36C24219R0002-006.pdf

RESPONDING TO THE SUICIDAL VETERAN IN-PERSON (SAVE)

Step 1: SEE the WARNING SIGNS & listen for SUICIDE RISK INDICATORS Examples: “I’m a burden on my family,” “I have no reason to live,” “others would be better off without me,” or “I would be better off dead.”

REMINDER 1: When you have reasons to believe a Veteran may be at risk for suicide, it’s important to: remain calm, listen attentively, act with confidence, and offer supportive comments.

Step 2: ASK QUESTIONS & VALIDATE THE VETERAN’S FEELINGS Explore your concerns about what you saw or heard by:

Asking questions to understand Vet’s situation and perspective Gathering information casually Using restatements (repeat back what was said in the Vet’s own words) Being supportive while avoiding judgmental comments or reactions

REMINDER 2: Many situations will indicate the need to immediately initiate the MH Safety Protocol: Examples:

when the Veteran reports s/he has already taken steps to harm self; makes a specific threat to harm self or others;

or appears to be highly anxious, intoxicated, desperate OR irrational. (Under these circumstances, go to Step 4 and initiate the MH SAFETY PROTOCAL.)

Step 3: ASK ABOUT SUICIDALITY & ENCOURAGE TREATMENT Do you currently have suicidal thoughts or plans to end your life?

And, do you have any intention of acting on these thoughts or plans?

When the answer to either of these questions is “yes,” suicide risk might be imminent, and the MH SAFETY

PROTOCOL should be initiated.

When the answer is “no,” attempt to connect the Veteran to behavioral health for additional suicide risk assessment (same day, if possible); then go to Step 5.

REMINDER 3: Never place your own safety in jeopardy. If a Veteran has a weapon or directly threatens you, protect yourself, remove yourself from the situation, and seek safety -- THEN IMMEDIATELY NOTIFY THE POLICE (62911). Refer to the Prevention and Management of Disruptive Behavior (PMDB) protocols for additional details about how to respond in these circumstances.

Step 4: EXPEDITE TREATMENT BY INITIATING THE MH SAFETY PROTOCOL Ensure the Veteran is not left alone – meaning s/he should stay with a VA staff person until they are connected to the professionals for an evaluation.

When in the medical center, escort the Veteran to the emergency room, and, when possible, notify the VA police before s/he is escorted.

Pass along all information shared about suicide plans, preparations and/or intent to the evaluators.

If the Veteran absconds without seeing the professionals, call 62911 or initiate a “Code Green” (in the MC) or call 911 and initiate a rescue (in community settings) Step 5: Notify your supervisor and the Suicide Prevention Team The Suicide Prevention Coordinator @ 65329 The Suicide Prevention Case Manager @ 65515

REMINDER 4: Regardless of outcome, consult with and otherwise seek support from your supervisor, involved behavioral health staff, suicide prevention team members, and/or other colleagues. These situations can be upsetting and normally will bring up emotional reactions that should not be ignored.

RESPONDING TO THE SUICIDAL VETERAN IN-PERSON (SAVE)

Step 1: SEE the WARNING SIGNS & listen for SUICIDE RISK INDICATORS Examples: “I’m a burden on my family,” “I have no reason to live,” “others would be better off without me,” or “I would be better off dead.”

REMINDER 1: When you have reasons to believe a Veteran may be at risk for suicide, it’s important to: remain calm, listen attentively, act with confidence, and offer supportive comments.

Step 2: ASK QUESTIONS & VALIDATE THE VETERAN’S FEELINGS Explore your concerns about what you saw or heard by:

Asking questions to understand Vet’s situation and perspective Gathering information casually Using restatements (repeat back what was said in the Vet’s own words)

D.11 RESPONDING TO A SUICIDAL VETERAN

Being supportive while avoiding judgmental comments or reactions REMINDER 2: Many situations will indicate the need to immediately initiate the MH Safety Protocol: Examples:

when the Veteran reports s/he has already taken steps to harm self; makes a specific threat to harm self or others;

or appears to be highly anxious, intoxicated, desperate OR irrational. (Under these circumstances, go to Step 4 and initiate the MH SAFETY PROTOCAL.)

Step 3: ASK ABOUT SUICIDALITY & ENCOURAGE TREATMENT Do you currently have suicidal thoughts or plans to end your life?

And, do you have any intention of acting on these thoughts or plans?

When the answer to either of these questions is “yes,” suicide risk might be imminent, and the MH

SAFETY PROTOCOL should be initiated.

When the answer is “no,” attempt to connect the Veteran to behavioral health for additional suicide risk assessment (same day, if possible); then go to Step 5.

REMINDER 3: Never place your own safety in jeopardy. If a Veteran has a weapon or directly threatens you, protect yourself, remove yourself from the situation, and seek safety -- THEN IMMEDIATELY NOTIFY THE POLICE (62911). Refer to the Prevention and Management of Disruptive Behavior (PMDB) protocols for additional details about how to respond in these circumstances.

Step 4: EXPEDITE TREATMENT BY INITIATING THE MH SAFETY PROTOCOL Ensure the Veteran is not left alone – meaning s/he should stay with a VA staff person until they are connected to the professionals for an evaluation.

When in the medical center, escort the Veteran to the emergency room, and, when possible, notify the VA police before s/he is escorted.

Pass along all information shared about suicide plans, preparations and/or intent to the evaluators.

If the Veteran absconds without seeing the professionals, call 62911 or initiate a “Code Green” (in the MC) or call 911 and initiate a rescue (in community settings) Step 5: Notify your supervisor and the Suicide Prevention Team The Suicide Prevention Coordinator @ 65329 The Suicide Prevention Case Manager @ 65515

REMINDER 4: Regardless of outcome, consult with and otherwise seek support from your supervisor, involved behavioral health staff, suicide prevention team members, and/or other colleagues. These situations can be upsetting and normally will bring up emotional reactions that should not be ignored.

RESPONDING TO THE SUICIDAL VETERAN ON THE PHONE (SAVE)

Step 1: SEE/HEAR THE WARNING SIGNS & listen for SUICIDE RISK INDICATORS Examples: “I’m a burden on my family,” “I have no reason to live,” “others would be better off without me,” or “I would be better off dead.”

SEEK HELP FROM ANOTHER EMPLOYEE (Text, instant message, or mute your phone and yell for help). The other employee is to be on standby for assistance.

REMINDER 1: When you have reasons to believe a Veteran may be at risk for suicide, it’s important to: remain calm, listen attentively, act with confidence, and offer supportive comments.

Step 2. ASK QUESTIONS TO GATHER INFORMATION & GIVE THIS INFORMATION TO EMPLOYEE STANDING BY (who is to await further instructions)

Name & last 4 digits of his/her social security number Address/location (where are you calling from?)

Phone number (what number are you calling from?)

REMINDER 2: Keep the caller on the line, gather information casually, use restatements (repeat back what was said in caller’s words), etc. until s/he is in contact with professionals or emergency personnel.

Step 3: ASK ADDITIONAL QUESTIONS & VALIDATE THE VETERAN’S FEELINGS Explore your concerns about what you saw or heard by:

Asking questions to understand Vet’s situation and perspective Gathering information casually Using restatements (repeat back what was said in the Vet’s own words) Being supportive while avoiding judgmental comments or reactions

REMINDER 3: Many situations will indicate the need to immediately initiate the MH Safety Protocol: Examples:

when the Veteran reports s/he has a weapon; has already taken steps to harm self; makes a specific threat to harm self or others; or appears to be highly anxious, intoxicated, desperate OR irrational. (Under these circumstances, go to Step 5 and initiate the MH SAFETY PROTOCAL.)

Step 4. ENCOURAGE TREATMENT & CONTACT THE VETERANS CRISIS LINE (with the conference call button). Dial 800/273-8255; press “1” and do a “warm handoff” AND introduce the Vet to the responder.

Try to redirect and repeat that you would like to transfer the call to someone who can help.

BUT….what if the caller doesn’t want to transfer? Ask:

Do you currently have suicidal thoughts or plans to end your life?

And, do you have any intention of acting on these thoughts or plans?

When the answer to either of these questions is “yes,” suicide risk might be imminent, and the MH SAFETY

PROTOCOL should be initiated.

When the answer is “no,” offer a referral to the Veteran to behavioral health for additional suicide risk assessment (same day, if possible), offer to have behavioral health call this Veteran back, and end call normally. Go to Step 6.

Step 5: EXPEDITE TREATMENT BY INITIATING THE MH SAFETY PROTOCOL Ask the other employee to call 62911 (VA Police Emergency) to contact and send local police to the caller’s location.

Keep the Veteran on the phone and call back if s/he hangs up Inquire about access to guns or other weapons – ensure responding police are notified if the Veteran has weapons.

Pass along all information shared to the emergency responders after they arrive.

Complete “Suicide Prevention Welfare Check” note

Step 6: Notify your supervisor and the Suicide Prevention Team The Suicide Prevention Coordinator @ 65329 or the Suicide Prevention Case Manager @ 65515

REMINDER 4: Regardless of outcome, consult with and otherwise seek support from your supervisor, involved behavioral health staff, suicide prevention team members, and/or other colleagues. These situations can be upsetting and normally will bring up emotional reactions that should not be ignored.

RESPONDING TO THE SUICIDAL VETERAN ON THE PHONE (SAVE)

Step 1: SEE/HEAR THE WARNING SIGNS & listen for SUICIDE RISK INDICATORS Examples: “I’m a burden on my family,” “I have no reason to live,” “others would be better off without me,” or “I would be better off dead.”

SEEK HELP FROM ANOTHER EMPLOYEE (Text, instant message, or mute your phone and yell for help). The other employee is to be on standby for assistance.

REMINDER 1: When you have reasons to believe a Veteran may be at risk for suicide, it’s important to: remain calm, listen attentively, act with confidence, and offer supportive comments.

Step 2. ASK QUESTIONS TO GATHER INFORMATION & GIVE THIS INFORMATION TO EMPLOYEE STANDING BY (who is to await further instructions)

Name & last 4 digits of his/her social security number Address/location (where are you calling from?)

Phone number (what number are you calling from?)

REMINDER 2: Keep the caller on the line, gather information casually, use restatements (repeat back what was said in caller’s words), etc. until s/he is in contact with professionals or emergency personnel.

Step 3: ASK ADDITIONAL QUESTIONS & VALIDATE THE VETERAN’S FEELINGS Explore your concerns about what you saw or heard by:

Asking questions to understand Vet’s situation and perspective Gathering information casually Using restatements (repeat back what was said in the Vet’s own words) Being supportive while avoiding judgmental comments or reactions

REMINDER 3: Many situations will indicate the need to immediately initiate the MH Safety Protocol: Examples:

when the Veteran reports s/he has a weapon; has already taken steps to harm self; makes a specific threat to harm self or others; or appears to be highly anxious, intoxicated, desperate OR irrational. (Under these circumstances, go to Step 5 and initiate the MH SAFETY PROTOCAL.)

Step 4. ENCOURAGE TREATMENT & CONTACT THE VETERANS CRISIS LINE (with the conference call button). Dial 800/273-8255; press “1” and do a “warm handoff” AND introduce the Vet to the responder.

Try to redirect and repeat that you would like to transfer the call to someone who can help.

BUT….what if the caller doesn’t want to transfer? Ask:

Do you currently have suicidal thoughts or plans to end your life?

And, do you have any intention of acting on these thoughts or plans?

When the answer to either of these questions is “yes,” suicide risk might be imminent, and the MH SAFETY

PROTOCOL should be initiated.

When the answer is “no,” offer a referral to the Veteran to behavioral health for additional suicide risk assessment (same day, if possible), offer to have behavioral health call this Veteran back, and end call normally. Go to Step 6.

Step 5: EXPEDITE TREATMENT BY INITIATING THE MH SAFETY PROTOCOL Ask the other employee to call 62911 (VA Police Emergency) to contact and send local police to the caller’s location.

Keep the Veteran on the phone and call back if s/he hangs up Inquire about access to guns or other weapons – ensure responding police are notified if the Veteran has weapons.

Pass along all information shared to the emergency responders after they arrive.

Complete “Suicide Prevention Welfare Check” note

Step 6: Notify your supervisor and the Suicide Prevention Team The Suicide Prevention Coordinator @ 65329 or the Suicide Prevention Case Manager @ 65515

REMINDER 4: Regardless of outcome, consult with and otherwise seek support from your supervisor, involved behavioral health staff, suicide prevention team members, and/or other colleagues. These situations can be upsetting and normally will bring up emotional reactions that should not be ignored.