Suicide Prevention Program Evaluation: The Case of the US Military - Research Paper Example

Suicide Prevention Program Evaluation: The Case of the US Military Introduction US soldiers have been involved in various operations aimed at bringing peace worldwide. These operations have been undertaken in several countries with the country’s longest ones being Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) (USDoD, 2010). Such operations have brought much psychological and physical demand on the warriors involved. According to the USDoD (2010), between 2005 and 2009, over 1000 members of the Armed Forces committed suicide. Over the same period, there was a sharp increase in suicide rates among Soldiers and Marines. Most of the Armed Forces personnel who committed suicide in the US were those who in Afghanistan. Furthermore, there was an increase in suicide rates, in the military, to around 80% from 2004 to 2008 and the level has been steady to the year 2011 (Gibbs & Thompson, 2012). This is indeed a big crisis in the US. As a result, Congress has attempted to address the issue through new legislation. Several programs have been instituted as a result of the legislation in order to address suicide cases among those in the Armed Forces. The paper will explore the success of the Veterans Health Administration (VHA) program in the USA. Literature Review Mainstream news informs the public about the increasing general suicide rates in the military and when a military member commits suicide, it will be publicized in either local or national news. The problems these military members face lay at the feet of commands that lack resources to deal with the issues. Most find it hard to ask for help fearing that their military employment will be terminated or even be discharged from the military, and have to face the economic situation the civilian population is facing. Psychiatric Times published an article entitled “The Epidemic of Military Suicide” which described how we need to change the military’s culture (Gahm et al., 2012). Army Major General Dana Pittard stated in his official blog which is a perfect example of how the military culture has turned its back on those who suffer but fear to ask because of how others will judge them or view them. The Navy and Marine Corps Public Health Center posted on their suicide prevention web page several factors that place a sailor at risk for suicide, but these do not mean suicide will be completed (Hyman et al., 2012). Engagement of Stakeholders All stakeholders have to be fully involved in the implementation of suicide prevention programs. Involvement of stakeholders ensures the creation of a responsive, caring, and responsible environment. Such an environment is essential for motivation of individuals to seek help without fear. In these programs, the key stakeholders involved in the provision of support to the Armed Forces personnel include mental health care providers, unit ministry teams, installation gatekeepers and the soldiers themselves (USACHPPM, 2012). Additionally partners acting as stakeholders include health departments, academic institutions, non-profit organizations, private sector players, and federal agencies (CDC, 2012). Stakeholder’s key roles include helping with data collection on suicide and its risk factors, development of strategies aimed at prevention, as well as ensuring the effectiveness of prevention programs in place. These groups are important as they participate in training about suicide awareness at different levels. At the primary level, training of stakeholders centers on anticipating potential times of crisis in order to structure pre-emptive support systems. Secondary level training focuses on recognizing signs of distress. With training offered at different levels, it helps in coming up with programs aimed at provision of support, as well as intervening if necessary. At the tertiary level of the training, stakeholders are taught how to recognize and treat psychiatric disorders responsible for acute suicidal behaviours. Suicide prevention measures and programs are aimed at reducing risk factors while enhancing protective factors which help to drastically lower the risk of suicide. Interventions are in three stages. The initial step entails development of pilot tests on a small scale. The key point is to ensure that pilot tests are safe, effective and ethical. In case these interventions are a success after the first stage, they are then implemented on large scale in the second stage. Eventually, there is evaluation of these interventions which have been implemented. This is in order to determine their effectiveness. It is vital that interventions are repeated severally so they can be refined for purposes of improving their effectiveness. Furthermore, repeatedly testing these interventions is essential for adjusting them to be used on different populations (Bagalman, 2013). Description of the Program A suicide prevention program for the Armed Forces should ensure easy access to health care which is vital as it acts as a protective factor against suicide. Consequently, programs in place aim at addressing barriers to care. These factors are varied and could include logistical challenges in terms of treatment schedules or attending appointments for patients. Another challenge is a lack of understanding or awareness on mental health care on issues relating to suicide. Many of the victims could be lacking knowledge on the existence of help for those in stressing situations. Additionally, there are issues concerning stigma especially directed to those with mental illnesses. Furthermore, there are concerns about care provided by (VHA), one of the programs already in place. As one of the programs in place, VHA is trying to address these challenges through two broad mechanisms. VHA increases access to health care by way of providing a wide range of mental health services. Moreover, the VHA offers mental health education to different persons affected for example veteran’s families (Bagalman, 2013). Provision of expanded alternatives in mental health services is aimed at alleviation of logistical barriers through making these services accessible. Here, accessibility is not only in terms of being available in more places, but also more frequent. This ensures that those with mental problems seek assistance within their areas more frequently. New patients that require referral for a mental illness, as per the VHA policy, receive assessment within 24 hours. Additionally, a full evaluation takes place within a period of 14 days. Follow-up appointments for mental illness patients occur within 30 days (Bagalman, 2013). Despite such elaborate measures, these policies still face criticism from the media, health care providers, as well as patients. Offering education to veterans, as a VHA policy, ensures there is a clear understanding of mental health care issues. This goes a long way in reducing the associated stigma and clearing all the misconceptions on the health care provided by VHA. However, to overcome such challenges, VHA, in its public health and outreach activities, has been incorporating messages focussed on reducing the stigma associated with mental illnesses. Moreover, the VHA is working to integrate mental health with substance use treatment services. By so doing, VHA aims at ensuring that there is increased convenience, while at the same time reducing the stigma that patients face in the course of seeking mental health care (James, 2012). At VHA, there is recognition mostly of education role creating awareness among different stakeholders about mental health illnesses. Consequently, VHA provides education on the prevention of suicide to different groups of people in its facilities and to communities within its surrounding area. All VHA staff, interacting with veterans, are specially trained. This training has also been offered to health care providers within surrounding communities. Furthermore, at a community level, training is for community guides and families of those in the Armed Forces. Community guides are important as they help identify those individuals at risk of suicide. After they are identified, these individuals are given the necessary treatment by VHA. Through these programs, everyone is able to access quality care hence reducing cases of suicide (Langford, Litts, & Pearson, 2013). The VHA program entails screening of patients for various reasons like depression, problem drinking, pain, military sexual trauma (MST), traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) (Gibbs & Thompson, 2012). After the screening, those found to be positive undergo follow-up evaluation and appropriate treatment provided in serious cases. Previous evaluation on the quality of mental health care services offered by VHA found that the program has better systems as compared to other programs in existence. However, the evaluation undertaken by RAND Health and the Altarum Institute found there is still room for VHA programs to be improved. Furthermore, VHA recommends there is a need to limit access to lethal means to soldiers in order to reduce suicide cases. Studies show that most cases of suicide are due to the use of firearms representing 50%, suffocation representing 24% and poisoning that represents 18% of the total population of suicide deaths. Consequently, restriction of access to lethal means including gas, drugs or firearms goes a long way in lowering suicide cases among the veterans in the US (Bagalman, 2013). Studies carried out in America indicate that two-thirds of the suicide cases reported in the military are due to the use of guns while 1 out of 5 suicidal incidences are where soldiers hang themselves (Gibbs & Thompson, 2012). One of the VHA initiatives entails a gun safety program where there is the distribution of literature on gun locks, as well as general gun safety education. This aims at creating awareness among people on how to handle such a lethal weapon especially if they are mentally-ill. On the medication problem, VHA undertakes demonstration projects to educate medical practitioners on safe packaging of medications as a means of drastically lowering cases of overdoses. By restricting means of accessing these lethal tools for committing suicide, incidences of suicide are reduced. However, as an option of reducing suicide, restriction of means is still being studied to clear misconceptions surrounding the subject (Warner, 2011). Government support for suicide prevention programs nationwide has been forthcoming. With the recognition of how serious suicide is, the Pentagon allocates nearly $2 billion of the annual medical budget for mental health. However, despite this allocation representing about 4% of the medical bill budget, authorities in the prevention of suicide claim this is not sufficient when it comes to adequately addressing the problem. Peter Chiarelli, an Army retiree says, “The Pentagon allocates about $2 billion–nearly 4% of its $53 billion annual medical bill–to mental health. That simply isn’t enough money” (Gibbs & Thompson, 2012). To provide more support, the VHA has come up with suicide hotlines for individuals to use. This is during times when they are in crisis situations. For instance, when one considers committing suicide, they call the hotline numbers to seek help from trained professionals. Using these numbers, one has an option of either remaining anonymous or identifying themselves when seeking help. Disclosure of information, however, is vital in enabling VHA staff to check one’s medical records to ascertain their past health records. However, the use of evidence from these hotlines does not form a basis for a conclusive decision on whether programs in place have been effective in reducing suicide in the Armed Forces (Bagalman, 2013). This can be attributed to the fact that these hotlines serve large geographic areas hence not easy to determine if success has been due to other interventions in place. Besides the monetary support from the government to programs already operational, Armed Forces personnel are empowered through various mechanisms. According to USACHPPM (2012), there are personal protective factors aimed at empowering the personnel to tackle the suicide problem. These include training them on how to solve their problems hence drastically improving the decision making process. By so doing, whenever they are faced with challenges, they easily generate sound decisions. Even within the Armed Forces, the personnel are able to pay attention to see warning signs so that they respond accordingly by helping those in need. Within a large community, empowered people pay close attention to personal needs of others. Through this, they are well positioned in order to help. Methods The US Navy conducts annual general military training based on the needs that each fiscal year presents in the list of required training that every command in the US Navy, both active duty as well as reserves, must conduct. For the fiscal years 2012 and 2013 suicide prevention training has been on the list and a top priority not only in the Navy but other branches of the armed forces as well. Suicide prevention training encompasses an introduction to what the driving force behind the training, the importance, the definition of suicide and suicide related terms, risk factors, warning signs, what a first responder is and their responsibilities are, and the resources available through the Navy as well as the department of Veterans Affairs and the civilian community. The target populations were those in the US Navy active duty, reserves, full-time contractors in navy and civilian navy employees. The suicide prevention training is held at the time and location that is designated by the command and will contain both males and females with ages ranging from 18-58, and with the educational background ranging from high school GED to college graduate. An educational workshop on the topic of suicide prevention was administered to 36 US Naval personnel and covered topics outlined in the lesson plan. A seven question pre-post-test measured knowledge gained from the workshop. A 12 question program evaluation for the program process was also administered. The pre-post-test question one asked for knowledge on the Navy’s suicide prevention acronym. Question two looked for knowledge about someone possibly planning to commit suicide would encourage them to do the act. Question three asked of a role played to assist one who wants to commit suicide. Question four looked to see who they believed to be responsible as a first responder. Question five was on the term suicide gesture. Question six looked at whether or not personnel believed military cultural hurts the protective factor process. Question seven looked at what ACT acronym stands for. During the course of the training, which was held at the Commanding Officers (CO) discretion, personal were given traditional Navy based power point lecture-based training on the fundamentals of the Navy’s Suicide Prevention First Responder program. Personnel were given a Pre-test that consisted of seven questions that consists of required acknowledgement of Suicide Prevention/First Responder. The researcher developed a power point training that covered the Navy’s objectives regarding suicide prevention, terms to know, identifying risk factors, warning signs for suicide, Navy’s acronym Ask Care Treat (ACT), and suicide resources. At that time, the post-test seven questions was given to evaluate for knowledge, comprehension, and the ability to intervene and analyze personnel who attended the suicide prevention training of their knowledge before the training and after the training. A program evaluation was given to gage the training in its entirety. The evaluation was to help the researcher keep the interest of personal on the topic that was given and ensure the key elements were clear and understood without losing the individuals interest on the topic. Hypothesis H1: Personnel who attended suicide prevention training gain knowledge that they did not have before from the training they received. Personnel believe that the military culture can contribute to an individual’s choice to have suicidal thoughts, beliefs, behaviours, gestures, and/ or even the act itself. As part of the long-term follow-up it is required by direction of the Chief of Naval Operations (CNO) as stated in his instruction OPNAVINST 1720.4A that all commands will conduct training which will cover command action plans, support, resources, and life skills/health promotion training. This training will fulfil the CNO’s requirements for satisfactory suicide prevention training for the fiscal year (fy) 2013. Results Appendix The FREQ Procedure PreQ1 PreQ1 Frequency Cumulative Percent Cumulative Frequency Percent 1 6 16.67 6 16.67 2 23 63.89 29 80.56 4 7 19.44 36 100.00 Pretot1 Frequency Cumulative Percent Cumulative Frequency Percent 0 13 36.11 13 36.11 1 23 63.89 36 100.00 PreQ2 PreQ2 Frequency Cumulative Percent Cumulative Frequency Percent 0 7 19.44 7 19.44 1 29 80.56 36 100.00 PreQ3 Pretot3 Frequency Cumulative Percent Cumulative Frequency Percent 1 4 11.11 4 11.11 2 32 88.89 36 100.00 PreQ3 Frequency Cumulative Percent Cumulative Frequency Percent 1 4 11.11 4 11.11 2 32 88.89 36 100.00 The SAS System 167 PreQ4 PreQ4 Frequency Cumulative Percent Cumulative Frequency Percent 1 3 8.33 3 8.33 2 1 2.78 4 11.11 3 2 5.56 6 16.67 5 30 83.33 36 100.00 Pretot4 Frequency Cumulative Percent Cumulative Frequency Percent 0 6 16.67 6 16.67 1 30 83.33 36 100.00 PreQ5 PreQ5 Frequency Cumulative Percent Cumulative Frequency Percent 1 12 33.33 12 33.33 2 24 66.67 36 100.00 Pretot5 Frequency Cumulative Percent Cumulative Frequency Percent 0 12 33.33 12 33.33 1 24 66.67 36 100.00 PreQ6 PreQ6 Frequency Cumulative Percent Cumulative Frequency Percent 1 12 33.33 12 33.33 2 11 30.56 23 63.89 3 13 36.11 36 100.00 The SAS System 168 The FREQ Procedure Pretot6 Frequency Cumulative Percent Cumulative Frequency Percent 0 24 66.67 24 66.67 1 12 33.33 36 100.00 PreQ7 PreQ7 Frequency Cumulative Percent Cumulative Frequency Percent 1 16 44.44 16 44.44 12 20 55.56 36 100.00 Pretot7 Frequency Cumulative Percent Cumulative Frequency Percent 0 20 55.56 20 55.56 1 16 44.44 36 100.00 2 4 11.11 4 11.11 3 5 13.89 9 25.00 4 7 19.44 16 44.44 5 8 22.22 24 66.67 6 9 25.00 33 91.67 7 3 8.33 36 100.00 PostQ1 PostQ1 Frequency Cumulative Percent Cumulative Frequency Percent 2 36 100.00 36 100.00 Pstot1 Frequency Cumulative Percent Cumulative Frequency Percent 1 36 100.00 36 100.00 The SAS System 169 PostQ2 PostQ2 Frequency Cumulative Percent Cumulative Frequency Percent 2 36 100.00 36 100.00 Pstot2 Frequency Cumulative Percent Cumulative Frequency Percent 1 36 100.00 36 100.00 PostQ3 PostQ3 Frequency Cumulative Percent Cumulative Frequency Percent 0 1 2.78 1 2.78 2 35 97.22 36 100.00 Pstot3 Frequency Cumulative Percent Cumulative Frequency Percent 0 1 2.78 1 2.78 1 35 97.22 36 100.00 PostQ4 PostQ4 Frequency Cumulative Percent Cumulative Frequency Percent 5 36 100.00 36 100.00 Pstot4 Frequency Cumulative Percent Cumulative Frequency Percent 1 36 100.00 36 100.00 The SAS System 170 The FREQ Procedure PostQ5 PostQ5 Frequency Cumulative Percent Cumulative Frequency Percent 1 5 13.89 5 13.89 2 31 86.11 36 100.00 Pstot Frequency Cumulative Percent Cumulative Frequency Percent 0 5 13.89 5 13.89 1 31 86.11 36 100.00 PostQ6 PostQ6 Frequency Cumulative Percent Cumulative Frequency Percent 1 33 91.67 33 91.67 2 1 2.78 34 94.44 3 2 5.56 36 100.00 Pstot6 Frequency Cumulative Percent Cumulative Frequency Percent 0 3 8.33 3 8.33 1 33 91.67 36 100.00 PostQ7 PostQ7 Frequency Cumulative Percent Cumulative Frequency Percent 1 35 97.22 35 97.22 2 1 2.78 36 100.00 Pstot7 Frequency Cumulative Percent Cumulative Frequency Percent 0 1 2.78 1 2.78 1 35 79.22 36 100.00 The SAS System 171 The FREQ Procedure Pstscor Frequency Cumulative Percent Cumulative Frequency Percent 4 1 2.78 1 2.78 6 7 19.44 8 22.22 7 28 77.78 36 100.00 The SAS System 172 TTEST Figures Subject Dev Down N CL Average UP Average CL Standard CL Dev Standard Dev Standard Prescor 36 4.1042 4.6111 5.118 1.2151 1.4981 1.9542 pstscor 36 6.5143 6.7222 6.9302 0.4985 0.4985 0.8018 Statistics Variable Std Err Minimum Maximum Prescor 0.2497 2 7 Pstscor 0.1024 4 7 T-Tests Variable DF T Value Pr>t Prescor 35 18.47 USDoD. (2010). The Challenge and the Promise: Strengthening the Force, Preventing Suicide and Saving Lives. Available [Online] at: < http://www.health.mil/dhb/downloads/Suicide%20Prevention%20Task%20Force%20fina l%20report%208-23-10.pdf> Warner, C. H., Appenzeller, G. N., Parker, J. R., Warner, C., Diebold, C. J., & Grieger, T. (2011). Suicide Prevention in a Deployed Military Unit. Psychiatry: Interpersonal & Biological Processes, 74 (2), 127-141. doi:http://dx.doi.org.ezproxy.nu.edu/10.1521/psyc.2011.74.2.127 Read More