Be the One training tackles how to help those in suicidal crisis

The American Legion’s Be the One suicide prevention program has remained the organization’s top priority since its creation in April of 2022. The program has received worldwide exposure through the Legion’s relationship with Chip Ganassi Racing and the NTT INDYCAR SERIES, and locally, American Legion posts have staged Be the One events and offered VA S.A.V.E. Training at their posts to amplify suicide awareness.

And now on the national level, The American Legion has teamed with a prominent university to provide training to recognize veterans in crisis and how to help that veteran through the crisis.

On Feb. 25, more than 80 Washington Conference attendees took part in the two Be the One training sessions developed by the Columbia Lighthouse Project. The training, “Saving Lives of Veterans, their Families, and Communities with the Columbia Protocol,” uses the Columbia Protocol, a screening tool developed in 2007 by Columbia University, the University of Pennsylvania, and the University of Pittsburgh and supported by the National Institute of Mental Health. The training also will be made available virtually. Click here for more details.

The Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale, supports suicide risk assessment through a series of simple, plain-language questions that anyone can ask. The answers help users identify whether someone is at risk for suicide, assess the severity and immediacy of that risk, and gauge the level of support that the person needs.

The Be the One training in Washington, D.C., was conducted by two individuals with extensive suicide prevention and mental health résumés. Wendy Lakso has served as chief of the U.S. Army’s Suicide Prevention Program; deputy executive director of the Office of the U.S. President’s PREVENTS Task Force, which is a part of the National Strategy for Preventing Veteran Suicide; and, more recently, director of Partnerships in the U.S. Department of Veterans Affairs Office of Mental Health and Suicide Prevention from 2018-2020.

Adam Walsh has a Ph.D. in Social Work and completed a post-doctoral fellowship focused on suicide prevention program development. He currently is an adjunct professor at the Uniformed Service University in the Department of Medical and Clinical Psychology and a senior scientist for the university’s Center for the Study of Traumatic Stress. He previously served as the Department of Defense’s Suicide Prevention Office’s Director of Research and Program Evaluation and has worked with the U.S. Marine Corps supporting suicide prevention and behavioral health programs.

Both talk about risk factors and warning signs, as well as how to address someone in crisis. They also did a roleplay session that simulated the question-and-answer protocol taught via the Columbia Protocol.

Both presenters said it’s important to ask a veteran if he or she is okay because many won’t ask for help.

“Many of the servicemembers that we’ve worked with, especially the Marines I used to work with, they want to fix their own problems,” Walsh said. “So, there’s this idea that if something’s bad, I was trained in the military that I don’t go and ask for somebody’s help. I fix it on my own.

“You all play a really important role in this because you can understand that. Especially men. Men are historically bad at asking for help, especial mental health care. A lot of times other servicemembers and other people are the ones that can relate to them to help fix their problems.”

Lakso said many won’t talk about their mental health for fear of being perceived as broken and jeopardizing their career, as well as worrying about confidentiality concerns. “They feel more comfortable coming to somebody that they know and trust, rather than going to a doctor,” she said. “This is why we do this training.”

Walsh said suicide isn’t only brought on by mental health issues. “There are actually a lot of people who die by suicide who don’t have signs of mental illness or don’t have a mental illness,” he said. “We now know there are multiple pathways (to suicide), and one of the common pathways is a life event or stressor. Losing a job. Losing a relationship that was important to you.

“We’re not just looking for somebody who is incredibly depressed and sad and visibly really upset. We’re looking for many people and listening and talking to lots of different people about their experiences in their life. What has happened in their life where they no longer have hope or want to live?”

When those issues pile up, that’s when thoughts of suicide begin to manifest.

“Suicide is not impulsive. In many cases, a person doesn’t know that they’re suicidal until they start thinking about suicide,” Lakso said. “A lot of the reason why … is some change might have happened. Like the breakup of a marriage. Or a loss of a job. Most of the time those people don’t think about it until something catastrophic happens. And then, they start to feel hopeless. So, it’s so, so important for us to make sure that we’re teaching everybody to know how to detect (those warning signs).”

Lakso said those signs can be recognizable. “We feel something when something’s off,” she said. “We know when somebody that we have known for a while comes in and they’re just different. We know when maybe someone we don’t know comes in and they look like they’re having a hard time. So, use that as an impulse to go and ask the questions and see if they’re doing OK.”

Walsh said when talking to a veteran who has expressed suicidal intentions, “They talk about, ‘I just want the pain to stop. I want the physical pain to stop, and I want the emotional pain to stop.’ So, the first pathway on how to prevent suicide is understanding that veteran’s pain and how we can stop it.

“There are many different ways to do that. Peer support, good coping strategies. Mental health care is one of them as well. But how do you help that veteran stop their pain? Listening to them, being there for them, social support, having a purpose. Making sure they feel like they matter in whatever they’re doing. Those are ways to help stop that pain.”

But Walsh took that a step further. “We also need to make it harder to die by suicide,” he said. “What you’re going to learn in our training is many times suicide can happen very quickly. We want to make it harder to die by suicide in that moment where that person is thinking about ending their life. That means keeping their environment safe.”

That includes being aware of the firearms situation of a veteran in crisis. Walsh noted that civilians use firearms 50 percent of the time in suicide, while veterans use them 70 percent of the time. There is a 90 percent chance of dying if a firearm is used in a suicide attempt.

“When somebody you know is going through a tough time, it’s really important to have a conversation about, ‘Let’s make sure those firearms are properly secured,’” Walsh said. “If that gun is harder to get a hold of in that moment of crisis, we can save a life. If you make it more difficult in that moment to access something that a veteran can use to harm themselves, most people will not go on to die by suicide.”

Lasko and Walsh said when attempting to help someone in a moment of crisis or someone talking about suicide, it is important to:

·         Be there, in the moment, looking the person in the eye.

·         Keep the person in front of you. If you’re on the phone, keep them talking and make sure to listen.

·         Make good eye contact.

·         Don’t be judgmental. Be open and accepting of what they have to say, even if that means that they don’t want to live.

·         Don’t be afraid to ask questions directly.

·         Ask if you can call the Veterans Crisis Line to connect them with resources.

·         If they don’t want to call the crisis line, see if there is someone else they can call to make them feel safe.

“You’d think it would be kind of common sense,” Lakso said of the protocol. “But when you’re in that moment, it’s also a little scary. Nerve-wracking. You’re probably thinking, ‘What are they going to say back,’ and you’re not listening. So, we have to think more about listening. Tell them that you’re worried about them, and that you’re they’re for them and that you can get them help.”

Walsh said it’s important to build some sort of camaraderie with the person contemplating suicide early in the conversation.

“If a person makes a connection with you, no matter how small or big that might be, the more likely they are to give you accurate information … about their risk of suicide. About their safety,” he said. “You don’t want them to hide it or gloss over it. To increase the probability that person will be open with you, you do want to build a quick rapport with that person.

“You can do that by showing that you care about them, that you are genuine, that you’ll do something when they tell you something. They’ll trust you that you’ll do the right thing.”

And Lakso stressed self-care after dealing with a suicidal veteran. “Afterward, it’s important to take care of yourself,” she said. “Because if you are listening to a story, that may have a trigger for yourself. You want to make sure you’re also taking care of yourself. Talk to someone about that story. Just keep that person’s personal information secure.”

The training made an impact on one of its attendees. On the post-training survey, a veteran commented, “The most impactful training I’ve had in suicide prevention. The tools/Columbia screener works. I’m still alive, because my wife recognized my issues and acted accordingly. Thank you for what you guys are doing.”