DCoE Blog

  • Clinical Guidelines for Suicide Prevention

    Read the full story: Clinical Guidelines for Suicide Prevention

    Suicide is a significant problem for the Defense Department. For providers, an essential piece of suicide prevention is a proven, step-by-step approach to treating potentially suicidal patients. A recent webinar presented by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury highlighted how the military constantly updates its suicide clinical practice guidelines.

    Eric Rodgers, director of the evidence-based practice program at the Department of Veterans Affairs (VA), talked about the standards and procedures for updating these guidelines.

    Suicide clinical practice guidelines undergo review by evidence-based practice workgroups. Workgroups include representatives from VA and the Defense Department, as well as individuals from multiple disciplines. They incorporate patient input and identify how new guidelines will affect treatment outcomes. The groups which oversee the suicide guidelines include members specifically chosen to address the subject of suicide.

    Guidelines often need multiple reviews before approval. In some cases they may not meet standards for approval at all.

  • DCoE Director: Honing our Efforts to Reduce Suicide – a Public Health Scourge

    Read the full story: DCoE Director: Honing our Efforts to Reduce Suicide – a Public Health Scourge
    Photo courtesy of DCoE

    This article by Capt. Mike Colston, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, is reposted from the Military Health System in recognition of Suicide Prevention Awareness Month.

    Suicide Prevention Awareness Month is a national observance during the month of September, but suicide prevention is a priority for the Department of Defense (DoD) every day of the year. Suicide is a pressing public health issue. Suicide rates have increased alarmingly in the U.S. over the past two decades. The Defense Health Agency (DHA) will lead in preventing suicide through three lines of action: fostering research, translating clinical knowledge to the field and informing policy.

    Research

    The evidence base for suicide prevention remains thin. Research efforts such as the “Study to Assess Risk and Resilience in Service members Longitudinal Project” (STARRS-LP) and protocols under the cognizance of the Military Suicide Research Consortium are producing slow but hard-won gains in the science of suicidology.

  • Military Comic Author Talks About New Book, How it Helps Vets

    Read the full story: Military Comic Author Talks About New Book, How it Helps Vets

    Disclaimer: The views and opinions expressed in this article are those of the author and do not reflect the official policy or position of Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. The “Terminal Lance” series does contain foul language; adult discretion advised.

    Former Marine Maximilian Uriarte began self-publishing his irreverent and often not-safe-for-work online comic strip on life in the Marine Corps infantry, “Terminal Lance,” in 2010. Uriarte’s sharp wit strikes a chord with service members of every branch by highlighting the trials, idiosyncrasies and absurdities of military life.

  • Clinician’s Corner: Patients Can Use Simple Tool to Identify Intense Emotions before Suicidal Crises

    Read the full story: Clinician’s Corner: Patients Can Use Simple Tool to Identify Intense Emotions before Suicidal Crises

    Through our work with military service members and their family members who have experienced a recent suicidal crisis, we have learned that emotions immediately preceding such crises vary significantly from person to person. During individual psychotherapy sessions, our clinicians ask patients to share their suicide stories to better understand the circumstances that resulted in the suicide-related hospitalization and which circumstances resulted most often in the decision to attempt suicide. While providing this narrative, patients report a wide range of emotions that preceded the suicidal crisis such as intense despair, extreme excitement, agitation, uncontrollable anger, numbness, or indifference, as well as debilitating feelings of inadequacy.

    We believe that an important clinical strategy in working with suicidal patients is to first identify emotions that activate and shape a patient’s trajectory from suicidal thinking to suicidal behaviors. The next step is to understand the intensity of these identified emotions so that we can teach the patient to modulate these emotions more adaptively in the future. By mapping out the patient’s emotions in a stepwise fashion, the clinician is able to help the patient identify key points for early intervention strategies, such as a self-soothing technique, deep breathing exercise, or other healthy coping technique (e.g., calling a friend, engaging in strenuous exercise) to impede further escalation.

  • Primary Care and Emergency Providers Can Help Prevent Suicide

    Read the full story: Primary Care and Emergency Providers Can Help Prevent Suicide

    An important finding about suicide is spurring a new approach to reducing it: In the month before they take their own lives, many people who die by suicide seek medical or psychological care.

    These patients don’t come to their local clinic or hospital for help with suicidal thoughts, but with other medical or mental health issues. They may have traumatic brain injury, or they could be depressed. They may have chronic health problems. They might have gone to the emergency department following a drug overdose. Those conditions are treated, but the patient is not necessarily assessed for suicidal risk.

    By evaluating all patients at risk of suicide no matter their reason for seeking care, immediately treating those at risk, and providing follow-up care, health care systems can substantially reduce suicides, presenters said at the 2015 summit of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

    “The potential is there for primary and behavioral health providers to reduce suicide,” said Eileen F. Zeller, an official with the Substance Abuse and Mental Health Services Administration (SAMHSA).

  • Military Medicine Tackles Suicide with Prevention Tools

    When DCoE, in partnership with the Department of Veterans Affairs (VA) released its Assessment and Management of Suicide Risk Clinical Support Tools last fall, they were hailed in a Rand report as an example of how to expedite providers’ adoption of new research. The tools make it easy for providers to apply the latest clinical guidelines for suicide prevention issued by the Defense Department and VA). Also included in the toolkit is information for families and patients. The following post from Health.mil explains how the tools were developed and how they can be used to improve care.

    Read the full story: Military Medicine Tackles Suicide with Prevention Tools
    U.S. Air Force photo illustration by Tech. Sgt. Nadine Y. Barclay

    When it comes to preventing suicide, the military provides resources for individuals, friends, families and providers who can make a difference and help save lives. The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) and other Department of Defense experts collaborated with the Department of Veterans Affairs (VA) to develop a new set of tools, released last year in support of the 2013 clinical practice guideline for the assessment and management of suicide risk.

    “We worked with the VA/DoD Evidence Based Work Group to develop clinical support tools that cover such areas as warning signs, evidence-based treatments and care transition,” said Public Health Service Cmdr. Angela Williams-Steele, a clinical psychologist and chief of evidence-based practices at DCoE’s Deployment Health Clinical Center.

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