A Grandpa's Notebook · Chapter 12Unquote
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Mental health experts have come to accept paraprofessional-level suicide intervention and prevention workers as among those in the forefront of primary resources. The view is that their intervention might reduce the lethality of a person contemplating suicide, and even influence someone who has actually initiated an act of suicide. In this regard, some years ago, Dr. Calvin Frederick, a past President of the American Association of Suicidology wrote (quoting):
(Dealing with suicidal behavior, that is, suicide prevention) differs from more classical diagnostic and treatment procedures in the following respects:
1) suicidal behavior covers a broad range of disturbances and personalities and is, therefore, not a unitary concept;
2) it possesses a unique life or death quality;
3) intervention does not utilize traditional therapy methods;
4) the problem is multidimensional and multidisciplinary, often involving social and cultural attitudes, the law, medical intervention, and innovative psychological approaches;
5) the use of indigenous volunteers as stable and sensitive crisis workers is greater than that found in most aspects of therapeutic endeavor. (unquote)
The following is quoted from the Institute of Medicine's (IOM) Healthy People 2000 Report-Citizens Chart the Course, a separate volume of Healthy People 2000 that records the testimony and suggestions of citizens interviewed by the Public Health Service in the development of year 2000 national health objectives. The quote is from the section: Violent and Abusive Behavior, page 137): 'Meyer (Mike) Moldeven of Del Mar, California, says that volunteer training is an important component of successful suicide intervention for all ages: 'A community's suicide intervention and prevention resources - of which the suicide prevention center, crisis center, and hotline are elements - depend to an enormous degree on local paraprofessionals and trained volunteers.' In the workplace, employers already provide programs for stress management, as well as cardiopulmonary resuscitation and first- aid training. Thus , 'why not a lay worker on the job site who is trained to function in an emergency suicide situation?' asks Moldeven. 'The United States [Armed Forces] have established formal suicide prevention programs, and the groundwork laid can be used to tailor comparable programs for other employers.'
The largest single federal department, formally recognizing suicide as a critical challenge to the good and welfare of their personnel, took a great leap forward by institutionalizing suicide prevention. With the foresight and efforts of advocates and caring managers, comparable initiatives, both formal and informal, can be expected from other government entities. When top-management directed - and supported - suicide intervention and prevention policies do take root throughout the federal system, as they inevitably will, they will merge or interact with adjacent Regional, State and community programs. The United States Armed Forces' everybody's business approach to crisis intervention and suicide prevention for their military and civilian populations has great potential for the public good.
Public and private sector employers and schools benefit from their awareness of policies, resources, and standard operating procedures for suicide intervention and prevention practiced by institutions and other employers in their area. Where such cross feed and mutuality does not prevail, employer-community initiatives can explore them and apply the results for the common good. Such efforts contribute to the well being of employees and their families; parents, teachers, counselors and students, encourage and improve industrial and community safety, and generally enhance esteem and mutual respect among employers and the community of which they are a part.
In order that ci/sp policies, practices, and training can move forward, information that will help the ultimate recipient of crisis intervention services needs to be disseminated to all levels and throughout all functions of the military and civilian communities: the line and the staff and their families; the civil services, academic and business communities, the domain of the elderly, and the general public. Readily accessible in public, institutional, and corporate libraries, adapted to and ingrained into the system, the procedures and delineation of who-does-what in crisis intervention/suicide prevention will help to coordinate and improve plans, methods, and collaboration across the board. It would be a true win-win.
The news media and the Internet can alert employers that do not as yet have their own programs, and keep them informed of opportunities to participate.
Suicide prevention is everybody's business.
Atch (Copy of letter from)
Meyer Moldeven
April 26, 1993
To:
Secretary of Defense The Pentagon Washington, DC 20301
Honorable Secretary:
[The opening paragraph in the original letter cited a number of suicides in a military organization. Identifying the activities involved is not relevant to the focus of this copy and has been omitted.]
There is one aspect of organizing around (suicide intervention and prevention)-all-services-that deserves review at command level and, if a covering policy or management system exists, that it be publicized throughout the services and in civilian communities adjacent military installations.
Normally, a military person with an intolerable personal problem tries to get relief from within the system of which he or she is part, e.g., a buddy, family support services, chain-of-command, personnel staff, the IG, etc.. Many personal problems are not job related, but because of the victim's inability to cope, spill over and affect "job." When the person is in a suicidal crisis, realizes that help is urgently needed, and wants such help, he or she will not hesitate to contact whomever can provide it, if not from within the system then from outside.
Unless the military administrative system has changed on this point, a suicidal military person, or a suicidal member of his or her family who seeks help from within the system, believes that a record of the contact will be made. The "record" transforms to stigma and a potential threat to present job and future career. "Records," more often than not, compel the person in a suicidal crisis to look elsewhere. Elsewhere includes the adjacent civilian community's crisis intervention resources, specifically, the suicide prevention telephone hotline where callers need not provide identification - they're as safe from being identified as anywhere they can be under their circumstances. The hotline worker does what can be accomplished quickly to keep the caller from slipping deeper into crisis and acting out a threat to suicide. They listen, offer nonjudgmental feedback, and together with the caller, explore options.
Almost invariably, when a civilian community crisis worker (telephone hotline or face-to-face) needs information on options unique to military life to help a suicidal military member or someone in his or her immediate family, the source is the nearest base's health care, personnel, or other administrative functions. Very often, when contacts with base officials occur and the worker has the name of a suicidal caller, confidentiality is literally vital; being tagged in the base's records as someone who phoned an off-base crisis center carries almost certain exposure to military authority, and might well add the final straw.
If it's accepted that the military base and its adjacent civilian community should cooperate in suicide intervention, then the civilian and military agencies need mutually accepted procedures to do the job. If a community's crisis resource has one set of procedures for cooperation from the Navy, another for the Marine Corps, and still others for the Army and the Air Force, confusion mounts and collaboration suffers. This is especially true when the situation is tight and there isn't much time to keep a suicide threat from becoming an act. To the telephone hotline worker in a suicide prevention center it makes no difference whatsoever if the person on the other end of the line is a soldier, sailor, airman, marine - or civilian. On the other side of the scale, however, is the we-take-care-of-our-own turf, and that, to the suicidal person, is meaningless.
I hoped that, by now, military bases would have been further along in collaborating with adjacent civilian suicide prevention resources and that such teamwork would be reflected in base and community media. How else would a military person or a member of his or her family on the edge of a life-death decision for themselves know where to go or whom to phone, especially where their privacy and confidentiality would be respected - if they decided to take a chance to continue living? Is a city telephone directory listing for the local crisis center enough?
Agreements, procedures and contact points for military-civilian teamwork in suicide prevention deserve to begin on a county, metropolitan, or other regional basis, rather than in single-base to community understandings, especially where the area has bases representing different services. When all the services in an area have maximum understanding among themselves about collaborating with community suicide intervention resources, it will optimize the support that they and their people as individuals can ask for from that resource, and the help that the hotline worker can offer to them. In effect, when a civilian suicide hotline has been appealed to for help by a military member/family member, the crisis worker will have clearly written, mutually agreed upon procedures for communications and actions with each base in the area. All concerned will have been trained, tested, and know to the greatest degree possible who is going to do what. With present computer networking capabilities the resources indices in such guides can be readily maintained current and widely disseminated throughout a region and on and among military installations.
The opinions in this letter are my own, and are based on my experiences as a civilian IG-analyst and suicide prevention hotline volunteer in the late '60s/early 70s (and hassling the bureaucracy on this issue into the mid-80s.) I am not now associated with any mental health profession or military organization-strictly a private citizen. It may be that what I've suggested already exists or, conversely, that it isn't justified; I don't know, but I would be remiss not to present my views for your consideration.
Respectfully,
s/Moldeven
Reply (Copy)
(From) Office of the Secretary of Defense Washington D. C. 20301
(Force Management and Personnel)
1 June 1993
(To) Mr. Meyer Moldeven
Dear Mr. Moldeven:
Thank you for your letter of April 26, 1993 to Mr. Les Aspin, regarding suicide prevention programs in the Department of Defense.
Your letter prompted a review of policy in the Department of Defense on suicide prevention. The Department of Defense does not address suicide prevention in its directive on Health Promotion. That directive was published March 11, 1986, and is in need of revision. The Department is reviewing and revising that directive and a suicide prevention section will be added. We will address in the development of that section the issues you raised in your letter to Mr. Aspin.
Thank you for your interest and continued concern in this important mental health area.
S/Nicolai Timenes, Jr. Principal Director (Military Manpower and Personnel Policy
[added, hand-written: 'Thanks!']