider relating the following data from
aware of and know how to mitigate. However, other a sample of 515 people who contemplated suicide by
risk factors are possibly more important. Connectedness jumping off the Golden Gate Bridge but were restrained.

From the SEMA 127