In Wake of Fort Hood, Focus Is on Mental-Health Readiness

In “At Walter Reed, a Palpable Strain on Mental-Health System,” Washington Post reporters Anne Hull and Dana Priest use the deadly shooting rampage last week by an army psychiatrist at Fort Hood, Texas, as a backdrop to starkly criticize what could be called the military’s lack of mental-health readiness.

More than two years after the nation’s political and military leaders pledged to improve mental-health care, their promises have fallen short at military hospitals around the country, according to mental-health professionals, Army officials, and wounded soldiers and their families … It isn’t only Walter Reed that is under fresh scrutiny [after the shootings]: Evidence of an undermanned, overworked health-care system stretches all the way to the Pentagon, where all of the top health-policy positions remain unfilled, leaving a void on an issue long fraught with inefficiencies and entrenched bureaucracies.

The report notes that the top civilian position in the Department of Defense focused on healthcare is vacant (Assistant Secretary of Defense for Health Affairs), along with “three other top positions — the principal deputy, the deputy for clinical programs and policy, and the chief financial officer post.”

The vacancies occur as the Army in particular struggles with a soaring suicide rate. In 2009 so far, 117 active-duty Army soldiers were reported to have committed suicide, with 81 of those cases confirmed — up from 103 suicides a year earlier.

Quoted in the report is PFC Sophia Taylor, who is receiving treatment at Walter Reed while the Army prepares to give her a dishonorable discharge, which she plans to oppose.

“The amputees get the great treatment,” Taylor said. “Purple Hearts, money for losing their limbs. I have a lot of respect for them. But I lost my mind, and I couldn’t even get a simple ‘thank you for your service.’”

Related SPNAC post: “Culture of Stigma Is a Key Cause of Military, Veteran Suicides” at http://tinyurl.com/StigmaMilitary .

[The abridged URL for this post is http://tinyurl.com/MentalHealthReadiness .]

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Malpractice Advice Generates Suicide Intervention Checklist

Dr. Phillip Resnick

An excellent suicide intervention framework is suggested by a recent article in Psychology Today titled “Strategies to Avoid a Malpractice Suit When a Patient Commits Suicide.”

The article, which covers psychiatrist Phillip Resnick’s presentation before the U.S. Psychiatric Congress earlier this week in Las Vegas, can be paraphrased to form a checklist, as follows:

• In order to make it nearly impossible for someone to harm himself or herself, do not leave a high risk person alone or unmonitored.
• Treat prior attempts and feelings of hopelessness as preeminent indicators of suicide risk.
• In determining risk, do not rely only on the person’s denial of suicidal ideas: Take into account
  • the person’s actual behavior and
  • input from his or her family.
• It is critical to assess protective factors, such as
  • “a sense of responsibility to family …
  • a positive support system,
  • a therapeutic relationship, and
  • good coping skills.”

It is interesting to note that the most common error in suicide risk assessment uncovered by litigation over suicide fatalities “is overreliance on a patient’s statements rather than on his observable behavior.”

A psychiatrist may assume a therapeutic alliance with a patient; however, about 25% of patients do not admit suicidal ideation to their health care provider. Once a patient makes up his mind to commit suicide, he may no longer view the doctor as an ally but as an adversary. Resnick said health care providers should not accept a disavowal of suicidal plans at face value — especially if the patient wants to leave the hospital.

Resnick also emphasizes the need for a suicidal person’s family to be involved in both determining and managing suicide risk.

“This is crucial,” he notes, “because a patient who is saying his final goodbye before killing himself has a 60% chance of saying goodbye to his spouse but only an 18% chance of notifying his therapist.” If a patient or a family member reports that the patient has a suicide plan, increased scrutiny is critical: 3 of 4 of these patients go on to attempt suicide.

Finally, the article states unequivocally that “no-suicide contracts may also create a false sense of security for the psychiatrist.”

“A no-suicide contract is alright as long as the psychiatrist doesn’t depend on it,” said Resnick. “I’ve seen nursing manuals that suggest that these no-suicide contracts can be used as a guide to determine whether the patient get privileges. I think that is just a mistake.”

[The abridged URL for this post is http://tinyurl.com/MalpracticeAdvice .]

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A Life Saved Connects the Dots on Data from Hotline Study

By Franklin Cook, SPNAC Editor

In March 2005, at the inaugural meeting of the Consumer Survivor Subcommittee of the National Suicide Prevention Lifeline, a troupe of the finest researchers in the field unveiled the results of several key studies of the operations and effectiveness of suicide prevention hotlines, and I was fortunate to be among the newly recruited committee members in attendance.

Of all the things I learned during that meeting at the headquarters of the Substance Abuse and Mental Health Services Administration (SAMHSA) in Rockville, Md. — much of which has continued to guide the committee’s work and the overall development of the Lifeline network of crisis centers — one bit of data stands out to me with utmost clarity: In a relatively larger study, 11 percent of hotline callers said that “the call prevented them from killing or harming themselves.”

Eleven percent! More than one in every 10 people who reached out to a suicide hotline said the call prevented them from making a suicide attempt.

That bit data came to mind today when I read a story from WYFF Television in Greenville, S.C.

On Saturday in the little town of Travelers Rest, a police officer shot a gun right out of the hand of a suicidal man.

The police officers spoke with [Jeffrey] Simpson for more than an hour as Simpson held a gun to his head. The officers said Simpson repeatedly waved the gun around and pointed it directly at the officers, refusing repeated commands to put it down. The officers said as Simpson extended his arm and pointed the gun at an officer, another officer fired, hitting the pistol.

It seems to me as if a life was miraculously saved (especially when one considers how many times incidents such as this end with police killing the gun-wielding suicidal person).

And here’s what brought to mind for me the data about hotlines:

Police said the man … had called the national suicide hotline, who in turn contacted the sheriff’s office. The officers quickly requested assistance from the sheriff’s office SWAT team. The police chief and captain both responded from home to the scene.

Who knows what the long-term story will be in this case (or in any case involving a starkly suicidal person who is rescued), but this much is clear: The man was ambivalent about dying, and he called for help. The people he called sent someone to him who was able to help. And the man lived another day, with a brand-new chance to recover from whatever it is that is causing him pain.

See all five articles related to crisis hotlines from the June 2007 issue of Suicide and Life-Threatening Behavior.

[The abridged URL for this post is http://tinyurl.com/HotlineStudy .]

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