Veteran suicide prevention: The power of connection

We’ve all heard suicide is a complex issue and dying by suicide is never influenced by just one thing. Yet our hearts continue to drive us to find a solution to end suicide and keep our loved ones here with us.
Survivors tell us that a smile, a conversation and listening have all saved a life; that’s the power of connection. Michiganders know the simple and powerful importance of coming together when times are tough.
Thomas Joiner, a recognized leading expert on suicide, highlighted the importance of looking at suicide behavior as a way to increase our understanding of human nature overall, in his book Interpersonal Theory of Suicide.
One approach to understanding human nature includes looking at the ways thriving, connection and fulfillment are achieved. Another is looking at catastrophic, disastrous malfunctions and their implications.
Another way to think about this is, what about human nature can go so wrong that suicide happens? Understanding this may be a window into understanding even more about human nature.

In Joiner’s book, there are three main components that are important for us to understand. Decreased sense of belonging, increased sense of burdensomeness and capability combined with the desire to die by suicide. Capability refers to decreased fear of pain and/or death alongside knowledge and experience with methods and/or items that might be used in a suicide attempt.
Capability, specifically, is a strong risk factor for veterans, one that we need to acknowledge, talk about and safely plan around. Starting at bootcamp, service members are trained to use lethal means, often firearms. Some military experiences come with an increased exposure to life-or-death situations and can create familiarity with death, which may desensitize and decrease fear of death.
When we think about how this fits with Joiner’s book, veterans potentially check the capability and decreased fear/death category, meaning they face life stressors at an increased risk of suicide. They possibly only need to meet the other two components, decreased sense of belonging and increased sense of burdensomeness, along with a desire to die by suicide. This is an important understanding for the community to be aware of.
You might be asking yourself- how else are veterans different and how does this information relate to health care?
Experiencing pain, new medical diagnosis, exacerbation of a chronic illness or diagnosis of a terminal condition are all potential risk factors for suicide experienced by many veterans.
Picture a backpack. Each person walks in with a backpack, carrying heavy rocks symbolizing risk factors. A veteran’s backpack potentially comes pre-loaded with extra rocks. Are you screening them for how many rocks they have in their backpack? Are you making community connections that will remove some of the rocks/risk factors from the backpack?
Inside a military service member or veteran’s backpack we might find a few of the following.
Military service members are more likely to have experienced adverse childhood experiences or ACEs, which increases vulnerability to future trauma.
A potential risk factor faced by many veterans includes moral injury; witnessing or participating in an activity that goes against their morals or values.
Transitioning from being in the Coast Guard, Army National Guard, Air National Guard, border patrol, or active-duty military service into their veteran role is a turbulent time with heightened psychosocial stressors.
Veterans die by suicide at a higher rate than their civilian counterparts. Asking, “have you served in the military,” and providing additional community connections can be a key opportunity for the power of connection. It can help save lives.
Let’s talk about Community Care
Rural Veterans often utilize the Mission Act for VA eligible health care services that occur in their local community. This creates a pathway for veterans to use their local health care systems to meet their physical and mental health needs close to home and with the provider of their choice. This also means, veterans utilizing community care services through the VHA Mission Act may not be utilizing their VHA facilities, which makes it even more important for community providers to understand the unique needs of the veteran population and screen for suicide risk factors.
In rural communities which veterans are using Community Care?
Studies show that veterans using community care are more likely to be unmarried, with lower incomes and less formal education. They’ve been assessed and diagnosed through VHA, and often have chronic medical conditions, and self-reported disabilities that are linked to mental or physical factors. They often are experiencing depression, anxiety, and trauma at greater rates with the adverse childhood experiences mentioned above. These potential risk factors all possibly cause suicidality.
Ways you can collaborate!
Working with a VA Community Engagement and Partnership Coordinator (CEPC) will connect you to subject matter experts from VA departments like Suicide Prevention, Interpersonal Violence, Caregiver Support, and Military Sexual Trauma, and training such as VA S.A.V.E for suicide prevention, military cultural training, veteran specific informational presentations on PACT Act, and more.
Community tools to consider for your health care system are Early Alert, a free wellness service through text messaging that provides instant personalized support and referrals for pain, sleep, finance, relationships and more. For Upper Peninsula of Michigan, service members may call 833-634-0770 to sign up.
To assist your providers in raising the topic of lethal means safety and how to advise clients and patients of safe firearm storage in the home, counseling on access to lethal means (CALM) training is also available.
To utilize the Columbia Severity Suicide Rating Scale for suicide screening, log on to https://learn.psycharmor.org/courses/Columbia-Scale-for-Healthcare-Providers.
To read about 15 things veterans want health care providers to know, log on to https://psycharmor.org/courses/15-things-veterans-want-you-to-know-for-healthcare-providers/.
Office: 1-906-774-3300 ext 32541