Military and Family Life Counselors (MFLC) are key components in the fight to prevent suicide in service members and their families. With clinical expertise, collaborating with helping agencies, and connecting participants to appropriate resources, MFLCs embody the 2024 Suicide Prevention Awareness Month theme: “Joining Your Fight: Connect to Protect” (Defense.gov).

Trends of Military Suicide

There has been an increase in suicides for active-duty service members from 2011 to 2022, with 492 suicides in 2022. This was slightly more than in 2021, but less than in 2020. In addition, the rate is similar to the civilian population after accounting for population differences. Suicide data was not available for family members in 2022 however, data from 2021 showed a slight decrease from previous years (Defense Suicide Prevention Office).

Risk & Protective Factors

While the rate of suicide is similar between service members and the civilian population, there are factors unique to the military community that increase the risk of suicide. It is important to not only understand these factors, but also know the protective factors that can decrease these risks.

Suicide Prevention Resources

If you are a service member or military family, connect with a MFLC for local suicide prevention resources. Additionally, here are options for further information and support:

• 988 Suicide and Crisis Lifeline: The 988 Suicide and Crisis Lifeline, created in 2022, connects individuals to trained crisis counselors for confidential support in managing mental health related crises, including suicidal thoughts.
• Magellan Healthcare resources: toolkit, tip sheets, national resources
• Publication: Military Child Suicide: Prevention Techniques and Best Practices
• Publication: Suicide in the Military: Misconceptions, Risk Factors, and How You Can Help

In today’s fast-paced, high-pressure world, mental health has emerged as a critical public health concern. Suicide, now the 11^th leading cause of death in the United States, continues to be a major concern. After a brief decline in 2019 and 2020, suicide rates rose in 2021, with an average of 132 suicides per day—a 5% increase. The situation worsened in 2022, with an additional 3% increase, bringing the average to 135 suicides per day. By 2023, over 50,000 Americans died by suicide, marking the highest number on record. These concerning statistics underscore the importance of integrating targeted suicide prevention strategies into all behavioral health initiatives.

While Employee Assistance Programs (EAPs) and behavioral health benefits from commercial and public insurers provide support for individuals facing mental health challenges, these organizations can further strengthen suicide prevention efforts by implementing data-driven systems that proactively manage and mitigate suicide risk, including:

• Early identification—Preventing crises before they escalate is critical. Utilizing predictive analytics, organizations can identify early warning signs and intervene promptly.
• Ongoing assessment—Continuous mental health monitoring allows care to be adjusted and personalized as needs evolve.
• Proactive outreach—At-risk individuals often don’t seek help on their own. Through population engagement tactics, such as targeted emails, app notifications and direct outreach by care managers trained in suicide prevention, organizations can ensure timely support reaches those in need.
• 24/7 supportive care—Round-the clock access to support is vital for effective suicide prevention. On-demand resources like digital tools for mental health and wellbeing, educational materials, safety plans, hotlines, crisis text lines and direct connections to mental health professionals provide individuals with the help they need, whenever they need it.
• Specialized care management—Licensed clinicians trained in mental health services and evidence-based practices have the expertise to deliver essential support to at-risk individuals, including designing individualized care plans to enhance protective factors, such as building social support networks and improving problem-solving skills and using ongoing remote monitoring to adjust and personalize interventions as needs evolve.
• Sub-specialty networks—Access to clinicians specializing in mental health conditions ensures at-risk individuals receive the focused care they need. Also, subspecialty medical clinics and primary care providers should screen for mental health conditions. Some physical health conditions (e.g., traumatic brain injury and cancer), can carry a risk of suicide.
• Outcomes and data-driven approach—Using data to measure the effectiveness of suicide prevention programs allows organizations to continuously refine their strategies, ensure efficient use of resources and better target interventions.

Integrating data-driven targeted suicide prevention and risk management strategies can significantly enhance the effectiveness of EAP programs and behavioral health benefits provided by private and public insurers. Early detection of warning signs and timely interventions can reduce the risk of suicide, save lives and foster a healthier, more resilient society.

Learn how Magellan Healthcare’s data-driven approach is helping organizations safeguard lives here.

Sources:

• CDC
• CDC
• NBC News

September is Suicide Prevention Awareness Month. Sometimes, suicide may seem like the only way to escape the pain of situations such as a breakup, job loss, social exclusion, bullying or other trauma. This type of distress can be a dangerous trap. It’s vital to take immediate steps to move yourself away from feelings of hopelessness. What can you do?

Spot the triggers. Recognize worsening distress in the form of self-blame, poor self-esteem, rejection, loss of interest in activities or feeling trapped and hopeless.

Remove lethal items. Rid your home of items you could use for self-harm, like guns, knives, razors or expired, discontinued and non-essential medicines.

Get help right away. Acting quickly can make all the difference. Call or text 988 for the Suicide & Crisis Lifeline. A trained counselor will help you talk through what you’re feeling, and together you’ll develop a safety plan.

Consult with a professional. Mental health professionals can help you with concerns like depression, anxiety and suicidal thoughts.

Reach out. Talk with a close friend, loved one or spiritual advisor. If you feel you’re in a crisis, dial 911.

Recognize feelings are temporary. Your dark feelings aren’t permanent. With responsive care, you can and will feel better.

For more on suicide prevention, visit our website for September Suicide Prevention Awareness Month, MagellanHealthcare.com/Prevent-Suicide, and be sure to check out the suicide prevention tip sheets and awareness campaign toolkit.

SOURCES: Mayo Clinic and Mental Health America

Talking about suicide is very important if you are worried about someone who may be struggling, or you feel suicidal. Discussing suicide does not make it more likely to happen. Showing you care helps reduce the risk of suicide.

If you are worried about someone who may be feeling suicidal or you are having suicidal thoughts, consider these tips.

You can also register for our upcoming webinar, “Say more, save a life” on September 29, 2023.

How you can help someone who may be feeling suicidal

Having an open, supportive conversation can be a lifeline for a person who’s thinking about ending their life.

Don’t be afraid to be direct.

You might say, “I’m concerned about you, have you had thoughts about harming yourself?” The person may be relieved to talk about it. Try to stay calm and not seem too shocked. Do not be judgmental. Accept that their feelings are real and let them know you care.

Be a good listener.

Pay attention and take them seriously. Make eye contact and don’t interrupt. Be alert for any reasons they give for wanting to live. When they’re finished, ask questions to ensure you understand what they said. Repeat what you heard, including anything they mentioned about what makes their life worth living.

Encourage and help them to seek support.

Tell them they deserve support and the most important thing they can do is speak to someone. You can say, “I know there are hotlines with trained counselors you can talk to confidentially. Would you like me to stay with you while you contact one?” Ask them if they have a plan. It may be scary to talk about, but a detailed plan contributes to a higher risk. Even if they don’t have a plan, take all talk of suicide seriously.

Follow these tips to help someone get support

• Offer to text or call 988, the Suicide and Crisis Lifeline, together.
• Call or text 988 yourself if the person is unwilling to.
• Call 911 if there is an immediate risk of harm and tell the operator you need support for a mental health crisis.
• Stay with them until they are connected to help.

If you are having suicidal thoughts

You are not alone. People from all walks of life have had suicidal thoughts at some point in their lives. While the pain may seem overwhelming and permanent, remember that crises are usually temporary. Give yourself the time necessary to allow things to change and the pain to subside.

Five steps to follow if you are feeling suicidal

1. Promise not to do anything right now. Thoughts and actions are two different things—your suicidal thoughts do not have to become a reality. Give yourself some distance between thoughts and actions.
2. Avoid drugs and alcohol. Suicidal thoughts can become more intense if you have taken drugs or alcohol.
3. Make your home safe. Remove things you could use to hurt yourself, such as pills, knives, razors, or firearms. If you can’t do that, go to a place where you feel safe.
4. Do not let fear, shame or embarrassment prevent you from seeking help. The first step in coping with suicidal thoughts and feelings is sharing them with someone you trust, (i.e., a family member, friend, therapist, clergy member or an experienced helpline counselor).
5. Have hope. People DO get through this. Even people who feel as badly as you do survive these feelings. No matter what you are experiencing, give yourself time to move through it, and don’t try to go it alone.

Additional emotional support resources

For more on suicide prevention, visit our website for September Suicide Prevention Awareness Month, MagellanHealthcare.com/Prevent-Suicide, and be sure to check out the suicide prevention tip sheets and awareness campaign toolkit.

You can also register for our upcoming webinar, “Say more, save a life” on September 29, 2023.

There are numerous studies looking at risk factors related to suicidality. In mental health-related training and educational textbooks, lists are presented on the contributing risks for, and protective factors against, suicide. In this article, I’d like to bring attention to one of those items in particular and share a brief synopsis of a scientific experiment.

About 70 years ago in the mid 1950’s, Dr. Curt Richter conducted a series of experiments on rats. No, this is not related to suicide directly, but read on, you’ll see the connection at the end.

Remember, I’m “making a long story short” here. In the series of experiments, a research team placed wild rats in buckets of water where they had no opportunity to escape. Understandably, the rats gave their swimming best to keep afloat and survive, but after a few minutes the rats looked like they were about to drown due to exhaustion and being unable to continue swimming. The researchers rescued them right before drowning. The rats were held, dried up and helped to recover. The researchers then placed the same rats back into the bucket of water.

Knowing that the rats had just swam to near death by drowning due to exhaustion only a few minutes earlier, the researchers would’ve thought the rats would reach that level of exhaustion and feeling of “I can’t swim anymore, I’m drowning” much sooner than the last time which had only lasted no more than 15 minutes.

But this second time around, these same rats kept on swimming for hours!

Having tried to account for a physiological explanation unsuccessfully, the researchers came away with postulating that the outcome was best explained by the psychological state of the rats rather than their physiological state. Sort of like, “mind over matter.”

What had changed to account for the hours of swimming was the fact that the rats experienced being rescued and cared for the previous time. They had developed an optimistic expectation of a positive outcome, namely, hope–a positive belief in their future that “we just have to keep on swimming to stay afloat until we are rescued again.”

That’s what made the rats not give up and keep on fighting (swimming) for hours. It was hope!

Now you see the answer to the title question of this article “What’s hope got to do with it?” and why having hope versus hopelessness plays a role in suicide prevention.

Putting aside the inhumane nature of how some studies were conducted 70 years ago, it is well understood that the lives of rats are much different from those of human beings.

In a vacuum, one cannot draw a simple line between this experiment and the human experience with its intricate relationships of stressors and complicating factors such as trauma and addiction.

With or without the presence of addiction, frequently there is a loving caretaker who is also fatigued. Hence, the importance of involving professionals, not only for the person who is dealing with depression, suicidality, trauma or addiction, but also for the caretaker of that person.

Having hope, a belief that things will get better and a future-oriented optimism for “better days ahead” are protective factors against suicide, whereas the opposite–hopelessness–is a contributing factor to suicide.

Fleetwood Mac exclaimed “Don’t stop” (thinking about tomorrow) in 1977. Gloria Gaynor added “I will survive” in 1978, and Journey chimed in with “Don’t stop believing” in 1981.

Perhaps famed author F. Dostoevsky said it best a century earlier, “To live without hope is to cease to live.”

Additional suicide prevention resources and support

On September 22, Magellan Healthcare hosted a webinar, “The role of mental health recovery in suicide prevention,” for Suicide Prevention Awareness Month. I participated on the panel, along with Dr. Pratt, Dr. Williams and Stacey Volz, who shared her inspiring recovery story from mental health challenges and multiple suicide attempts.

Watch a recording of the webinar as we share our knowledge and personal and professional experiences in addressing mental health and substance use challenges to prevent suicide: https://www.magellanhealthcare.com/event/the-role-of-mental-health-recovery-in-suicide-prevention/.

Visit Magellanhealthcare.com/Prevent-Suicide for more information and materials to learn more and spread awareness about suicide prevention.

Suicide claimed the lives of almost 46,000 people in the United States in 2020.[1] It is the second leading cause of death for children aged 10–14 and adults aged 35–44, and the third leading cause of death for young people aged 15–24.[1]

Now is the time to raise awareness and reduce the stigma surrounding suicide. Learn more about the warning signs and what you can do if you suspect someone is thinking about suicide. Be the one to save a life.

Know the warning signs

• Hopelessness
• A negative view of self
• Aggressiveness and irritability
• Making suicide threats
• Increased alcohol or drug use
• Withdrawing from friends, family and society
• Trouble sleeping or sleeping all the time
• Changes in mood or behavior
• Feeling like a burden to others and giving things away

Take time to reach out

You can help give someone hope by showing that you care. Notice what is going on with people in your life—a family member, friend, colleague or even a stranger. By stepping closer and reaching out, you can become aware of those around you who may need help. You do not need to tell them what to do or have solutions. Simply making the time and space to listen to someone talk about their experiences of distress or suicidal thoughts can help.

Don’t be afraid to ask someone if they are suicidal

You may not think it is your place to intervene, you may be afraid of not knowing what to say and/or you may be worried about making the situation worse. Offering support can reduce distress, not worsen it. When someone is upset, they are often not looking for specific advice. What you can do is listen without judgment, be compassionate, and know about resources to get help like the 988 Suicide and Crisis Lifeline (call, text or chat).

Additional suicide prevention resources and upcoming webinar

Register for our free webinar, “The role of mental health recovery in suicide prevention,” on September 22 to hear the inspiring recovery story from Stacey Volz, CPRP, CPS, Magellan Healthcare family support coordinator and a person who lives with mental health challenges and has lived through multiple suicide attempts. I will also be on the panel to share my knowledge and professional experience in addressing mental health and substance use challenges to prevent suicide, along with Andrew Sassani, MD, Magellan Healthcare chief medical officer, California, HAI and MHS, and Samuel Williams, MD, MBA, FAPA, Magellan Healthcare medical director.

Visit Magellanhealthcare.com/Prevent-Suicide for more information and materials to learn more and spread awareness about suicide prevention.

[1] National Institute of Mental Health, “Suicide” information

This article was co-authored by Stephanie Bender, DA, MA, LMHC.

Misconceptions, Risk Factors, and How You Can Help

The military suicide rate has gradually increased over time. Among active-duty members, the suicide rate per 100,000 significantly rose from 2015 (20.3) to 2020 (28.7). Most of the suicides were completed by enlisted service members less than 30 years old. The most common method of suicide was a firearm, followed by hanging/asphyxiation. (1)

Misconceptions about Military Suicide (1, 3)

Due to stigma of mental health problems, cultural issues, and ways in which the media covers suicide, there are many beliefs among the general population and the military about suicide that are not true. Some are:

• Seeking mental health treatment will negatively impact one’s ability to obtain a security clearance and pursue a chosen career.
  • Fact: Seeking mental health treatment, in and of itself, does not negatively impact one’s ability to obtain/retain a security clearance. In fact, waiting to seek mental health treatment may cause increased work-related problems that could negatively affect one’s career.
• After receiving hospital care for mental health issues, individuals are no longer at risk for suicide.
  • Fact: Suicide risk is significantly higher immediately following hospitalization when individuals are in the process of adjusting to their previous lives and return to settings in which stressors previously occurred.
• Most military firearm deaths are from combat.
  • Fact: Most military firearm deaths are from suicide.
• Suicide risk is not related to how firearms are stored.
  • Fact: Unsafe firearm storage increases suicide risk. Those who lock or unload guns when not in use are much less likely to die from suicide when compared to those who keep them unlocked and/or loaded.
• Most people who have suicidal thoughts die by suicide.
  • Fact: Most people who think about suicide do not act on these thoughts.
• Suicide is never impulsive.
  • Fact: Some individuals ponder suicide for significant periods of time, while others do not. It can take less than 10 minutes between thinking and acting on suicidal thoughts and concomitant use of substances can increase impulsivity.
• Most military suicides are completed by individuals who experience deployment and/or combat.
  • Fact: Most military suicides are completed by individuals who have never been deployed and/or experienced combat.

Suicide Risk Factors (1, 2, 3)

Suicide is rarely caused by a single issue. It is a complex phenomenon, precipitated by a combination of emotional, psychological, physical, and cultural/environmental circumstances. Many military suicide risk factors are similar to those in the general public; but some are unique to military life. Major military suicide risk factors include:

Life circumstances

• Relationship problems
• Financial problems
• Legal issues
• Lack of advancement or having a sense of a loss of honor due to a disciplinary action
• Lack of social support
• Challenges related to post-deployment reintegration
• Multiple redeployments
• Challenges related to retirement and re-engaging in civilian life

Physical/Psychological issues

• History of physical/sexual abuse, violence, or trauma
• Prior suicide attempt and/or family history of suicide
• Prior or current alcohol and substance misuse
• Severe or prolonged combat stress
• Combat-related psychological injury
• Traumatic Brain Injury

Environmental/Cultural issues

• Limited access to mental health care
• Religious beliefs that support suicide as a solution; negative attitudes toward getting help
• Perception of being weak or placing career at risk if mental health support is sought
• Stigma from family, friends, and colleagues

How the Military is Addressing Suicide (5)

Due to concerning levels of suicide in the military population, in March 2022, Secretary of Defense Lloyd J. Austin announced the creation of a Suicide Prevention and Response Independent Review Committee to explore and recommend interventions to address suicide and the mental health of military service and family members. Findings and recommendations will add to the already existing information and initiatives the Department of Defense has previously established across all or specific to military branches.

New Suicide Hotline

The 988 Suicide and Crisis Lifeline launched in July 2022. Congress designated the new 988 dialing code to improve access to crisis services in a way that meets our country’s growing suicide and mental health-related crisis care needs.

988 connects those experiencing mental health, substance use, or suicidal crises with trained crisis counselors through the National Suicide Prevention Lifeline. People can also dial 988 if they are worried about a loved one who may need these types of crises supports. Chat is also available.

Pressing “1” after dialing 988 will connect you directly to the Veterans Crisis Lifeline which serves our nation’s Veterans, service members, National Guard and Reserve members, and those who support them. For texts, continue to text the Veterans Crisis Lifeline short code: 838255.

Learn more about 988 in Magellan’s blog post: https://mfed.info/988.

How Family and Friends Can Help (6)

Family and friends can also help prevent suicide by (6):

• Being aware of risk factors (see above-listed risk factors) and warning signs such as:
  • Statements regarding no reason to live or being a burden to family
  • Buying or storing means to suicide such as weapons or medications
  • Making plans to say goodbye such as updating wills and giving away possessions
• Being supportive and non-judgmental
• Staying involved: just asking “how was your day?” can help one feel supported and connected
• Giving positive affirmations that the loved one is not a burden and is loved
• Knowing how to contact emergency help
  • Call 911, 988, or the Military/Veteran Crisis line at 1-800-273-8255 (press 1)
  • If there is any chance that someone might get injured:

– Remain calm

– Remove yourself or your children from any danger

– If possible, remove items that the person can use in a suicide attempt

For a downloadable version of this article, please visit MFed Inform.

References

1. Department of Defense Under Secretary of Defense for Personnel and Readiness. Annual Suicide Report. Calendar Year 2020. https://www.dspo.mil/Portals/113/Documents/CY20%20Suicide%20Report/CY%202020%20Annual%20Suicide%20Report.pdf?ver=0OwlvDd-PJuA-igow5fBFA%3d%3d
2. Military OneSource. When a Service Member May Be at Risk for Suicide. Sept. 2, 2021. https://www.militaryonesource.mil/health-wellness/mental-health/suicide/when-a-service-member-may-be-at-risk-for-suicide/
3. Association for Behavioral and Cognitive Therapies. (No date) ABCT Fact Sheet. Military Suicide. https://www.abct.org/fact-sheets/military-suicide/
4. Suitt TH. Watson Institute. International & Public Affairs. Brown University. High Suicide Rates among United States Service Members and Veterans of the Post 9/11 Wars. June 21, 2021. https://watson.brown.edu/costsofwar/files/cow/imce/papers/2021/Suitt_Suicides_Costs%20of%20War_June%2021%202021.pdf
5. U.S. Department of Defense. May 17, 2022. DOD Names Lead for Suicide Prevention and Response Independent Review Committee. https://www.defense.gov/News/News-Stories/Article/Article/3034968/dod-names-lead-for-suicide-prevention-and-response-independent-review-committee/
6. Mental Illness Research Education and Clinical Center. Suicide Prevention: A Guide for Military and Veteran Families (no date). (https://www.mirecc.va.gov/visn19/docs/A_Guide_for_Military_Veteran_Families.pdf

Stephanie Bender, DA, MA, LMHC is a Regional Supervisor for Magellan Federal working in the Military and Family Life Counseling Program. Stephanie currently manages school-based MFLCs in Virginia Beach, VA. Stephanie received her undergraduate degree in Family Studies from Messiah University, her Master’s Degree in Counseling from the Seattle School of Theology and Psychology, and her Doctorate in Ecopsychology and Environmental Humanities from Viridis Graduate Institute. She has been independently licensed since 2008 in the state of Washington. Stephanie’s grandfathers were Veterans of the Army, and her father is a retired Lieutenant Colonel in the Air Force. Stephanie’s hobbies include hiking in the mountains, taking walks with her goats, and hosting visitors to her hometown of Olympia, WA.

The new 988 Suicide and Crisis Lifeline launched on July 16, 2022. With 988, it’s now easier than ever for anyone experiencing mental health-related distress–whether that is thoughts of suicide, a mental health or substance use crisis, or any other kind of emotional distress–to seek immediate help.

The new 988 dialing code operates through the existing National Suicide Prevention Lifeline (the Lifeline) network of over 200 locally operated and funded crisis centers across the U.S. People can now access a strengthened and expanded Lifeline via 988 or the existing 10-digit number (which will not go away).

In this post, we’ll continue the introduction of the new 988 Suicide and Crisis Lifeline and provide additional resources for you to learn more and be prepared if you or someone you know experiences a mental health crisis.

What is 988?

Beyond being an easy-to-remember number, 988 provides a direct connection to trained, compassionate and community-based crisis counselors for anyone experiencing mental health-related distress–whether that is thoughts of suicide, a mental health or substance use crisis, or any other kind of emotional distress.

Who can use 988?

988 services are confidential, free and available 24/7/365 for anyone experiencing a mental health, substance use or suicidal crisis. And 988 isn’t just for you. People can also dial 988 if they are worried about a loved one who may need crisis support.

How are 988 services accessed?

The 988-dialing code is available for call (multiple languages) or text (English only), and chat services (English only) can be accessed at 988Lifeline.org. 988 services are available through every landline, cell phone and voice-over-internet device in the U.S.

 How is 988 different from 911?

The focus of 988 is to provide easier access to the Lifeline network and related crisis resources, which are distinct from 911, where the focus is on dispatching Emergency Medical Services, fire and police, as needed.

Why was 988 created and where can I get more information?

Congress designated the new 988 dialing code in 2020 to improve access to crisis services in a way that meets our country’s growing suicide and mental health-related crisis care needs. The Substance Abuse and Mental Health Services Administration (SAMHSA) is the lead federal agency, along with Vibrant Emotional Health (operational home of the National Suicide Prevention Lifeline), in partnership with the Federal Communications Commission and Department of Veterans Affairs, to make 988 a reality in the U.S.

SAMHSA provides comprehensive resources for anyone to learn more about 988, suicide prevention and mental health crisis services at   SAMHSA.gov/988.

Is my state ready for 988?

States are at varying degrees of readiness for the volume increases expected from moving to the 3-digit code, 988. The federal government is responding to resource challenges with unprecedented levels of funding and an all-of-government approach to partner with state and local leaders to improve system capacity and performance.

Find additional information and materials on suicide prevention at MagellanHealthcare.com/Prevent-Suicide, and stay tuned for our September Suicide Prevention Awareness Month campaign and free webinar.

Sign up to receive updates a few times a month from Magellan on free behavioral health resources you can use and share with family, friends and colleagues here.

Sources: SAMHSA and the National Action Alliance for Suicide prevention