Scott W. Stern, LCSW
Psychotherapist, Empowerment Professional
|Posted on November 2, 2014 at 1:55 PM||comments (20)|
"Risk factors" refers to an individual's characteristics, circumstances, history and experiences that raise the risk for suicide.
HOW TO READ THE 'NEGATIVE LIFE EVENTS THAT INCREASE SUICIDE RISK' LIST: Having experienced any one (or even several) of the items listed in the Negative Life Events list does not necessarily mean that a person is suicidal or contemplating self-harm. However, these negative experiences do increase the risk of suicidal behavior when compared with individuals who have not experienced such events.
INCREASED DISPOSITION TO ENGAGE IN SELF-HARM: When compared with individuals who have not experienced these events, the occurrence of an immediate "precipitating event" such as a personal crisis may increase the suicide risk for people who have previously encountered the life events noted in the Negative Life Events list.
NEGATIVE LIFE EVENTS THAT INCREASE SUICIDE RISK:
OTHER RISK FACTORS RELEVANT TO MILITARY LIFE:
Protective factors are skills, strengths, or resources that help people deal more effectively with stressful events. Protective factors enhance resilience and help to counterbalance risk factors (negative life events such as academic, occupational, or social pressures). Protective factors may be personal, external, or environmental. A protective factor reduces the likelihood of attempting or completing a suicide. Increasing protective factors can decrease suicide risk. Strengthening protective factors should be an ongoing process to increase resiliency when increased risk factors or other stressful situations occur. Positive resistance to suicide is not necessarily permanent; programs that support and maintain protection against suicide should be ongoing.
Personal Protective Factors
External/Environmental Protective Factors
Definition: Suicide is the deliberate taking or ending of one's own life. It is often associated with a severe crisis that does not go away, that may worsen over time, or that may appear hopeless. Friends or loved ones in crisis may show signs that indicate that they are at risk of attempting or committing suicide.Warning Signs:
WHAT IF I LOSE SOMEONE TO A SUICIDE?
Individuals experience grief uniquely and at their own pace. For some, the experience of grief following a loss can be intense, complex, and long term, while others are able to more readily ‘move on’. The grieving process varies from individual to the next because of many factors: having coped with prior losses; the quality of the relationship with the deceased; the availability of a support system, and so on. What is certain is that the lives of the survivors will be different. At first, and periodically during the next days and months following the loss, survivors may feel an array of sometimes overwhelming emotions. The expression of varying emotions, sometimes accompanied by tears, is a natural part of grieving. Common feelings experienced during grieving include: abandonment, depression, hopelessness, sadness, anger, despair, loneliness, self-blame, anxiety, disbelief, numbness, shame, confusion, guilt, pain, shock, denial, helplessness, rejection, and, of course, general life stress.
WITH SO MANY FEELINGS TO MANAGE, HOW CAN I COPE?
FAMILY AND FRIENDS
SERVICE MEMBERS AND VETERANS
|Posted on November 2, 2014 at 1:23 PM||comments (26)|
PTSD therapies focus on concentrating on
the thoughts and cues that trigger stress.
“We see it all the time and since the wars in Iraq and Afghanistan, we have seen an increase,” said Dr. Ronald Johnson, clinical psychologist at the Lebanon VA Medical Center. “We’ve increased our staff and tried to become more efficient in our therapies in response. We take the safety of our veterans very seriously.”
Returning soldiers are given a medical and mental health assessment twice within the first 90 days after they leave active duty, Johnson said.
“Part of why we do this is to identify what needs they have and get them the services they need right away,” he said.
For a true PTSD diagnosis, in addition to the stressor, there must be intrusive symptoms, said Dr. Scott Bunce, clinical psychologist at Penn State Milton S. Hershey Medical Center.
"Some people with PTSD can get better and function well, but some never do get over it,'' said clinical psychologist Scott Bunce.
Bunce said symptoms may include:
“You’ve learned that certain cues are signals for traumatic events that mean the world is not safe for you and so when you hear or see these cues in the future, you will experience stress whether it’s safe or not,” Bunce explained.
Learning to deal with the memories
Treatment often includes different types of psychotherapy in conjunction with medications such as anti-depressants and mood stabilizers.
Prolonged exposure therapy helps by repeatedly exposing the person to the trauma-related thoughts and situations they have been avoiding, but without experiencing the trauma. This lessens the power of the memories.
Cognitive processing therapy involves the veteran looking at what incorrect thoughts they may have about their role in the trauma and replacing them with accurate, less distressing thoughts, Johnson said.
“For instance, a patient may say, ‘I should’ve seen that roadside bomb up there so it’s my fault what happened.’ The reality is that it’s difficult to see and so they shouldn’t take that responsibility upon themselves,” he said. “You help them discover their thoughts and come to new conclusions.”
Relaxation therapy – learning to relax the body through breathing exercises or muscle relaxing techniques – can also help, Bunce said.
Research into causes and treatments of PTSD is ongoing. One treatment on the horizon is a medication called D-cycloserine, which seems to increase the effectiveness of psychotherapy in helping people process their memories, Bunce said.
“Some people with PTSD can get better and function well, but some never do get over it,’’ Bunce said. “It depends on the situation that created it, [the individual’s] biological constitution, how much support they get and what kind of help they get.”
|Posted on November 2, 2014 at 1:12 PM||comments (23)|
Dane Michael Freedman was a machine gunner for the U.S. Marines who served two combat tours, one in Iraq and other in Afghanistan.When he returned home, however, the 25-year-old Camp Hill man faced internal enemies of fear, guilt and hopelessness. But for these enemies he had no training and all the weapons he tried — counseling, medications and sheer will — failed.Dane Freedman suffered from post-traumatic stress disorder, or PTSD, which doctors say can happen to anyone who is exposed to events that involve actual or threatened loss of life or limb. The exposure can be direct or indirect, such as first responders to the aftermath of a trauma.“They take these boys who are gentle souls and they turn them into warriors and killers and they do nothing to help them return to the gentle souls they were. They send them home with no assimilation back into the life they used to live,” said Donnamarie Freedman, Dane’s mother.Dane took his own life in December.“Part of our decision to talk about the suicide is to do something about the stigma associated with mental illness ... to let people know our soldiers are suffering when they come back and we need to do more for them,” Donnamarie Freedman said.
They send them home with no assimilation back into the life they used to live.” - Dane's mother, Donnamarie FreedmanThe U.S. Department of Veterans Affairs estimates that 11 percent of veterans of the war in Afghanistan, 20 percent of Iraqi war veterans and nearly 31 percent of Vietnam veterans have PTSD. About 7.7 million Americans suffer from it, according to the National Institutes of Health.Called “soldier’s heart” during the Civil War and later “shell shock” and “battle fatigue” in the First and Second World Wars, PTSD was included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in 1980.“We see it all the time and since the wars in Iraq and Afghanistan, we have seen an increase,” said Dr. Ronald Johnson, clinical psychologist at the Lebanon VA Medical Center.
At its worst, the disorder leads to suicide. In the most exhaustive study to date on veteran suicide, the VA reported that 22 veterans kill themselves every day.More than 69 percent of veteran suicides in the report were among people age 50 or older, however. VA officials say higher rates of suicide among older adult men in the general population may contribute to the higher prevalence seen in older veterans.Suicides among younger veterans, those between the ages of 18 and 24 and who were receiving healthcare from the VA, increased from 46 per 100,000 in 2009 to almost 80 per 100,000 in 2011 — numbers that officials at the VA Suicide Prevention Program say will prompt a closer look.“These are extremely significant numbers and it’s very important for us to follow up on what the data is showing us,” said Caitlin Thompson, deputy director of suicide prevention at Veteran’s Affairs.(The Department of Defense also has a Defense Suicide Prevention Office for active-duty military. More information at www.suicideoutreach.org)Thompson said the overall suicide rate is down among veterans who are in the care of the VA, which she said suggests that treatment works. It also shows effort must be made to get all veterans connected to VA mental health care, she said. Many of the younger veterans who killed themselves were receiving VA care but not mental health care, Thompson said.Returning soldiers are given a medical and mental health assessment twice within the first 90 days after they leave active duty, Johnson said.“Part of why we do this is to identify what needs they have and get them the services they need right away,” he said, adding “We take the safety of our veterans very seriously.”
Criticism of VA’s treatment of returning troops persistsCarlisle resident Craig Williamson levels a criticism that is common among veterans and their families: “The VA system isn’t working or we wouldn’t have these suicides rates.”The 68-year-old Vietnam veteran said he has battled PTSD since he returned in 1969. Unable to get the help he needed from the VA, Williamson said he has found relief through holistic medicine and adopting positive thinking techniques to battle negative emotions.Williams recently began a veteran’s support group that meets from 6:30 to 8:30 p.m. Mondays at Bosler Memorial Library in Carlisle.“I tried everything the VA had to offer as well as my own private counseling,’’ Williamson said. “Many veterans like me get discouraged because they get in the VA system and they don’t see themselves getting better.”In response to such concerns, Thompson said the department is ramping up suicide prevention efforts with dramatically increased staff and outreach efforts.She said the department has increased staff by 50 percent at the Veteran Crisis Line national hotline (1-800-273-8255 and press 1) and is using social media to connect with veterans, such as the Veterans chat service, available 24 hours a day at www.veteranscrisisline.net.The VA is also making peer specialists — trained veterans who are in successful recovery from their own mental health issues — available to work with veterans at all VA centers, she said.Johnson said the VA has its own National Center for PTSD and there are PTSD critical care teams in place at the Lebanon and Camp Hill locations. The Lebanon VA Medical Center and six community-based outpatient VA clinics, such as the one in Camp Hill, are prepared to see veterans with behavioral health issues the same day they seek help, he said.
Combat veterans or families of those who have been killed in action can receive counseling services at two VA centers located in Harrisburg and Lancaster. A new 43-bed Residential Rehabilitation and Recovery Center will open at the Lebanon VA Medical Center by summer.“
If someone is known to be high risk for suicide, we have a system where those veterans are flagged or put on a list so whenever they go to the VA to see a podiatrist or anyone in the facility, their medical record will immediately show they are at high risk or recently had a suicide attempt,” Thompson said. "The provider can then ask follow-up questions to gauge how they are doing and whether they are still feeling suicidal.''Doctors say there is no way of knowing who will suffer from PTSD.“You can have two people in the same traumatic situation and one will develop PTSD and the other not. It’s a combination of nature and nurture and that specific event,” said Dr. Scott Bunce, clinical psychologist atPenn State Milton S. Hershey Medical Center. “You’re more likely to develop PTSD if you have a genetic predisposition toward anxiety or if you’ve had some significant trauma in your childhood.”A family’s painful experienceThe Freedmans knew Dane was suffering with chilling memories that haunted his days and nights.“I noticed a difference in him,” said his 22-year-old sister, Rachelle Freedman. “I remember being in the backyard with him and a plane went overhead and you could tell he was really uneasy. Any little sound would put him on guard. He would never stand with his back to a door.”Often smells or sounds associated with the trauma can create a stress response in those with PTSD, Bunce said. For someone who has been in combat, the sound of a car backfiring can bring on a stress response, he said.At night, Dane slept with his gun in his hand and he often kept it on his belt during the day. He suffered terrible nightmares.For a young man who watched the images of Sept. 11 on television and signed up to serve his country as soon as he graduated from Camp Hill High School in 2007, the disappointment he felt about the country’s involvement in Iraq and Afghanistan was keen, his family said.
His parents say Dane struggled with a feeling that what he did overseas was pointless; he never felt like his mission was completed.Dane was sent to Iraq in August 2008 and to Afghanistan in November 2009. There, two of his best buddies were killed and his family thinks part of Dane died along with them. After his four- year commitment was up, Dane was honorably discharged in June 2011.Once home, Dane struggled with how to return to civilian life, having seen what he had seen.“They tell you that you’re probably going to die there and then when you do come home, you’re thinking, ‘I wasn’t supposed to come home. Now what do I do?'” said Dane’s father, Ronald Freedman.In the fall of 2011, Dane enrolled at Penn State University’s main campus as an environmental science major, but mounting anxiety prevented him from succeeding. He received a disability medical discharge from Penn State that fall as well.In April 2012, he checked himself into the Lebanon VA Medical Center, where he was given a diagnosis of depression and bipolar disorder, which devastated him, his parents said. His family never believed the diagnosis was correct.It wasn't until early 2013 that Dane was officially diagnosed with PTSD, although he knew he had the symptoms of it.“It was a circus,” said Ronald Freedman, referring to the treatment Dane got at the VA. He was switched from one counselor to another and he was put on and off many antidepressants and mood stabilizers by different doctors, his father said.His mother still has a large basket of nearly full pill bottles, representing all the medications he was prescribed, many of which listed suicidal thoughts as a side effect. “He kept getting these pills in the mail even after they had been discontinued,” Donnamarie Freedman said. “It was like no one was monitoring what he was taking.”Dane had already told his mother that he wanted to kill himself. “He had extreme survivor’s guilt,” she said. From his journal entries, the Freedmans know that Dane thought about how he would do it and how it would affect his family.Johnson said he could not comment on specific cases and it would be speculation to comment on whether patients are routinely shifted from one therapist to another.Thompson, however, said the scenario sounds unusual. Sometimes, if a patient and a counselor aren't a good match or if the counselor is reassigned to another position, a patient will receive a new counselor, she said.“Overall, in my experience, these transitions are fairly seamless and bring the treatment team into play,'' she said.
Collaborative effort neededThe National Alliance on Mental Illness, the nation’s largest mental health grassroots organization, has stated that the lack of access to treatment and community-based support for veterans with severe mental illness is one of the greatest unmet needs in the VA. In a recent report on mental health needs of military and veterans, NAMI called military suicide “a national crisis.”However, the VA’s efforts are improving, according to Jean Moore, manager of military and veterans’ policy and support at NAMI, based in Arlington, Va.“I deal with a lot of mental health professionals in the VA and I do feel they are doing better. We know the VA has its hands full,” she said.In fact, Moore said, it is unreasonable to expect that the VA alone could possibly care for all the veterans who need care.Moore, who fields calls from veterans and their families who are dealing with mental health issues like PTSD, said there is a great need for coordinated service and for outreach to those who may be struggling but hesitate to admit it or try to hide it.“It’s a huge amount of work and will only increase as soldiers return so there is a need for community organizations, providers and neighbors, everyone to collaborate. The question is ‘How?’” she said. “The system can be so hard for the families to navigate and so often they feel like no one is listening. More emphasis and energy has to be put toward how we embrace veterans together.”
Masking the painOftentimes, Dane Freedman would paste a smile on his face and say everything was fine.“I’d always offer to talk to him,” said his brother Daniel Freedman, 44, a police detective in Carlisle.”He’d always say ‘I’m cool.’”Although Dane told them little of what he had seen in combat, his parents said they have since heard from soldiers who served with him and their parents. Three other soldiers who served with Dane have also taken their lives, Dane’s parents said.“The father of one of them is in counseling himself after hearing what his son dealt with,” Donnamarie Freedman said. “The machine gunners are the first ones to see all the action, the first ones up out of the turret. They really protect the troops.”For Dane's family, nights turned into silent vigils, with either his mother or sister keeping watch over Dane as he struggled to fall asleep.“I thought to myself, ‘If I wait here, he’ll be alive in the morning,” said Donnamarie tearfully. “When he was asleep, I’d take the gun from his hands.”The Freedmans watched their son go from 160 pounds to 130 pounds. At one point, he was taking 21 different pills a day.For almost a year, Dane never left the house and barely left his bedroom.
The final strawThen, Donnamarie Freedman had the idea to get her son a puppy – something to take care of and love. Although Dane initially balked at the work of housebreaking Lager, the German shepherd pup, the two grew to be the best of friends.Finally, Dane was sleeping with Lager in his arms instead of a gun.“He was singing in the shower, swimming in the pool again with the dog. I told Donnamarie, ‘I think we got our son back,’” Ronald said. “Lager did what no psychologist, therapist, clergy, mother, father or anyone could do. Lager changed his life.”Dane trained Lager as a service dog and took him everywhere he went.Then, unexpectedly, at just 14 months of age, Lager died of a heart attack.“I saw the life drain out of Dane’s face,” his sister Rachelle said.His mother added, “I never saw Dane cry as much as he did when his dog died. He told me, “Mom, he brought me from the depths of hell and taught me to love again. I have such a hole in my heart.”She paused and added, “He decided to fill that hole with a bullet.”On Dec. 13, Dane texted his mother, “I’m saved Mom!”Minutes later he shot himself in the heart. He was in the parking lot of a restaurant in Hanover. His family is convinced he chose a location they don’t frequent to spare them further pain.“People ask me if I’m angry at him; I could never be angry with my son,” Donnamarie said. “We feel like he really tried to stay alive for us.”Although the grief is sometimes unbearable, his family says they wouldn’t wish him back.“He was suffering so much. How can I be so selfish to want him to keep suffering? I know he’s in heaven and he’s at peace,” his mother said.The family treasures photos of Dane on their many vacations, in their backyard pool, at his base in Hawaii, with his girlfriend just weeks before he died.“He chose death over everything he had here; that must’ve been some pain,” his father said.The Freedmans bear no grudges against the military but they do question the support — or lack of support — they say their son received from Veterans Affairs.“I went with him to one of his appointments at the VA and the counselor told him he needed to stop being a child. To call him a child when he already felt so degraded was a terrible thing to do,” Donnamarie said. After Dane left the room, his mother said the counselor told her that her son was doing this “for attention.”Thompson said the VA is constantly addressing concerns that families raise and she would be interested to know the particulars of the Freedman case. “That sounds like it is not in the best interests of the veteran at all,'' she said when told what Dane's parents said their son experienced. "That is not the quality of care that we would be happy about at the VA.''Added Johnson: “The death of any veteran is a tragic loss to the nation and to the family. We experience it too, not to the level of the family; but we feel it too.”
Making a difference for othersThe Freedman family is on a crusade to write a different ending for other returning soldiers.The family has established the Corporal Dane Freedman Suicide Awareness Scholarship Fund at Integrity Bank in Camp Hill. In addition to scholarships, they want to use some of the money to purchase service dogs for veterans. They also set up a memorial website, www.danefreedman.com, to gather information on PTSD, links to resources and related news.Since Dane’s death, his parents say the only correspondence they have had from the VA was a letter requesting that Dane’s $129 military disability check for the month of December be returned. To learn moreThe Freedman family has set up a memorial website,www.danefreedman.com, to gather information on PTSD, links to resources and related news. They have also established the Corporal Dane Freedman Suicide Awareness Scholarship Fund at Integrity Bank in Camp Hill.
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