Feature Article

Putting the program into practice

In 1996 the U. S. Air Force (USAF) began to implement its newly established suicide prevention strategy - a population-based prevention program involving community agencies inside and outside the healthcare sector. By 1997 the program was in place across the entire USAF.
“The 11 initiatives that comprise the program were originally put into practice by releasing Air Force instructions through existing communications channels,” recalls Col. Wayne Talcott, Ph.D., with the Office of the USAF Surgeon General.
A social marketing campaign was launched within the Air Force that included a series of strong messages to the force from USAF chiefs of staff. These messages repeatedly and unequivocally communicated the urgent need for Air Force leaders, supervisors and frontline workers to:

Support each other during inevitable times of heightened life stress, even when the stress stemmed from violating community norms or the Uniform Code of Military Justice.
Personally offer assistance to others and promote use of community resources when necessary.
Seek help from mental health clinics and point out that when they seek help early, it's likely to enhance their career rather than hinder it.
Ensure that commanders and supervisors support and protect those who responsibly seek this kind of help.

To streamline access to prevention services the USAF integrated the services of six key agencies - mental health, family support centers, child and youth development, health and wellness centers, chaplains and family advocacy. These agencies were required to conduct an assessment of risk for suicide in their community and develop a coordinated prevention plan with measurable goals.
Mandatory annual suicide prevention and peer support/crisis intervention training was put in place and provided to about 80 percent of USAF personnel the first year. And concentrated training was given to gatekeepers including supervisors and leaders within each military unit, medical providers, attorneys and chaplains so they could better channel persons at risk to appropriate agencies.
“It's not enough to just know the warning signs of a suicidal crisis. We need to know what to do,” says Lt. Col. William Wall, chief of the behavioral health section of the AFMC Command Surgeon Office, who likened crisis intervention training to cardiopulmonary resuscitation training.
“Anyone who has taken CPR has learned what to do when someone is choking. … On an awareness level, you know how a person looks when he or she is choking. When applied to suicide, you have to move from recognizing that a person is in distress to taking action to get them help,” adds Wall. “Signs of suicide are not as clear as a person choking. So we must have people who are trained in crisis intervention available to those who appear at risk.”

Tools to use

Innovative tools created by the Air Force to help prevent suicide include:

A two-part video series to improve understanding on how to respond to suicide. The first, “Suicide Prevention - Everyone's Willingness to Care,” is aimed at prevention. The second video, “Suicide - Supporting Those Left Behind,” targets survivors and features interviews with family members, peers and supervisors who have lost someone to suicide. Both videos were released in 2003.
An Air Force Suicide Prevention website. Launched in 2003, the site features a wealth of information including an overview of the prevention program; how to implement a local program; links to relevant Defense Department and Air Force policies, instructions and other publications; and senior leader memos and links to other existing program products. The site also contains links to various agencies in and outside of the Defense Department and provides answers to frequently asked questions.
A 46-page clinical guide, “Air Force Guide for Managing Suicidal Behavior: Strategies, Resources and Tools.” This set of recommendations assists mental health professionals in assessing and managing suicidal behavior. The guide is organized within eight topical chapter headings including Assessment of Suicide Risk, Documentation Strategies, Ensuring Continuity of Care and Links Within the Community. The guide also features a 42-page appendix that contains examples of procedures, forms and program products. “Experts within and outside the Air Force recognize the guide as state-of-the-art, a product without equal in the military or civilian community,” says Brig. Gen. Gary H. Murray, commander of the Air Force Medical Operations Agency at Bolling Air Force Base, D.C.
Frequent electronic messages sent servicewide from USAF chiefs of staff. These messages recognize the courage and sound judgment of persons who address difficult issues in their lives by seeking professional help from marital, family, legal, financial, mental health and spiritual counseling.
Comprehensive health questionnaire, administered when USAF members enroll in the military healthcare plan. First launched in 1996, the questionnaire includes inquiries about mental health status and is given annually in an abbreviated form. Data collected are used to determine when referral to a healthcare provider is indicated.
Removal of policies impeding mental health care for those being charged with violations of military law. To ensure that those facing significant stress receive the care and support of their military unit even when those stressors stem from violating community norms, i.e. the Uniform Code of Military Justice, prevention services on all USAF installations were restructured to establish a limited psychotherapist-patient privilege to protect members charged under the UCMJ.
Newcomers’ orientation briefs on suicide prevention resources within the USAF.
Annual suicide prevention training and ongoing suicide prevention consultation through the command surgeon's office.
Applied Suicide Intervention Skills Training, a buddy care course offered quarterly. Directed by chaplain offices, the course teaches common language and protocol to intervene with those at risk.