Here, as an addition to my entry about Suicide in the Military, I offer my fellow healers and trauma specialists a few tips for working with military populations at risk for suicide (they are just brief tips, not meant to replace any formal training).
- Know your scope of practice. Continue to assess clients using the protocol implemented within your field. The VA, for instance, offers this pocket card as a quick guide to “coping strategies and sources of support veterans can use who have been deemed to be at high risk for suicide.”
- Assess the risk factors. Members of this population tend to carry multiple risk factors simultaneously. Chronic pain, complicated grief, and connectivity to other suicides are risk factors and a given for many veterans. PTSD often goes hand in hand with lack of sleep, substance abuse, and higher divorce rates. Difficult transitions are risk factors for suicide and, of course, readjustment issues are common for veterans. The sense of being a burden is also risk factor for this population: many are returning to a life that seems to have moved on without them; they may sense they are not pulling their weight, especially if they sustained injuries that require special care. Keep in mind the multiple risk factors within this population at any given time.
- Get comfortable with veteran issues. Can you readily talk about killing? How did you respond, just reading the word? There is nothing wrong with some discomfort; the problem arises if your discomfort presents a barrier. Warriors are incredibly intuitive as a population: through specific training, they have honed their senses of fear, threat, and suspicion. Why would they reveal their reality to someone who apparently has difficulty with it? If you are uncomfortable with particular topics relevant to those serving in the military, seek training, consultation, and supervision to help.
- Be aware of access to means. Studies cite guns and overdoses as primary means of suicide for veterans and active servicemembers. Consider this: a majority of veterans own guns while most clinicians do not (according to studies like this one in the Journal of Community Health). Be aware of the firearms your veteran client has at his or her disposal. Keep in mind many veterans have a relational connection with their firearm: it is a source of comfort and safety. There is plenty of inaccurate chatter about veterans, mental health, and firearms. Veterans are not likely to be forthcoming if they have the misconception that their firearms will be taken away if they are seen as “mentally unstable.” I would suggest that if you can make veterans feel comfortable discussing their firearms with you, then they will talk about them as readily as grandparents who brag about their new grandchildren. This also may lead to deeper therapeutic trust and a greater likelihood that the veteran will consent to your recommendation of temporarily removing their firearms— if the risk of suicide reaches that level.
- Learn the culture. As a veteran working with veterans, this is something I cannot urge strongly enough. The U.S. military has its own values, rituals, language, and history— some are unique to specific branches and others are consistent across all members of the military. Do some research and seek out trainings: a working knowledge of military culture can go a long way in establishing a deeper trust with those who have lived and breathed it.
- Be real. I typically share suicide rates with my clients. Bear in mind that many veterans believe if they report any suicidal thoughts they will be hospitalized. I explain to my clients the different responses to different levels of severity. I let them know that most of the vets I work with have at least thought about suicide at some point. I try to keep the door open for more honest assessments of risk.
- Keep asking about it. Treating trauma is not linear; it is more like walking through a labyrinth. Suicide assessment should be ongoing.
Author Vanessa Hughes is a veteran of the United States Marine Corps, having served as a firefighter both in the military and as a civilian. Today she is an MFT (marriage and family therapist) with the VA, treating returning combat veterans with PTSD. She is pursuing her doctorate in clinical psychology at Fuller Theological Seminary Graduate School of Psychology, emphasizing neuropsychology and intercultural studies. Her areas of research include trauma-related hypoarousal and dissociation among veterans. She incorporates somatic therapies in her treatment of combat trauma— including Somatic Experiencing®, yoga, movement, and dance— along with other state of the art and empirically validated treatments. Vanessa is married to a Presbyterian pastor and they have four boys aged 7, 6, 4, and 3 years old.